Whatever the modality and theoretical model used by the therapist, the essence of psychotherapy is concentrated feedback, specifically cultivated, and operating in many varying ways. . . (having) in common their aim to stimulate some shift in the client’s awareness of themselves. . . This enables the client to experience a more differentiated experience of life and more elaborated, varied responses to challenge and change.

Source: Carroll, R, Rhythm, reorientation, reversal: deep reorganization of the self in psychotherapy, in How Does Psychotherapy Work?, Ryan, J, ed., 2005, London: Karnac

The essence of clinical work involves different kinds of communication, ideally distilled down into the most concentrated form possible in order to support the client’s more rapid movement towards increasingly adaptive ways of living in the world. The very nature of the clinical relationship means that any unit of communication between the client and the clinician is going to be imparted with a more intense and more concentrated kind of meaning.

It is for this reason that social networking has special challenges for clinicians who wish to engage in acts of communication in this forum. The specificity of direct communication with a client is much harder to control in a social forum, with maximum openness and maximum reach. Let’s examine some of the positive – and problematic - purposes in order to address both the opportunities and the concerns present here.

Human Service organizations, as well as private practitioners, typically maintain websites in order to provide information to the general public on their services, specializations, and areas of expertise. Additionally, many insurance companies host information about practitioners who serve on their panels. In both instances, a clinician may post some biographical information in order to give clients more information about their specialties or training to help the clients make an informed decision about whether to engage in therapy with that clinician.

In addition, there are now privately run websites – separate from insurance company sites – whose stated purpose is to help clients find a therapist, as well as online networking sites specifically for therapists. While the knowledgeable clinician will often try to shape this information in ways that increase his/her appeal and marketability, in the end all of these uses of the internet can serve the client’s best interests, helping to make available important information that allows the client to find the best fit for his/her treatment needs.

This is the information that the clinician can – to some degree – control. It is also important for the clinician to consider information for which they have less control. Practices – your practice - may show up on consumer review sites and it is possible that a client coming upon such a site may feel compelled to leave a review. It is the clinician’s responsibility to understand that they must not ask current clients to leave reviews on such sites.

If a client decides on their own to leave a review, the clinician must under no circumstances respond to any review since the client’s privacy is at risk. If a therapist were to respond to such a review site, it would be clear that they either were confirming that a client is currently in therapy, or was formerly in therapy. That would be a clear breach of the client’s confidentiality.

Beyond these organized sites, there are other kinds of information that clinicians may not be able to control. There are savvy internet searchers who can cobble together bits and pieces of a counselor’s private information from various and disparate places on the web. Information that a practitioner may have thought was safe in one venue, when combined with other bits of information from other sites, can be puzzled together to reveal more complete information. It may be something that you would not want others to know.

Generally speaking, the client in a traditional therapy relationship has typically known very little about the therapist, other than what the therapist chose to reveal during the course of therapy. Now, it is possible to research each other via Google and social networking sites, raising serious concerns about where lines need to be drawn and how much information should be obtained in this manner.

This leads to one of our cautions with regard to social networks and clinicians. Once a person joins a social network, there are inherent risks involving the dissemination of personal information. If you don’t want to take these risks, then it is best to not join a social networking site. If you do choose to join a social networking site, you must remain aware of the possibility that all of your information might be viewed by someone in your professional circles – including clients. In the language of Twitter and texting, this is a TMI problem: the potential availability of Too Much Information.

As clinicians, we must also be aware of how the TMI problem can operate in the other direction. Clients who come to see us may post information on the internet about their personal lives that is available for anyone to see, including their therapist.

This availability of personal information online threatens to alter the basis of the traditional therapeutic relationship, whereby the therapist would only obtain information about a patient through face-to-face interviews. If information from other sources was deemed necessary, it would require the use of release of information forms to obtain further information from family members, other professionals involved with the client, or previous providers. This provided a measure of security to the client concerning what information a clinician would be permitted to know about a client’s personal affairs.

At present, clinicians often have the capacity to review a client’s personal website or conduct a search of the web without the client’s consent. The implications of this reality need to be carefully considered and potentially discussed in clinical supervision. Obtaining information without the client’s consent has the potential for changing the therapeutic relationship - with clear ramifications for trust. With the TMI problem, there is the potential for the client to feel violated.

This leads to the question of under what circumstances an internet search is conducted or even warranted: is it permissible to conduct an internet search of a client strictly to satisfy the therapist’s personal curiosity, or even to verify information discussed by the client in therapy? Professionals universally agree that conducting an internet search to satisfy personal curiosity is not ethical behavior and a clinician needs to evaluate, preferably with a supervisor, this intent.

Moreover, internet searches are not perfectly targeted to limit the information that appears on the screen. A general search on a clinical topic performed by a clinician may open a site in which a client has initiated contact and revealed information that he/she was not ready to bring into the therapeutic relationship.

To keep things clean in the therapeutic relationship, it is always best practice to let a client know when an internet search related to their therapy is being considered in order to process any of the client’s concerns. It is also important to remember that many clients may not have easy access to computers and the internet, and for these people discussion of an internet search may, at a minimum, cause anxiety or unease which may need to be processed beforehand.

It is also important to remember that familiarity and comfort with the internet has generation implications as well. Many clients from earlier generations may have a different relationship with the internet. Some may not even have easy access to computers and the internet, and for these people discussion of an internet search may, at a minimum, cause anxiety or unease which may need to be processed beforehand.

The generational difference also applies to how clinicians of different generations may interact with online activities. Younger clinicians, who grew up with the internet, generally have a clear understanding of the internet and how to give and receive information through social networking sites. This comfort and familiarity has its advantages in terms of the fluency with which they use this medium. Their difficulty - from a professional standpoint - is more likely to consist of insufficiently understanding the ethical and boundary issues that may arise from their social networking activities.

Because of their comfort and familiarity with this medium - because social networking has been such an integral part of their social experience - some of these practitioners may view sharing a high level of personal information normal and expected, and privacy an old-fashioned concept. This may cause them not to give adequate consideration to the ramifications of their activities on social networking sites, and how these actions may have a negative impact on their work and/or careers.

Conversely, older clinicians, who may not possess as broad an understanding of the internet and social networking sites, may be inclined to approach social networking sites with distrust and choose the route of social networking abstinence in order to avoid all possible problems associated with the internet.

For both positions, it is important to note that the intricacies and challenges for the use of social networking for therapists are still being worked out. All parties to this social experiment will need to remain aware of the changing landscape and stay current with the legal and clinician implications.