B (2:20)

I was looking at Our emails back and forth. And that was back last year when we were going through Hurricane Irma in September of 2017.

C (2:27)

Yes. Yeah.

A (2:29)

What a whirlwind.

C (2:30)

Give us a little time to reorient.

B (2:33)

Exactly. So before we get into today's topic, let's just take a quick break for our sponsor.

A (2:40)

Yes, today's sponsor for our episode is TherapyNotes. When it comes to keeping your practice organized, you want to have software that's not only simple, but the best. We highly recommend TherapyNotes. Their platform lets you manage notes, claims, scheduling, and more. Plus they offer amazing unlimited phone and email support. So when you have a question or you're stuck with something, they're really there to help. To get started with the practice management software trusted by over 60,000 professionals, go to therapynotes.com and you can start your free trial. And then you can also get two free months with the code pps, as in the private practice startup. We'll put the link in our show notes to make it easy breezy for you to sign up. And again, you can get two free months with promo code pps and to get more information and really listen into the user experience of TherapyNotes, listen to podcast episode 54 with Brad Pleiner, where we really explored all the ins and outs of their amazing ehr. So make sure to check that out. Without further ado, let's dive into today's podcast.

B (3:46)

So, Keely, I think one of the first questions we have is how did you get so passionate about media social media policy as it relates to our field?

C (3:54)

Yeah, you know, that's such an interesting question for me because I was sort of an Internet nerd back in the 90s. So in the early 90s, I was spending a lot of time online and I started graduate School in 1995, and I was the student who would be asking the administrative assistant when I got into school, hey, can I sit at your computer and check my email? Because I wasn't carrying a laptop to school back then. I was just always online and much of my social life existed online. I was really meeting tons of people and involved in a number of online communities. So that was kind of like a separate identity from my psychology psychologist identity. And I remember when I worked at Stanford University, I was doing my postdoc there in 2004, and I remember being in a staff meeting and saying, you know, we really need to reach these students. We should have a blog. We should consider, you know, doing outreach and providing information on our website and the ideology then of some of the more senior staff Was, oh, no, the Internet is the problem. We have to get these people off the Internet. It's, you know, making them antisocial. And I remember feeling like, ooh, like I'm one of them. I'm like part of the them that this person is thinking about as, you know, this not being healthy. So there was still this idea back then that the Internet was not for healthy, functioning folks. And so I started my private practice in 2008 and I was trying to figure out how do I integrate this personal life, which is with, you know, lots of community, under a pseudonym, pseudonym I had been using for years. And then how do I establish this professional identity? And what do I do if these two places blur? And what can I do? And how can I think about existing ethical standards and apply them to my practice and what I'm doing? Because I couldn't find anything that actually talked about how do we manage ourselves ethically when we're in these worlds. And a lot of what I had to actually think about was really rural and small community ethics, because that's what the Internet does is it turns us all into a small village. So that's kind of how it. That's kind of the trajectory for me. That's so interesting.

B (6:30)

Like, I was kind of like laughing as you said, like, ethics back then. Right. So you're talking about like 2004. Like, we were definitely not talking about that in our ethics at all. I think as I think about technology and I remember, I think reading the first ethics around technology was it like 2015, 2014. Some of the professional associations started, like, putting them in. I remember double amft. Now we're both licensed marriage and family therapists, Kate and I, and we look at that ethics as super sparse now. The NASW ethics 67 pages on technology is amazing. Yes, I know for the three of us talking about it, we're like, that's amazing. And someone else might be thinking, like, I'm not going to read 67 pages of technology ethics, but we're going to give you a crash course today and that and utilize Keely's knowledge to really share with you guys about that. So that's so cool. Like, I love hearing your story and your journey and that you were an Internet geek back then. I remember the Internet is the way that I learned how to type. Remember in middle school taking those typing, like, classes where they put something over your hands and you're supposed to stare at the screen and figure out how to type? I remember watching my friend in 1995 on AOL messenger. I was like, that's so cool. How are you talking to people? And then slowly I began to type that.

