To Accept or Not to Accept?
How to respond when clients send "Friend Request" to their psychotherapists or counselors on Facebook, LinkedIn, Twitter or other social networking sites
By Zur Institute
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Updated article on To Accept or Not to accept? How to respond when clients send "Friend Request" to their psychotherapists or counselors on social networking sites
Increasing numbers of therapists have profiles on Facebook or other social networking sites. While some therapists' profiles are highly personal, others are strictly professional. Some therapists post a profile on Facebook as part of their marketing efforts.
Most therapists with Facebook profiles cringe at the idea and dread the moment when a client posts a Friend Request. They wonder whether it is ethical to accept such a request, and they are concerned with the clinical and relational ramification of ignoring it.
Social Networking & Dual Relationships
Sometimes accepting a friend request on a social networking site from a client constitutes a dual relationship or multiple relationships, and other times it does not. Whether or not accepting the request constitutes a dual relationship depends on what kind of information clients are privy to and the nature of the therapist-client online interaction.
Scenario #1: Non-Dual Relationship:
If the therapist's profile is strictly professional OR the therapist allows (through the use of privacy controls) clients to view only professional information and postings on the profile, this would not constitute a dual relationship. This is because the therapist has not established a secondary relationship, such as a social relationship, with the client. In these cases, a client can only view professional information on the therapist's profile that probably can also be viewed on the therapist's practice Website or other professional Websites and online directories. Therapists who choose to segment lists of friends into categories must use privacy controls effectively and correctly and be sure to know how they work. This is especially important if the therapist has sensitive-personal-intimate information somewhere on the profile. Unless you are tech-savvy, I recommend that you consult with a nearby expert - a son, daughter or other digital native - for help in navigating privacy controls.
Scenario #2: Dual Relationship:
In most cases, a client making a friend request on Facebook is asking the therapist to engage in a secondary (social) relationship in addition to the therapeutic one. If the therapist accepts the Friend Request and allows the client to post comments of a personal nature and be privy to personal information on the profile, this constitutes a social dual relationship (or multiple relationships). The next question is whether a therapist should or should not engage in a Facebook-type social dual relationship with a particular client. However, before we explore this issue, I would like to reiterate that as we all know (or should know) by now, dual relationships are NOT unethical per se. According to most major professional organizations codes of ethics (e.g., APA, NASW, CAMFT, ACA, NBCC, AAMFT), multiple relationships should be avoided if they could reasonably be expected to impair the therapist's effectiveness or cause harm. Following is a list of questions that therapists must consider before they accept a Friend Request from a client.
Questions for therapists to consider before responding to clients' Friend Requests
- What is on the Facebook profile? A profile that is strictly professional may be viewed differently than a highly personal profile with family pictures, vacation videos, ex-lovers' notes, etc.
- Did the therapist use privacy controls to control access? Therapists can segment the list of "friends" into Limited Profile, Personal, Family, Business and Client contacts, to name a few. This way therapists can post things that pertain only to one group and control the posting that each group can view. If you use the privacy controls to add your client to a list, such as Limited Profile, accepting a friend request from a client does NOT have to mean they get unfettered access to your profile.
- What can a client view on the therapist's profile? It is important to be clear about what clients may be privy to on one's social networking site. My digital-native and savvy daughter recommends getting comfortable with privacy controls and how to add friends to lists such as Limited Profile BEFORE you consider accepting a Friend Request from a client. She explains that you can decide what friends on various lists can see; it just takes a few moments, and it is best to be comfortable with this if you have sensitive information on your profile. These controls also help you determine how your clients can communicate with you on the site (write on your wall, message, etc.)
- What is the Context of Therapy? The context of therapy determines whether certain dual relationships are ethical and clinically appropriate. See details in the following bullets.
- Who is the client? Would the client be able to easily process the emotional and psychological aspects of the dual relationship? Is the client a highly functioning fellow professional or a very disturbed person? Does this client need clear limits or can he or she benefit from a more flexible approach?
- Why did the client post the request? Younger clients, or what we call "digital natives," often have very different attitudes towards Internet disclosure than therapists who often fall into the "digital immigrant" or "reluctant adapters" categories. Younger clients may post "Friend Requests" routinely without a second thought, as they are friends on social networking sites with almost everyone they know . . . and often people they don't know in person.
- What is the meaning of the request? Does the client tend to push boundaries? Is making the link between therapist and client public a way to take healthy 'ownership' of the connection? Is he/she seeking more meaningful connection with the therapist?
