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When psychotherapists and other mental health care providers search their clients on the Web with or without their clients' consent and/or knowledge Opening Statement By Ofer Zur, Ph.D. This blog focuses on the clinical, ethical, and legal issues that surround the question whether and under what conditions psychotherapists and counselors may, should, or should not conduct web searches of their clients. Consider the following situations: Following is a mix of real-life and hypothetical situations relevant to the question of whether it is permissible, ethical, reasonable, or generally okay for therapists to conduct online searches of their clients:
Consider the following questions:
Further Reading:
Nicholas C. Aliotti, Ph.D. wrote:
This has not come up much as an issue in my practice. In this age of "no more privacy" the therapist office may be an important sanctuary of privacy. Are we going to be healers or cops? Forming a strong therapeutic allainace is essential for therapy to work. I believe we should have permission of a patient and there should be a therapeutic rationale. I am now thinking of adding a statement in my office procedure papers. In a true emergency to prevent harm to the patient or others googling could be justified. I am not comfotable being listed as a friend of facebook by my patients. Interestingly, new patients have googled me and commented on what they learned. One patient labeled me a neuropsychologist based on some of my publications ...it can work well as "warm-up" for conversation and development of the therapeutic alliance. I would not google a patient without signed permission.
05/26/10 18:39:31
Shari Levine, M. S. LMFT wrote:
In my own practice, I, or they, would not derive any benefit from googling a client to the work we are doing in therapy. Since I work from a relational perspective informed by moment to moment awareness and mindfulness about what is occurring in the present moment, content becomes irrelevant. Process oriented therapy gives me everything I need to know about my clients by mining what is happening inside them in the here and now. I teach the couples I work with to look underneath the content of their conflict to the attachment needs and longings underneath trying to be expressed and understood. Thus, for me, a google search would amount to little more than curiosity about the details of my client's life, and pursuing those outside the therapy would feel intrusive to me.
I recognize that I am able to hold this position because of the population I work with - mainly couples and what some like to call the "worried well". If I worked with a population that were mandated, or had a history of violence, or struck me as creepy in some way, I might well see this differently. It is a fascinating question. In the end, I believe we do our best work because of what we learn directly from our clients, and that if we listen well with all our sense, they will tell us everything we need to know to help.
05/26/10 09:00:46
Stephen Whiteley, BMASc wrote:
It seems to me that what we all want and need out of life and therapy is a greater understanding of truth. Connecting with truth (recognizing that truth can be subjective) leads to congruence and therefore better happiness/health/relationships in our lives. If any legally available information source leads to greater truth, then it is of value. How, or if, one uses this information is open to the therapist. The therapist is always making decisions about how to use the information they have and more/better information generally supports better judgement (also recognizing that more or conflicting information can support confusion). People post information on the internet voluntarily making it a public resource. The search for greater truth is both ethical and effective.
05/25/10 16:25:37
Nadia Shah, MSW wrote:
Information that can be searched on google or another search engine is public information, not protected health information. I need a release to obtain PHI from other sources but if I am getting information readily available on the internet, then I don't think I need a release. The only instances in which I have googled a client was when he or she informed me that she/he used to be in a band and released CDs, or they were proud to be in a newspaper article or something else that made the news. In that case, I'm just verifying the information and also getting a baseline of their functioning prior to the mental illness.
I wouldn't befriend a client on facebook though. I consider that an unnecessary dual relationship.
05/25/10 14:49:36
Carol Tyler, Ph.D. wrote:
If, one day, it becomes entirely normative for everyone to routinely read about all of one's acquaintances (both social and professional) through some electronic mechanism, then as responsible professionals would we be obligated to become equally informed, so that we are applying the same assumptions and data sets in our dealings with clients as is everyone else? In a sense, isn't that day... now? To intentionally function from a blind perspective, when in some circles it is entirely normative to acquire information about people we meet, either places the therapist at a disadvantage (less "informed") or at a distinct advantage (again, less "informed") because the relationship and therapeutic process can evolve within the client's tolerance, rather than happen to the client by default because of a more immediate, viral data dump into the therapist's realm. Illustrating the latter outcome is the religious confessional model, in which a supposedly neutral and uninformed support figure is safely approached with only the content and depth that the confessing person wishes to divulge at that time (to both the priest and also to the church's model of an ostensibly all-knowing God). As others have commented here, the importance of the client's control of the content and rate of information relates to safety and trust. In striking contrast, uninformed therapists may be taking avoidable personal safety risks, and also professionally operating in the dark when perhaps increasingly assumed by their clients to be in the Internet know. Peace.