C (7:44)

So, anyway, I want to say something, though, to your point, about a lot of people don't want to immerse themselves in 67 pages of ethics. You know, one thing that's so easy to do because most of these ethics codes are accessible online, is just to go to the ethics code and type in informed consent or technology, and you don't have to read all 67 pages. You can find the piece that's specifically about the question you have. That's something I really want to encourage listeners to do, to feel empowered to consult their ethics code to see what am I supposed to do in this situation?

B (8:21)

Totally. It's really important and it's such a beautiful guideline. And one of our rules of thumb is always going with the highest standard, the best practice. So if there's something in your ethics that's not. Not exactly clear or you're looking, you have a certain situation is check out some of the other ethics. It's been totally invaluable to the work that we've shared with clinicians because we also teach, we're talking about CE courses before we get got started. We teach the laws and rules, ethics and boundaries and medical errors. And being able to be aware of what others are doing in their ethics is super helpful.

C (8:53)

Yes, I agree.

A (8:54)

What do you see as some of the biggest mistakes that clinicians are making in terms of the social media realm?

C (9:01)

Ethics? Yeah, you know, the biggest mistakes that I wind up seeing are often poorly masked clinical information. At least for the psychology ethics code. When we're seeking referrals or consultation, the code explicitly says that we share the minimum amount of information necessary for the purpose of the consultation. And I will see all kinds of referral requests giving details about recent accident, which members of the family died, how old mom is, you know, or sometimes even this is the email address of the client. Send your referral, you know, send your emails directly to this person. And I think what we're seeing is just how the ease of access and transfer of information is getting people to kind of skip the steps of protection that, you know, we used to take, I think, a little more seriously. And I think, yeah, it can be inconvenient sometimes to collect and gather referrals and then send them to the person, but to actually share someone's name or email address is really potentially identifying. So. So I see mistakes in that area. I've seen some things like clinicians who Post on Twitter, their favorite client quote of the week. So sharing these really personal, confidential moments in our work and wanting to kind of open the window on them and put them out there. But I get concerned about what are the clinical effects on this person or the other people in your practice when you're doing that.

B (10:48)

Gotcha. And so when, when you were talking about, like, realizing the Internet makes things really, like, small, were there certain situations that you came across that made you kind of think about this more? Like how you were navigating all of that?

C (11:03)

Certainly a few things that happened early on were like, I would be on Twitter and I would see that one of my friends would retweet somebody and I would realize, oh, that's my client, you know, and I would notice that urge to kind of click, you know, because this is what the Internet invites us to do, is to be curious and click on things and go down a whole rabbit hole of information. And, you know, the next thing you know, you're buying something you never needed. But, you know, it was like having to kind of check my impulse to be curious and click and realize, wait a minute, this is someone who I'm seeing professionally. What would it mean if I get this information? And then I started talking to my friends and saying, you know, do you Google your. Do you Google your clients? You know, like, sometimes I'm curious about it, but it seems like it would be a violation. But why? Why would it be? So it was situations like that, you know, where I would find myself in a, you know, my hand hovering above the trackpad, thinking, this seems like something that requires more thought, you know, maybe thinking about ethics and thinking about the relationship. And why would I not do what I might do in my off therapy hours in a different type of relationship? So it was kind of matching myself.

A (12:32)

Yeah, that's so true. Because when we have that curiosity, it is so easy to explore things. And when someone shares a referral or the first thing we do is we go online and we look it up, we type in the name, we look it up, we see what pops up. For me, I have a lot of professional athletes that will come to my practice or high profile clients, and the natural curiosity is to, oh, let me go look. But I always have a very firm boundary there with myself because that would transform my relationship with them and could leave me with biases or assumptions or just having more information that I don't need to have. So as easy as it is to go and just hop on and find all sorts of information, I have to Be really firm with myself there.