- What is the nature of the therapeutic relationship? Intensive or psychodynamic psychotherapy may merit different responses to a friend request than family therapy, group therapy or individual intermittent-long-term therapy, where a therapist sees the client once or twice a year over a period of many years.
- Where is therapy taking place? Does the therapy take place in a private office, home office, community mental health or prison setting? Each setting may have a different bearing on the question.
- What is the community location of therapy? Does the therapy take place in a small and isolated rural community where everyone already knows everyone else's business anyway or in a more anonymous urban setting?
- What does being a friend with this client mean for the therapist? Therapists must explore their own feelings, wishes and counter-transference reactions.
- What is the potential effect on other and potential clients? Current, past or potential clients may be or may become your online friends or your clients' friends. People often get to know each other online, including through the profiles of other friends. The level of interaction you allow your clients to have on your site will affect the possibility of their getting to know your other friends. If you are going to make your friend list public (the default option on most sites), you must consider the collateral effect of your connections.
- Ultimately, the most important question is: How might the therapist's response to a Friend Request affect treatment and the therapeutic relationship? As with most other types of boundary crossings or dual relationships, therapists must consider the potential benefits of accepting or not accepting clients' friend requests as well as the potential risks. Therapists should think through whether accepting clients as online friends is reasonably likely to cause harm, exploitation, loss of effectiveness, or loss of objectivity.
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- Needless to say, therapists do not need to have a social networking profile. Most digital natives understand that the older generation does not necessarily enjoy time online quite as much as they do. Nonetheless, it's important for digital immigrants to understand the world that many of our clients, especially young ones, live in. Here is an article I co-authored with my daughter on the digital-generational divide.
- Clients may be Facebook friends with your spouse, colleagues, and friends, with or without the knowledge or awareness of yourself, your colleagues, spouse or friends. You must come to terms with the inevitability of digital or online transparency and learn what you can control (i.e., what is posted by you on your social networking profiles and your own website) and what you cannot control (i.e., what other sites or profiles post about you). To learn more go to The Google Factor: Therapists' Self-Disclosures And Internet Transparencies.
- Some therapists may choose to add a statement to their Office Policies form stating that they do not engage in social networking with clients. However, such a statement is not going to protect against the need for discussion with the client should the client send a request, nor will it eliminate the potential feeling of rejection by clients.
- If therapists choose to interact with clients on Facebook or other social networking sites, they may want to define the parameters of such involvement in the Office Policies.
- Some people propose that therapists have two profiles, a professional one and a personal one. However, this can be very cumbersome and unnecessary. My "digital native" expert daughter informs me that dual profiles are a "social networking no-no". She highly recommends using the Privacy Control rather than two profiles.
- Regardless of your decision, support your clinical rationale in the treatment records.
Bibliography and Additional Reading:
- Lehavot, K. (2009). Is Being Exposed All Bad? Implications of Internet Self-Disclosures for Psychotherapists, Clients, and Graduate Students. Professional Psychology: Research and Practice, 40 (1), Feb 2009, 28-29.
- Kolmes, K. (2009) Managing Facebook as a Mental Professional. Online Publication. Retrieved on Feb. 15, 2010 from http://drkkolmes.com/2009/06/08/managing-facebook-as-a-mental-health-professional/
- Professional Organizations' Codes of Ethics on Dual Relationships
- Zur, O. (2008). I Love These E-Mails, or Do I? The use of emails in psychotherapy and counseling. New Therapist 57, September/October, p. 23-25.
- Zur, O. (2008). The Google Factor: Therapists' Self-Disclosure In The Age Of The Internet: Discover what your clients can find out about you with a click of the mouse. The Independent Practitioner, 28/2, 82-85.
- Zur, O. (2009). Psychotherapist Self-Disclosure and Transparency in the Internet Age. (Invited lead article to "Focus on Ethics" section) Professional Psychology: Research and Practice, 40, 22-26.
- Zur, O. (2010). Dual Relationships, Multiple Relationships & Boundaries In Psychotherapy, Counseling & Mental Health. Online publication. Retrieved Feb. 3, 2010 from http://www.zurinstitute.com/dualrelationships.html
- Zur, O. and Donnor, M. B. (2009). Google Factor: Therapists' Transparency In The Era of Google and MySpace. California Psychologist, Jan./Feb.,p. 23-24.
- Zur, O. & Zur, A. (2009): On Digital Immigrants & Digital Natives: How the digital divide creates conflict between parents and children, teachers and students, and the older and younger generations. Online Publication, Retrieved Feb. 3, 2010 from at http://www.zurinstitute.com/internetaddiction.html.
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