05/24/10 15:32:22
Sevilla I. Love, MSW, LCSW wrote:
I live in an isolated rural Alaskan village (pop 650)where I am the only BH provider in town. Everyone is a social associate of some kind. "Dual relationship" is an gross understatement out here. There is NO privacy so I don't pretend to have any as it's not possible. When a client friends me on Facebook, it would be more harmful for me to decline as it would be seen as a rejection when I am friends with everyone ELSE in town. I take responsibility by keeping my own FB neutral and not posting things I wouldn't want anyone to know about. Some of my former clients use it as a way to stay connected in a "here's how I am doing" way after moving out of the village. I've never had it abused or visa versa. If there were a concern I could use the privacy settings to block their access. Living like I do is a totally different way of practicing Behavioral Health care that is hard to understand unless you live it.
05/24/10 11:17:48
Katie Terrel, MS wrote:
I would only google a client if I initially talked with them on the phone and thought their name rang a bell with me from some news story about a local violent crime--of which we only have a few. If I thought of that at the time I'd ask them on the phone why their name seems familiar to me. If I thought about it later and wondered, I'd scan search result summaries for that. Anything else I want to know I'd ask the client in person.
05/24/10 09:23:32
Margaret Donohue, PhD wrote:
A person I was evaluating was discussing how he was not able to get a job. I thought he was leaving out background.It was a hunch. So I explained there was a lot of information available to an employer on the internet. I asked permission to do a criminal background check using a free website readily available to the public. His name came up as a registered sex offender. Once he saw how easy it was to get the information, he then knew he would need a different strategy to deal with his background. It took about 2 minutes to find out. He and I went back over the history he had provided adding back in the criminal issues.
I think looking up someone on the internet is common. I'd rather do the search with the person present and have a therapeutic reason for that than my own curiosity. I know what's on the internet regarding me and my background. It's worthy of a discussion. If someone starts calling my home it becomes a boundary issue to be dealt with as part of treatment.
05/24/10 07:23:17
Keely Kolmes, Psy.D. wrote:
I feel strongly that whether or not you use search engines in your clinical practice, it is extremely important that you make your policies clear to your clients.
I posted my own blog post on whether therapists should Google their clients last June: http://drkkolmes.com/2009/0... If you're considering doing a Google search on a client, I think it's good practice to ask yourself if you would be comfortable documenting your search and your rationale for it in the chart and sharing that you did so with your client. If not, perhaps, reconsider. I also state the following in my Social Media Policy: USE OF SEARCH ENGINES It is NOT a regular part of my practice to search for clients on Google or Facebook or other search engines. Extremely rare exceptions may be made during times of crisis. If I have a reason to suspect that you are in danger and you have not been in touch with me via our usual means (coming to appointments, phone, or email) there might be an instance in which using a search engine (to find you, find someone close to you, or to check on your recent status updates) becomes necessary as part of ensuring your welfare. These are unusual situations and if I ever resort to such means, I will fully document it and discuss it with you when we next meet.
05/11/10 16:55:04
Bruce M. Gale, PhD wrote:
Reading through the responses makes it clear to me that the issue is much less about whether or not we should perform a search of our clients' information without their knowledge or consent (of course we shouldn't!). Rather it is a technology question. Because we can now do something so easily, should we give into our impulses to do so? It reminds me of the occasional employee at local hospitals who peek into a medical records of a celebrity (so wrong, apparently so tempting for some). I like the idea of a "technology and social media policy." Personally, I encourage my clients to send me emails with concrete questions, especially if it relates to something I've asked them to do between sessions and they wish clarification or want to report on progress.
05/06/10 08:38:07
Susan Ullman wrote:
I work for a community mental health center and specialize in treating clients referred by the courts and correctional institutions, including sex offenders, thieves, and people with other violent offenses. I do court evalutions as well running groups for sex offenders and thieves (this includes robbery, burglary, etc.) On occasion I google a client if I'm working on a court ordered evaluation. I also check court web sites, and their public information on their My Space and Facebook. I do this both for my personal safety and because I want to be able to write a thorough evaluation. It is amazing the things people will put on their web sites. As you may have guessed, to protect my privacy, I don't have any social networking profiles.
05/05/10 08:59:37
Lucie Tetrault, MFT wrote:
More and more, clients communicate with me via email and sometimes send me links to look at photos or other material on the web. It can be tempting to search out additional information at times, but this is more about curiosity than anything else. Mostly, I encourage clients to bring into session anything they want to share with me so that it can be received in person and processed together. I can't imagine any situation where Googling a client would feel necessary or otherwise useful. If there is something I want to know about a client, I ask them. Anything else borders on duplicitous. Certainly, there are times when we discover something about a client that they haven't willingly shared with us. Depending on the nature of this information, it may or may not feel necessary to reveal it. But to seek out information independent of a client's explicit permission feels intrusive and disrespectful of the implicit therapeutic contract. We deal in the realm of story - not investigative journalism. I want to respect my clients' narrative authority. Of course, clients will search for information about their therapists online from time to time - but that's a whole other issue. Grist for the mill, if given the opportunity to discuss it!