C (13:17)

Yeah. And one thing I do want to say, because I actually did research on clients searching for their therapist information online and therapists searching for their clients information online. And the range of reasons why clinicians endorsed doing it were really diverse and interesting and sometimes made a whole lot of sense. For example, people who were working with violent offenders and wanted to see if they would feel safe working with this person. Or I heard from people who had kids in school, so they would go on Facebook and see if the child was friends with their child to avoid entering into a multiple relationship. You know, so there are certain. There are certain times when it may actually be relevant to do a Google search. But what I came to in my social media policy, and we're now seeing statements like this in the American Counseling Association's ethics code and the national association for Social Workers ethics codes are that, you know, this is something that it should be part of informed consent. If this is your practice, let your clients know it's your practice. It shouldn't be a secretive thing. It should be something that's done with knowledge and potentially collaboratively.

B (14:42)

I like how you incorporate that because it's there, people are going to do it. And I know you're talking about, like, protecting client information, even in an email. Even though we might suggest to clients like, hey, don't text me or email me, they just naturally do, because that's just the way of the world. Right. So it's being able to be mindful at the same time, understanding our own model, our own style and that, assuring that we're protecting them the best that we can and inviting them to protect themselves. I think if I remember reading in, part of your social media policy is you definitely recommend to clients not to follow or comment or things like that, and also not to be upset when you don't respond. Something like that. Am I kind of hitting on it? Yeah.

C (15:23)

And what you're making me think of, too, is the intersection of the legal with the ethical and the clinical. Because what I will tell my clients is, you know, you can opt to send me an email, but please be aware that anything you send me via email becomes a part of your legal record. That includes if you want to forward me an exchange that you had with someone else and you want my opinion on it, once it's sent to me, if the notes were to. If I had a court order to release the notes, that's part of the legal record. So if you want to share that material with me, it may be better just to Hand me your phone or to print it out at home and bring it in, and then I'll give it back to you. It's not kind of in the system already as something that is now part of your medical record. So that's something that I will talk to people about. And certainly people share all kinds of things. And there is. Clients have autonomy, and they can make choices to do that. But I'd like them to know what are the consequences of these choices. Right, right.

B (16:30)

So share with us a little bit more about the social media policy and. Or information that you have found that's been helpful as we continue to progress in this area in our field.

C (16:40)

Yeah, so I wrote the social media policy in, like, maybe January 2010, and at the time, I posted it on my blog, but I was asking folks on Twitter, what do you think about this? And I kind of crowdsourced it and asked people, are there other questions you have? Or might you do this differently? Or what do you think? And so I was getting a lot of interesting input. Pretty much kind of went with what felt right to me. But there were some folks, like, for example, who really strongly disagreed with me, that clients should be able, at the time, you could fan someone on Facebook. Now, I guess it's like them. But, you know, I was, like, having problems with the terminology and what it meant for the therapy relationship. So when I published it, you know, there were certain things that were not standard but just were my interpretation of my ethics code and how it meant I should conduct myself. And so some things that really surprised me were, one, how much it took off, because I have heard from people in England and Australia who have adapted my code. I've heard of someone who's a massage therapist in another country who used it and kind of felt like it was helpful for her practice. So the other thing that's been interesting is seeing how some of the ethics codes have changed to kind of mirror some of the things I was thinking now. Like, one example of this is I really advocated at the beginning a separating of your personal and professional online identities. And I've kind of come more to the middle of the road on that now because I feel like, well, you know, some of us do work in small communities, and it's just not feasible to have, like, this is me, you know, being a psychologist, and this is me, you know, going to my dinner group on Friday. But I think it's. It may be the American Counseling Association. I can double check that for you. But there is one ethics code that specifically says you should make two separate, clearly distinguishable identities for your personal and professional life. And I thought that was kind of heavy handed and intense for an ethics code to tell people to do that, you know, whereas I feel more now like for most people it's a personal choice, you know, what works for you and your practice and your life and your integrated identity.

