Washington - For the past two weeks, whenever I've scrolled through my Facebook newsfeed I've come to the section “People You May Know.” The suggestions offered have included relatives, co-workers, some people I don't even like in “real” life - and my current psychologist.
“OMG!” I've winced repeatedly at the profile photo of my shrink, who for the sake of his privacy I'll just call Dr E.
Still, being the curious sort, I clicked to view his page, which isn't very well protected from eyes like mine. For starters, there are 12 photos of him available for all the world to enjoy, several of them shirtless and one that had a “friend” of his posting “Woof!” underneath it. I also discovered pictures of Dr E from high school with two nice-looking young ladies. Although I've known he was gay, I started to wonder: Was he bisexual then? When did he come out? I found myself thinking much more about his personal life than any patient should.
Among Dr E's Facebook friends was another psychologist, one who seemed to deploy no privacy safeguards whatsoever. Any patient clicking on his Facebook page could see tons of photos, including those of his wedding and honeymoon, and even his attendance at a celebration of “Bush 43's” last night in office. (That makes it a good bet he's a Democrat which might be TMI for a Republican patient.) Feeling nosy, I found yet another shrink on Dr E's friend list with equally little privacy protection.
At that point I started wondering: Are there no social media best practices for mental health professionals? To my surprise, I discovered that the answer to this question is no. According to a recent article in Academic Psychiatry, “[T]here are no firm guidelines for psychiatrists regarding how to manage information on the Internet.”
The authors also highlighted one of the central problems for mental health professionals using social media: “Facebook users commonly list their sexual orientation, marital status, religion, age, hometown, and political affiliation in their profiles, most of which information is not typically shared with patients.”
Before Facebook and Twitter, psychotherapists had varying boundaries regarding what they disclose to patients. Some revealed nothing at all, while others disclosed personal information they thought might help the therapeutic relationship (for example, that they are married, divorced, Jewish or a recovering alcoholic).
Over the course of my adulthood, I've had two previous therapists, both of whom divulged very little about themselves in our sessions. Each of them ended up spilling some rather personal beans to me (one unintentionally, the other out of necessity), but neither of these revelations felt as inappropriate as the Facebook page of Dr E.
Unlike Dr E, my first therapist never even told me he was gay - a fact that might have reassured me a good bit, since this was the early 1980s, when I was first coming out. He was a Woody Allen lookalike who, every time I'd ask him a personal question, would turn the query back to me, asking, “Why do you want to know?” Mostly, I was eager to learn whether he had a boyfriend or a girlfriend. One night, long after dark, I was in the West Village in New York when I spotted him leaving a gay bar, dressed in a black leather jacket and cap. Silently, he nodded hello. Well, that answered that question, although we never actually discussed it.
“Dr Woody” and I had had what therapists call an “extra-therapeutic contact” - it may have been awkward, but it was accidental and he had done nothing wrong. After all, even a therapist is allowed to have a personal life.
A dozen years later, I found myself in a new therapeutic relationship. While deeply empathetic, this psychologist also drew strict boundaries between her professional and personal lives - until the day an armed guard showed up outside the office. She explained that her attorney husband had once successfully prosecuted a man who - after being convicted - came to their home and shot him. Now the felon was being released, with no requirement that he stay away from his old nemesis. Thus the armed guard.
Dr Woody's disclosure was accidental but important (to me at least); the second therapist's was necessary but irrelevant (except in that she and her husband ended up going underground, which ended our successful therapeutic relationship). Dr E's personal disclosures on social media seem different to me because he was repeatedly presented to me as a peer and not my therapist. I may have been curious, but I didn't really want to see everything behind that black curtain. Even though I couldn't stop myself from looking.
I understand that mental health professionals are only human, and they often make the same digital-era mistakes we all do. Just like the rest of us, they need some rules of the road.
While no firm social media guidelines have been adopted by the various mental health professional organisations, the American Psychological Association has published a manifesto of sorts on the topic. In “The Internet's Ethical Challenges,” Stephen Behnke, director of the APA's Ethics Office, wrote that “psychologists have special ethical issues they need to think through to determine how this technology is going to affect their work.”
Eric Harris, who serves on a task force on tele-psychology guidelines for psychologists, says figuring out how to use social media can be challenging for mental health professionals: “It would be wrong to say they can't participate on social networks, but they have more responsibility to think through how they manage their privacy settings. Your psychologist should have made it hard for you to find him.”
“The patient has some responsibility in this, too,” says Harris, a psychologist and lawyer, noting that he would have put the onus on me had I actively sought out Dr E. on Facebook, sent him a friend request or used Google to determine his political contributions, the tax-assessed value of his house or his genealogy.
But I didn't. Facebook suggested Dr E. as a friend because he probably hadn't really thought about his privacy settings, which allowed the website's bot to find friends and groups we have in common. He's far from the exception: A University of Florida study reported that only 37.5 percent of medical students and residents use their privacy settings, which Harris told me is probably a good barometer of the problem in his discipline.
The mental health profession is not unaware of this issue. In 2011, Glen Gabbard, a professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y., proposed nine “recommended guidelines for maintaining professional boundaries online.” First on the list: “Psychiatrists and other mental health professionals who use social networking sites should activate all available privacy settings.” Three years later, the guidelines have yet to be formally adopted. More than a decade after Facebook exploded across the globe, that's an unconscionable lapse that needs to be fixed.
In the meantime, I'm going to ask Dr E. to change his privacy settings so thinking about his personal life and get our sessions back to what they should be, which is all about me.