05/02/10 16:46:20
oferzur wrote:
FROM THE MODERATOR: In response to many therapists who have asked me about adding a "Social Networking and Internet Searches" policy statement in the "Office Policies" or "Informed Consent" that all clients review and sign prior to treatment, I offer the following example:
SOCIAL NETWORKING AND INTERNET SEARCHES: At times I may conduct a web search on my clients before beginning therapy or during therapy. If you have concerns or questions regarding this practice, please discuss them with me. I do not accept friend requests from clients on any social networking site, such as Facebook. I believe that adding clients as friends on these sites can compromise your confidentiality and our respective privacy. For the same reason, I request that clients do not communicate with me via any interactive or social networking websites. A NOTE: What therapists put in their policies will need to be personal to them, as they understand their ethical and professional obligations, their personal preferences, sense of integrity, and comfort level with the technological options available to them. What's important is communication between therapists and their clients and clients' consent. Content of these policies is likely to vary greatly from therapist to therapist. These issues are very new to our profession and are likely to evolve in the coming years.
05/01/10 19:32:06
Nancy De Andrade, PhD wrote:
Clients search for me on Google without my knowledge. They read all about me on the Internet before they find me. Whatever information is posted on the Internet is not private anymore, mine or theirs. Information that the client is posting willingly for everyone to see should not require an informed consent. I have not had the need to Google anyone, yet I have gone to their websites if they give me their address. For the most part the information I need, they provide by allowing me to see their Facebook or MySpace page, where I can obtain a lot of information about the world they live in. This way, they show their trust in me and I get to take a peek in their world. If I were working with clients like Katie, I would definitely do a search prior initial session and let them know I did. Searching about a client can help us be prepared, educate and protect ourselves, however it can hurt the relationship if they know you don't believe them or are not siding with them. Each person has their own version of the truth and our job is to support our clients and help them find inner resources to manage their world as they see it, not a we see it.
04/29/10 23:52:54
Larry Brooks Ph.D. wrote:
It's not surprising that there would be range of responses to this question that speaks to the larger question of how the computer and the Internet are changing the way we practice. With respect to this question, the ethical issue is informed consent. Clients need to be informed clearly what to expect from treatment and this involves how the new technology will be utilized, especially actions that involve actively searching out information about your client. Dr. Keely Kolmes a psychologist recommends developing a social media policy that states how the therapist handles many of the questions that have been raised in this blog.
04/29/10 09:49:53
Julie Schmidt LMFT wrote:
Unless there is threat of harm, the old adage "Do unto others as you would want them to do unto you" (if you were a client). comes to mind. And by the way, what if the information you googled is incorrect? This is the internet, not all is truthful, or what about a mistaken identity? Ack! How is that going mess up the course of therapy? We are as sick as our secrets. Have faith in the process. Skip the google, unless you have a feeling there is harm. And if thats the case, you should be doing something else anyway with the client. No?
04/28/10 21:38:55
Jon Pedersen, Ph.D. wrote:
I believe it is unwise to perform an internet search on a client (with the concern of danger being a possible exception). I have my client's address, but I believe it would be invasive to drive by her house to get a better sense of her. The therapy room is not a social space; it is a therapeutic space, and there are very important reasons why and when a client presents himself to us. Maybe our client is not ready for us to know certain facts and will feel ashamed. It is a mistake to assume that any person has control over their presence on the internet. And what do we do with information that the client hasn't disclosed, or has *possibly* misrepresented? Do we confront, like a parent? Do we keep a secret with ourselves, believing that it won't influence our attitude and behavior? The client's story is hers to tell, and the telling of it helps us understand who she is. Why jeopardize this? If we believe we need extra-therapeutic information, then as in every other case, we can ask for permission. Isn't there far more to be lost than gained in surveilling a client?
04/28/10 20:22:55
Kathryn A Downing, MA, LMFT wrote:
Reading these very interesting & helpful comments causes me to consider putting another question on my family-of-origin questionnaire, right after "10 good, 10 unpleasant experiences & how they affect you": "If I were to google you, what might I find out that I haven't already asked on this intake form?" and maybe add, "...and would that be OK? why or why not?" Just an idea I am toying with - haven't decided.