B (19:20)

Right. And a lot of that also has to do with really our transparent communication with our clients around all of this. Right. And especially if you are in a small community. You know, I think one of my interns, he was orthodox Jewish, so he lived and worked in his community and his community knew him and vice versa. And he also got referrals from his community. So how do you navigate that, those dual relationships physically, but then also online and the other cool thing and you know, this is what Kate and I love talking about is marketing and branding. You know, therapists. When we think, when we think therapy back then, whatever that was, it was more like the Freud style therapy. Right? Someone cycle analyzing you, you're talking, they're listening, but it's not that. And so many therapists are really just bringing themselves into the therapy room and they have a personal brand and style, which is often a nice marriage between who they are personally, but also professionally, we don't have that, that black and white rigid wall anymore. Like, okay, and I'm the therapist or the client. So there are so many different places that it's potentially difficult to navigate. But I think having those open conversations, I guess understanding your own, you know, beliefs and stuff around that, and then conversing with your clients, how do you kind of bring this into the therapy room with your clients? What's the conversation?

C (20:36)

Yeah, and, you know, I love the, you know, that this question is kind of grounded and sort of, you know, or started with a question about multiple relationships. Because I actually find the multiple relationships section of the ethics code, that's probably the place I geek out the most.

B (20:54)

We use that terminology all the time.

A (20:56)

Yes, we do.

C (20:58)

I geek out multiple relationships because it really requires us to think carefully. It also invites us to engage our paranoid selves a little bit. But, you know, the ethics codes never say avoid all multiple relationships. What they do is they invite us to consider whether this particular multiple relationship could impair our objectivity and our ability to perform our primary role as a psychologist, or can it lead to the exploitation of the other person. And if the answer for those questions is no, then, you know, we can document that we have concept these issues and, you know, are aware of this multiple relationship and are moving ahead. So an example of how this comes up in my practice, that's been really kind of. It was tricky and surprising for me when it started happening. But I work with a lot of folks who practice consensual non monogamy. And so it is not uncommon that I will get a referral. Maybe a couple wants to come in and talk about the issues going on in their relationship. And then I find out that they were referred by one of their partners who saw me for individual therapy. And so, you know, I have to think, okay, you know, one of these people, or maybe both of them are in a very close relationship with someone who I am seeing in individual therapy. I can't violate anyone's confidentiality, you know, but I have had, like, I've had a partner say, well, you know, it was her boyfriend who referred us to you. And I'm not sure how I feel about that. And so I've been able to say, you know, I, you know, I can't say anything more than this. But it sounds like, you know, it might be good if you had a space where you felt more safe to kind of talk freely, you know, without feeling like this idea that there's another connection. You know, I've had to very carefully weigh those situations. But I mean, that's an example. It's not necessarily about social media, but it's like, how do I. How do I be sensitive to the fact that some people may feel like it's okay to refer their lover to see me, But I think that's kind of ripe for creating problems. One person might feel exploited, or I might be hearing two versions of the same story and start getting caught in a. Who do I believe? Rather than really being able to serve each person and really be fully there with them.

B (23:39)

Totally share with us a little bit about, like, protecting client confidentiality regarding social media. What are your, what do you do there? What are your tips?

C (23:49)

