Making Ethical Relationships a Priority on Facebook

Being a technologically savvy psychotherapist and being an open person has positive and negative qualities.  When I was first introduced to social media, I thought it would be a waste of time, because I did not realize how useful it could be to connect with people.  Then I learned why they call it “social media.”  I was introduced from the minister at our church as a tool for creating community with other and I liked seeing what others members of my spiritual community were thinking and talking about.  Pretty soon, I was LinkedIn and FaceBooking with friends, colleagues and clients.

Social media is a tool for creating community.  I see value in sharing my path toward making the world a better place, so I did not hesitate to include current and former clients as “friends” on Facebook.  I focus my “status updates” on affirming life messages and only post information that I would readily admit to a complete stranger.  Social media is not private, and I accept responsibility for the nature of my communication in cyberspace.

I have thought, discussed, and researched the ethical implications of communicating with clients through social media.  My practice and my clients seem to have benefited through social media.  For example, my practice has benefitted with referrals from friends and colleagues to my practice because they see me on Facebook and refer.  Former clients and acquaintances from community settings (former agencies where I have worked, churches, and schools) have referred to my practice.  Colleagues have asked me about my practice and referred those who could use my services.

Current and former clients have also benefitted from being my Facebook friends.  A former client who moved out of state stays connected to the work we did through status updates.  When they need help in another community I use the internet to research providers and make suggestions. I share community resources and my insights on current events through posts to my profile, and announce blogs from my website and upcoming workshops.  My fan page for my practice is available to anyone who wishes to address issues related to my practice.   I hope to create a community for individuals read and share resources there.

For example, one client was unable to attend therapy in the office due to a high risk pregnancy.  She accessed my support through chat and status updates as she faced life threatening complications to her baby and her own health while in the hospital.  While we chatted on Facebook, I emailed colleagues who worked in that hospital to learn how to garner behavioral health care and relayed the resource to her while she was in the hospital.  Once she gave birth and was able, she resumed therapy in the office to prevent the post-partum depression she experienced previously.   As far as I can tell, there is no way for someone to know how we are associated outside of Facebook.

Recently another client ended our Facebook connection to support the therapeutic relationship.  This client indicated that the casual nature of Facebook communications prevented the depth of the therapy relationship needed to progress to more intimate issues.  Our lives overlap in professional and community associations, and Facebook made it too difficult to let the guard down in therapy.   I understand and support the need for a boundary between our professional relationship and the casual “chatter” that happens in status updates.  Not all clients are in similar situations and some individuals need clearer boundaries.  There are clients with whom I do not accept as friends due to their difficulty with knowing casual personal information about me.

This has lead me to wonder how others might feel or have felt interacting with their psychotherapist outside of therapy.  Is it like seeing being a kid who sees the teacher in the grocery store?  Does it help to think of your psychotherapist in other roles from life such as a parent, spouse, sibling, child, or student?

I have thought deeply about the pros and cons of providing therapy to acquaintances, such as students who have attended the school where I worked, people with whom I have served on professional committees and members of my church.  I am less rigid about working with people I know in the community than some psychotherapists tend to be. I used stories from my own life when it is pertinent and seems useful in the therapeutic process, but there are some who would discourage this kind of personal sharing.

The ethical guideline from the American Association for Marriage and Family Therapy (AAMFT) that governs my profession discourages dual relationships due to issues of power. If I were a customer or employer of a client that would make it difficult for the client to feel completely safe being open with me for fear that it would affect our business relationship. The same applies if I was a teacher, or professor, etc. My ethical code states to “avoid dual relationships when possible” and if not possible to talk about the issues of power openly to avoid disrupting the therapeutic relationship. Aside from that broad statement, the only clearly defined restriction states that we shouldn’t engage in a sexual relationship for at least 2 years following the end of therapy, but that level of intimacy is not what we are considering here.  Webinars offered by my professional liability insurance cautions about securing internet communications with encryption whenever sensitive confidential information is being shared across the internet, and I have researched these resources for online communications.

Since I have worked in home based and school based settings I have seen how valuable it can be to know the community in which a person interacts with others, and Facebook is a community where people interact. In fact, I continue to see people and the family members of people I knew or worked with at the high school where I worked as they have gone to college and become parents.  I have worked with a former teacher of my son’s preschool once that dual relationship had ended and the former professional association did not seem to interfere in our working together.  I have worked with members of my church and this association did not appear to interfere in our interaction at church or in therapy.  The most important consideration to me is the comfort level of the client and family. (Read My Private Practice Social Media Policy) The research says that there are two factors that have the most influence in therapy success 1) the client’s confidence in the provider, and 2) the provider’s confidence in their ability to help. As a family therapist, I value knowing my clients and their family and community well. I feel confident that I can discuss the wide variety of options available to assist them and make a good referral if it seems that I am not the right provider for their situation.  If the family is comfortable and their situation is an area that I have expertise in treating, I do not hesitate to serve if the family wishes to work with me.   I will respect the level of privacy and separation my clients need on Facebook and in other community settings.

I welcome discussion of the issues raised here and will not indicate in any way if any of the comments are from clients or community members.  If you feel more comfortable commenting privately, my contact information is available on my website.  The responses to my blog are moderated and I reserve the right to remove any comments that undermines your privacy or others.

2 Responses to “Making Ethical Relationships a Priority on Facebook”

  • Dominique says:

    Wow, great questions. I wanted to say that it probably is an individual matter. I have a therapy relationship that extends beyond the therapy, and it works really well at this time in my life. I am able to work on forming trust with another woman who is very much a mentor for me, and it is healing some early wounds in a unique way. sans the opportunity to try out being myself with someone, with all the false identities resting for a while in life, I think the therapy would not be as rich. It’s really a first for both of us, because you would think we would need those boundaries… but instead, it’s a testament to both of our abilities that we’ve matured into the ability to be flexible. I don’t think I could do this with just anyone, and vice-versa. But she is also an open person and that openness builds trust for me, and helps me learn to trust and care for myself without feeling like I have to “act out” the cultural scaffolding that built up within me while I worked to survive without all the resources I needed to nurture myself.

  • Lisa Johnson, LMFT says:

    Thanks for your comments Dominique. Can you think if a condition in which you would want that to change? Like if you knew each other in another context (spirituality group, workplace, school or other setting) and felt the need to create a boundary there?