04/28/10 19:03:40
Andy Stewart, Ph.D. wrote:
I think it's a question of ethics, the leading questions being, first and foremost, is it in the patient's best interest or is it harmful? Regarding the former, I can't be sure my curiosity is always in patients' best interest other than I believe the better I know someone, the more effective I might be (or some such illusion like it). On the other hand, searching publicly available information would probably be difficult to prove as being "harmful" in court or by a licensing board. If I then use the information I might obtain in a way that's potentially harmful, or in a way that advances my own agenda (e.g., animal-loving clinician confronts or reports patient), then it would be clearly unethical.
04/28/10 18:08:06
Tom Smith, Ph.D. wrote:
We live in the age of information. As the internet evolves, so does the society in turn. The internet is public space. I read the newspaper or magazine and see information about a client ... perhaps a business deal gone good or sour, a domestic violence report or DUI on the police blotter. Now what? Often, when I have questions about anything or anyone, a quick google or wiki search opens up interesting doors. I think what is paramount is WHAT WE DO WITH THE INFORMATION rather than how we get the information. We do not ask permission to read or search the newspaper or other media nor should we to search or read on google or wiki or any other site that offers alternative sources of information. We are not legally or ethically bound to restrain our freedom to read or search about anyone or anything. Like all technology, the net and cell phones can be used for the good or the bad. How about another provocative question: Do we or the client text or twitter before, during or after sessions? It might be a "best practice" to clear all this up before therapy starts with disclosure statements about what is going to happen and the terms of the therapeutic contract.
04/28/10 13:42:23
Celenia Delsol, MA, MFT Intern #60852 wrote:
I feel that if clients are willing to put information about themselves on the internet for the world to see (with whatever privacy restrictions they may have selected), then that information is "fair game." Just as the information about me that is out for the world to see is also "fair game." I don't feel I need my clients' consent; the consent is implied.
04/28/10 10:52:28
Giovanni Voltaggio, B.M. wrote:
Just like everyone else, I have access to public information about the client. I must research the client. In some cases, research of this kind is more efficacious than having the client talk. Moreover, I prefer to do this kind of research without having the client present. I can take notes, think something through, draw conclusions, think of strategies, etc. How I use what I find depends on whether or not I want the best results. For example, if the client is involved in grandiose delusions about himself and an internet search reveals the truth, approaches concerning dealing with defense mechanisms would still be necessary. In other words, these days not only do I have what the client happens to think of during his sessions, but I also have any and all public information on him. Fees and charges would be applied for all research.
04/28/10 08:46:29
Dawn Lipthrott, LCSW wrote:
I agree with Phil -- information on the internet is public. I can hear a name dropped at a restaurant and Google it if I want. So searching is not an issue in my mind. Having said that, I don't have the time or inclination to Google all my clients. But if something feels 'off' to me and I don't think a client is being open and honest about something important, I could see myself doing it--but only after I've tried to address my concerns in session. I don't like sitting with unspoken suspicions.
To me, the bigger question is the "what do we do with it" piece? I would be inclined to simply bring any information of concern to the client session. If I'm not going to do use it therapeutically, why search? If I don't share it, I would not be open and honest with the client (which is me acting out the same thing that bothered me with the client!) And I think that does raise ethical and therapeutic issues of how it would affect my 'reading' or interpretation of words and behavior having the information and not sharing it.
04/28/10 08:13:44
Phil Monroe wrote:
Is it ethical? Is it wise? These are different questions but worthy of consideration. Ethical: We do seek consent to gather private information about our clients. However, information on the Internet is not private. It is freely available to the general public and so therefore not covered by our ethical codes. Azzia raises a question about how it would impact therapy--and while not an ethical matter, certainly something to think hard about from both a practical and theoretical perspective.
But is it wise? Given today that you can find out who is searching you, you may not want your clients to know this. For example, there are ways to find out who is searching for you on Facebook. If a client has a blog they may have the ability to see who is searching for them and then clicking to their blog.
04/28/10 07:34:52
Azzia Zur, B.A. wrote:
I believe it is unethical to conduct a search of a client without the client's consent and an open discussion, UNLESS there is suspicion on the part of the therapist of some sort of danger, which would be aided by such a search.
As a longtime client, I value the authenticity that comes with my therapist seeing me as I show up and present. I want our process to be free of outside information, so that it feels organic. Also - if a therapist does a search without the client's knowledge, wouldn't it be tricky to remember what to disclose and what not to? If I were a therapist, I'd rather not worry about that piece.
04/27/10 19:29:38
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April 27, 2010: To Google Or Not to Google . . . Our Clients?
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