Yeah, my tips are there are a few things that I personally avoid and that I recommend people avoid. I think that if you want to talk about something that happened in a session, you should be very careful that you're not referencing even the time that you saw the person. So in the early days, I used to see. I actually saw a specific tweet that was like. Just worked with my 3 o' clock erectile dysfunction client and he is making progress. And I'm thinking as I'm reading this on Twitter, well, how do you know that people on Twitter don't know that this person goes to see you at Three o'. Clock. You know, you didn't say things that were identifying, but you may not realize that this person says, oh, I go see Dr. Sean at 3 o' clock every Thursday. And now they know why. So, you know, being careful about mentioning the time of the session is one thing. Making sure. One of my rules is make sure that the client themselves could not identify themselves by anything you're sharing. If you're blogging or tweeting or just posting a status update, are you taking care that you are protecting the identity enough that someone won't read that and think, oh, they're talking about me. And the tricky piece is that oftentimes we cannot be talking about a particular person, but they may think it's about them. So there have been times where I've published articles and I've done composite cases, but if it's enough of a theme that was very active in someone's therapy, even if I've done a composite case, I've brought the writing to the client and said, this is not about you. It touches on some themes that we've discussed, but other people have had these issues. But would you like to edit this and tell me if there's anything we should change so that you feel you would feel comfortable with me posting this? And, you know, I feel like I have to be very careful about that because it feels a little bit like, you know, this is my agenda, you know, to bring something in like that. But I feel like I. That, to me, is worth taking a little time and doing it rather than have a client come to me later and say, you posted my issue on your blog. Why would you do that?

B (26:18)

Right. And share with us a little bit about, like, navigating testimonials and reviews, Like a spontaneous review from a client not solicited. Like, how do you talk to clients about that? And what do you recommend?

C (26:30)

Yeah, so I do have a statement. It's actually on my Yelp page and on my. In my social media policy. Just making it clear that finding me on a site is not my request for a review. Every ethics code I'm aware of prohibits soliciting testimonials from current clients. Some do not make a distinction about former clients. Most don't. It's people under undue influence. So I sort of don't ask for testimonial. It says on my Yelp page that because I care about people's privacy and it's against my ethics code, my presence here is not a request for this. And it's my hope that you can share any feedback that you have about our work, positive or negative, with me directly. And also, if you feel like I've done something egregious, you know, there's a board of psychology that's set up to protect consumers, so I give that information. I have yet to receive an unsolicited review. I also created a product called Getting Better, which was meant to try and fill in the gaps of what I thought these consumer review sites were missing. So I have people opt in to whether they want to receive this when therapy is over. And it asks questions that I created based on 145 psychotherapy patients saying what they wished they could find on a Yelp review that's not there. So I've been collecting my own data, and it promises that any text testimonial, like, things that are in there that I won't publish, I'll just keep that to myself. The tricky thing is that I get consultation calls most often from people who have received a review and it's a negative one and they don't know what to do about it. So I kind of went the preemptive route of like, I wanna. I'm worried about this and I want to not have. Either not get a negative review or not have a client feel they have to defend me and write a positive review, because I've seen some of that when I look on Yelp. So my. My way of dealing with it was to try to get there first and get my statement on there and say that I wouldn't be responding to reviews and then create this other instrument that I could send to people hoping that it would give them an opportunity to give feedback that might be hard to give face to face.

B (29:05)

Nice. I really love the style that you've created. And, you know, I'm always curious. Not curious, but I'm always fascinated because therapists really put their therapeutic spin on these types of things that sometimes feel, like, very rigid and unflexible. And I just like that you talk about that as a relationship. You're very proactive and very transparent. And, you know, when we do those things and we take the time to be really mindful of the way that the world operates and social media and Internet and things like that is we really can create awesome relationships and good client care and really, like, avoid some of the stuff that might occur later. So I just. I really enjoyed listening to your spin. And of course, we've read your social media policy and recommend it. So it's nice to hear from you about it and please Share a little bit about your social media policy. We'll actually put that on our Show Notes page for folks to get if they would like to.

C (29:53)

Yeah, absolutely. So, you know, this is a free offering. I've had it for a long time and it lists my thinking through the various aspects of things that could go wrong. It talks about email, it talks about friending or following on social media sites and why I recommend people don't do that, which is more confidentiality concern. I let folks know that they're welcome to browse those pages at any time. I don't put anything there that I wouldn't want a client to see. It talks about the fact that it's not my regular practice to use search engines to obtain information. I have a little bit of a loophole in my policy there and I say if for some reason I'm not able to get in touch with you and I'm concerned, I may look at your profiles, but if I do so, I will document it in your chart and we will talk about it when we next meet. And that's happened twice in like nine years. But I wanted to be able to say, you know, okay, if I do that, I have to have a strong enough rationale to do it and I have to be willing to stand behind it and document it as a clinical decision, not a curiosity decision. So I talk about the testimonials trying to think of. I did put something in there originally about location based services because at that time so many people were using Foursquare and having passive LBS enabled on their phones so it would check them into places. So I wanted people to be aware if they were inadvertently flagging, you know, Every Tuesday at 10am I'm at Dr. Collins's office, you know, just to help also educate clients who might not be aware of what kinds of trails they were leaving.

