Private Practice Startup Podcast

Episode 113: Avoiding Ethical Mishaps on Social Media

Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Dr. Keely Kolmes
Date: November 24, 2018

Overview

This episode explores the complex and evolving ethical challenges mental health professionals face regarding social media. Dr. Keely Kolmes, a psychologist and pioneer in digital ethics, shares insights on creating effective social media policies, protecting client confidentiality, staying within ethical boundaries, and fostering open, transparent client communications. Listeners receive actionable tips for avoiding common pitfalls and learn how to approach social media use mindfully and ethically in private practice.

Main Discussion Points & Insights

Dr. Kolmes’ Digital Journey & Motivation (03:54–06:30)

• Dr. Kolmes recounts being an "internet nerd" in the 90s, integrating online spaces into daily life and recognizing early the disconnect between digital culture and psychotherapy ethics.
• Noted initial skepticism towards the internet from the mental health field ("The internet is the problem"), which contrasted with her experience.
• Experienced the challenge of managing overlapping personal and professional online identities.
  • Quote [05:20]:
    “A lot of what I had to actually think about was really rural and small community ethics, because that's what the Internet does—it turns us all into a small village.”

Evolution of Ethics Codes Relating to Technology (06:30–08:21)

• Technology was largely absent from earlier ethics codes; changes only became prominent closer to 2015.
• NASW’s code expanded to 67 pages on technology; many practitioners feel overwhelmed but can search for relevant terms online.
  • Quote [07:44]:
    “You don't have to read all 67 pages. You can find the piece that's specifically about the question you have... feel empowered to consult their ethics code.” – Dr. Keely Kolmes

Common Mistakes Clinicians Make on Social Media (09:01–10:48)

• Oversharing clinical information when seeking referrals or consultation; unnecessary or identifying details shared online.
• Posting “favorite client quotes” or session details on social media risks breaching confidentiality and clinical boundaries.
  • Quote [09:01]:
    “The biggest mistakes... are often poorly masked clinical information… I will see all kinds of referral requests giving details about recent accident, which members of the family died... that's really potentially identifying.”

Navigating Curiosity and Online Boundaries (11:03–14:42)

• The ease of online access heightens ethical risks; “clicking” on clients’ profiles can be tempting but undermines professional boundaries.
• Dr. Kolmes’s research showed diverse reasons for therapists Googling clients (e.g., safety, avoiding dual relationships).
• Suggests transparency: make any search or research part of informed consent.
  • Quote [13:53]:
    “If this is your practice, let your clients know it's your practice. It shouldn't be a secretive thing.”

Building and Communicating Social Media Policy (16:40–19:20)

• Dr. Kolmes created a social media policy in 2010, crowdsourced via Twitter.
• Her approach influenced ethics codes internationally; policy emphasizes client confidentiality, transparency, and rationale for digital boundaries.
• Evolution from insisting on strict personal/professional separation to a more balanced, context-dependent stance.

Practical Conversations & Multiple Relationships (20:36–23:39)

• Importance of transparent communication with clients—especially in small or insular communities.
• Navigating real or potential multiple relationships (online and offline) requires thoughtful self-assessment and documentation.
  • Quote [20:58]:
    “The ethics codes never say avoid all multiple relationships... they invite us to consider whether this particular multiple relationship could impair our objectivity... or lead to exploitation.”

Protecting Client Confidentiality on Social Media (23:49–26:18)

• Avoid referencing session times, details, or anything potentially identifying even in seemingly vague anecdotes.
• Ensure no client could recognize themselves in your postings or writings.
• When themes overlap, consider proactively discussing de-identified writing with clients for their comfort and consent.

Handling Testimonials and Online Reviews (26:18–29:53)

• Never solicit testimonials from current clients; place clear statements on platforms like Yelp.
• Address negative reviews proactively by providing direct feedback mechanisms outside public forums.
• Developed an opt-in feedback survey (Getting Better) for post-therapy satisfaction, giving clients a private channel for honest feedback.
  • Quote [26:30]:
    “Because I care about people's privacy and it's against my ethics code, my presence here is not a request for this [review].”

Social Media Policy Details (29:53–31:51)

• Free, public policy for clinicians to adapt; includes guidelines on friending, email use, online search, and testimonials.
• Policy includes rationale for when a clinician might look up a client (e.g., safety, missed contact)—must be documented and discussed in-session.
• Educates clients on location-based tracking and digital privacy.

Upcoming Resources and Offerings (31:51–33:43)

• Annotated, discipline-specific social media policy in development—integrates direct references to various ethics codes.
• Discount code (“PPS”) offered for listeners on Dr. Kolmes’s store: CEU courses, policy templates, feedback instruments.

Final Takeaways and Mindset (33:43–34:48)

• The Internet isn’t inherently dangerous but is an extension of the therapy “village”—planning and policy matter.
• Encourage preemptive strategizing and open conversation to head off ethical problems before they arise.
  • Quote [33:43]:
    "I want people to feel like they can play and express themselves, but just be aware that clients are in the same playground... strategize before a problem occurs."

Notable Quotes & Timestamps

• “[The internet] turns us all into a small village.” – Dr. Keely Kolmes [05:20]
• “You can find the piece that's specifically about the question you have... feel empowered to consult their ethics code.” – Dr. Kolmes [07:44]
• “The biggest mistakes... are often poorly masked clinical information.” – Dr. Kolmes [09:01]
• “If this is your practice, let your clients know it's your practice. It shouldn't be a secretive thing.” – Dr. Kolmes [13:53]
• “The ethics codes never say avoid all multiple relationships... they invite us to consider whether this particular multiple relationship could impair our objectivity.” – Dr. Kolmes [20:58]
• “Because I care about people's privacy and it's against my ethics code, my presence here is not a request for this [review].” – Dr. Kolmes [26:30]
• “I want people to feel like they can play and express themselves, but just be aware that clients are in the same playground.” – Dr. Kolmes [33:43]

Key Takeaways for Clinicians

• Stay Informed: Regularly consult relevant ethics codes for guidance on digital dilemmas.
• Minimize Identifying Details: Even seemingly generic posts may risk identification—always prioritize privacy.
• Transparent Communication: Explicitly discuss social media policies, boundaries, and digital practices with clients.
• Written Policy Matters: Develop and share a social media policy—adapt from Dr. Kolmes’s free template if needed.
• Be Proactive with Reviews: Address testimonial and review challenges up front; never solicit client testimonials.
• When In Doubt, Document: Any unusual digital action (e.g., searching for a client online) should be documented and discussed.
• View Social Media as a Relationship: Approach all digital interactions as extensions of the therapeutic relationship.

Resource Links

• Dr. Keely Kolmes’s Social Media Policy
• Private Practice Startup Podcast
• CEU and feedback resources at Dr. Kolmes’s store: Use code PPS for 10% off

Segment Timestamps

• 03:54–06:30: Dr. Kolmes’ background and digital journey
• 06:30–08:21: Evolution of technology in ethics
• 09:01–10:48: Common mistakes in clinician social media practices
• 11:03–14:42: Dealing with curiosity and boundaries online
• 16:40–19:20: Developing and evolving a social media policy
• 20:36–23:39: Multiple relationships and practical conversations
• 23:49–26:18: Protecting confidentiality in social media use
• 26:30–29:53: Navigating testimonials and reviews
• 29:53–31:51: Social media policy details and tips
• 31:51–33:43: Annotated social media policy and resource offerings
• 33:43–34:48: Final takeaways and clinician mindset