Navigating Social Media as Clinicians in the 21st Century PowerPoint Presentation

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Navigating Social Media as Clinicians in the 21st Century Ashley Smith & Andrea Skaflen James Madison University February 19, 2011

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What is social media? “Social” – refers to instinctual needs humans have to connect with other humans “Media” – what we use to make connections with other humans “Social Media” – how we can use technology effectively to reach out & connect with other humans, create a relationship, build trust Media used for social interaction 2 way communication - interactive dialogue

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Types of Social Media Written word Telegraph Telephone Radio Television Email Websites Photographs Audio Video Mobile phones (cell phones) Text messaging Picture-sharing V-logs (video blogging) Wall postings Music-sharing Weblogs Social blogs Internet forums Podcasts Social bookmarking Virtual game worlds (video games) Virtual communities Social networking

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Social Networks Examples: Facebook Twitter Myspace LinkedIn Skype Social networking accounts for 22% of all time spent online in the U.S. Twitter averages almost 40 million ‘tweets’ per day 1 in 4 people over the age of 65 use social networking sites “There are over 200 active sites using a wide variety of social networking models today.”

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Possible situations counselors might encounter Diagnosing clients with internet, gaming, etc addiction Helping a parent understand how technology use is negatively impacting their child’s life Providing psycho-education about dangers of online social sites – stalkers, sexual predators, bullies etc Adults – might be new to technology Children – might be oblivious to dangers Client’s personal information available online Counselor’s information available online Personal use Professional use Dilemma of being friend requested by a client Using technology in counseling services

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Social Media Revolution http://www.youtube.com/watch?v=NB_P-_NUdLw&feature=related

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Communicating with Clients Face to face In the room Via computer Verbally Over the phone Written word Email or letter Chatting or texting

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What is social networking? “It's the way the 21st century communicates today.” A social network service is an online service, platform, or site that focuses on building & reflecting social relations among people who share interests &/or activities Essentially consists of a representation of each user (profile), social links, & other services Most are web based; interact through internet, email, instant messaging(chatting), or phone applications

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Dangers of Posting Pictures Online http://abclocal.go.com/wabc/video?id=7621105

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Telephone Work phone number Personal phone number Texting Hotlines Provide free, anonymous and immediate help Offer information, emotional support, and referrals 234 million people over 13 years old used mobile devices in Dec 2009

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Telephone Reduces response time Increases accessibility Agencies should have emergency services available 24 hours a day, 7 days a week Telephone also integral part of traditional counseling Adjunct to face-to-face work with clients Few professionals have training in this area though Client is in complete control of the duration of the conversation Client can hang up when they want

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Suggestions for Telephone Communication with Clients Track more Tune into nonverbal cues Appreciate the intimacy of telephone communication Use your body as you talk Take notes Have vital resource information near your telephone Maintain contact

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Internet Email Skype Chatting Social Networks (Facebook, Twitter, LinkedIn) “Self-help” websites, blogs, and chatrooms

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Internet Michael Feeny (2001) stated that a large number of online counseling and therapy sessions will be taking place every day in the not too distant future Currently, about 5,000-25,000 online contacts between counselors and clients take place daily

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Telephone & Internet Like using a telephone, most internet communication does not involve visual cues, however that may be an advantage Comfort and privacy of client’s home Can take whatever time needed to compose messages (email) Because client isn’t seen, may feel sense of anonymity and be less inhibited and candid

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Suggestions for Internet Communication with Clients Use emoticons Use acronyms Use emotional bracketing Offer descriptive immediacy Be aware of ethical concerns and legal issues

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Crisis Most fundamental task – make yourself known as someone who can help in a crisis In person, in writing, over the phone, or through the internet – making contact with person in crisis is essential step in crisis intervention

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Initial session vs Established Relationship How do you think an established relationship would influence efficacy of online or telephone communication with clients? Rapport already established Trusting relationship built

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Accessibility How accessible should counselors be? 24 hours a day; 7 days a week? Monday-Friday 8-5? In what ways should counselors be available? Texting? Voicemail? Pager number? Personal telephone number?

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Boundaries Appropriate to text client? Policies about emailing clients? Phone etiquette Available 24/7?

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Confidentiality Difficult to maintain People can overhear or accidentally see conversations How could the information be used? How do you keep records? Could a transcript of a session be called into court? If using a type of “real time” chat or e-mail how do you limit the risk of third party knowledge of an online session encryption—how much does this limit risk?