B (31:51)

Great. And that is for other people to utilize, giving you credit. And so I'll put that on the Show Notes page. And you also have a giveaway, you have some CE courses. So share with us about that.

C (32:01)

Yeah. And so one thing I did want to add is that I'm working on now and it should be finished by certainly by the end of this year, an annotated social media policy which will, you know, include my updated policy, but then it'll be annotated to include notes from every ethics code about what each person's and each discipline's ethics code says about this issue so that people can use it both to create their own social media policy or update it. But Also learn and get credit for checking out their ethics codes. So I'm going to be doing that and that will be included in the giveaway. I'm giving all of your listeners a 10% discount on anything in my store, which will include that I have two continuing education courses right now. One is a five hour video on digital and social media ethics and one is a three hour video on working with the consensual kink community in clinical practice. I also have Getting Better, that instrument that I use. That's the Post Treatment Satisfaction Survey. And I offer consultation both as standalone or in bundles. So all of those products will have a 10% discount for your listeners who use the code PPS, which I guess is the one you use as well.

B (33:29)

It is.

A (33:29)

We just make it to be the code.

C (33:32)

I'm going to keep it simple and make it consistent for everyone.

B (33:35)

That sounds good. Well, we've really just enjoyed having you. And what do you most hope our listeners take away from your message today?

C (33:43)

Yeah, what I hope people take away. You know, I actually think the Internet is not the scary playground that that senior staff person thought, you know, over a decade ago. I just think the Internet, you know, has its upsides and its downsides, but it is where a lot of us really connect and find community and network. It's how you, how the two of you and I found each other, you know, and I want people to feel like they can play and express themselves, but just be aware that clients are in the same playground and so, you know, to kind of strategize before a problem occurs. How do I want to handle these things? I think it's a lot easier if you have a policy document to refer clients back to than on the fly figuring out what you want to do about something. So to just kind of give some thought to what is your approach and does it resonate with your values as a clinician and will it serve the clients you're serving? And then, you know, you've got your policies and you can refer people to them and talk about them clearly. Great.

B (34:48)

And you just kind of like highlight. What we believe is that like paperwork really should be about a conversation in this conversation in the relationship. And this is just another one of those conversations around social media. So, Keely, thank you so much for joining us today and we're finally glad we're able to come full circle within the year and get you on the podcast. It's going to be exciting because now when we do our paperwork webinar, we can reference the podcast we did with you as well as your social media policy. So we're excited about that. Startup Nation, you want to make sure you join us next week for Travis Hornsby. This is a different topic. We have not talked about how to get rid of your six figure student loan. So if you're listening to this and you have a six figure student loans that you want to say goodbye to, or maybe you and your spouse combined, you'll definitely want to check out this podcast for sure. We appreciate you hanging out with us today. If you haven't hung out with us yet in Facebook, find us there. Just look for the Private Practice Startup group and we will see you there. Thank you so much for joining us today. We look forward to having you next week. Or maybe we'll be in your ear for the next five hours as you binge listen on a bunch of podcasts. So Startup Nation, have an amazing and inspired day.

C (35:55)

Take care.

A (35:56)

Thanks for being here Keely. See you next time. Startup Nation.

C (36:00)

Thank you.

A (36:07)

Thanks for joining us on the Private practice startup. Visit theprivatepracticestartup.com for awesome resources, free trainings, attorney approved private practice paperwork and so much more.