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Ethical Framework for Use of Social Media Practitioners are mindful that social media activity can blur the boundaries between personal & professional lives Applicable ethical principles relevant to clinical care & social media: Confidentiality Multiple Relationships Testimonials Informed Consent Minimizing Intrusions on Privacy Initiating Professional Relationships Documenting and Maintaining Records

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Ethical Framework continued… Social media interactions which relate to ethical principles: Personal vs. professional behavior on the web for practitioners Friend and follow requests Search engines Interacting using email, instant messaging, etc Consumer review sites Location-based services Online treatment

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ACA Code of Ethics (2005) A.12. Technology Applications Counselors inform clients of benefits & limitations of using information technology applications in the counseling process Include but are not limited to computer hardware, software, telephones, Internet, online assessment instruments & other communication devices When providing technology-assisted distance counseling services, counselors determine that clients are intellectually, emotionally, & physically capable of using the application & the application is appropriate for the needs of the clients When technology-assisted services are deemed inappropriate, counselors consider delivering services face to face Counselors ensure that use of technology does not violate laws of any local, state, national, or international entity

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Code of Ethics continued… As part of the process of establishing informed consent, counselors do the following: Address issues related to difficulty of maintaining confidentiality of electronically transmitted communications Inform clients of all colleagues, supervisors, employees who might have access to electronic transmissions Urge clients to be aware of all users including family members & fellow employees who have access to any technology clients may use in the counseling process Use encrypted websites and email communications to help ensure confidentiality When encryption is not possible, notify clients & limit electronic transmissions to general communications – not client specific Inform clients if & for how long storage of records maintained Discuss possibility of technology failure & alternate methods Provide clients with emergency procedures (calling 911 or crisis hotline) if counselor not available Discuss time zone differences & cultural or language differences that might impact service delivery Inform clients when technology assisted distance counseling services not covered by insurance

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Scope of Practice Indicates the specific area to which a practitioner may practice May also define where a practitioner may practice Understanding boundaries & limitations of one’s specific discipline Understanding specific laws or ethics within one's own discipline or geographic location Respect specific laws of potential client’s geographic location Competence

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Training and Supervision of Online Counseling Work Limited course work regarding the specifics of online counseling work to ensure competency and efficacy through online medium Limited number of Supervisors available with experience in online counseling work to provide appropriate supervision of online counseling work

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Efficacy How effective is it to communicate with clients via social media RESEARCH STUDIES?

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Client’s Access to Counselor’s Personal Info “Prior to calling or interviewing their potential psychotherapists, consumers are likely to search for the therapists Facebook profile or page, or other social networking profiles” (Zur, 2009) Through social networks How much personal information should be available for public view? Pictures, interests, hobbies, phone #, address, communication with others (Facebook wall, etc)

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Counselor’s Profile Related to Professional Practice Websites available to the public should include: Crisis intervention information Counselor contact information Counselor education, license/certification information Terms of use, privacy policy, & social media policy Encrypted transmission of therapeutic & payment information Informed consent process

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Counselor’s Access to Client’s Personal Info Pictures, interests, hobbies, communication with others (Facebook wall, etc) Previewing client’s information before initial meeting (“scoping out client”) Gain access to client’s information not expressed in sessions “Checking up” on client after sessions have been terminated

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Digital “Natives” vs Digital “Immigrants” Things to be aware of Cautions to remind children/teens of Cautions to remind parents of Understanding purpose of social networks Understanding dangers of social networks Privacy Cyber-bullying

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Themes Counselors Might Address Trolling Online bullying (Cyber-bullying) Lack of interpersonal interaction Barrier between kids/teens and parents Inappropriate pictures Threats Teachers and students “friends” online

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Ways Social Media will Change Mental Health Care Changing how we communicate & define “relationship” Professionals will collaborate more – more comfortable communicating via social outlets Also learn to consult & collaborate more on cases (careful with confidentiality), share research information, & become partners on treatment programs The stigma & isolation of mental illness could decrease Online patient advocacy sites allow people to discuss mental health issues with one another – share similar experiences & provide suggestions for coping

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Ways Social Media will Change Mental Health Care continued… Increased demand for high quality mental health care Surge of “e-clients” – those who are “plugged in” & research, advocate, & communicate online Current & potential clients asking providers educated questions about their expertise, treatment philosophy, & expected outcomes Stay up-to-date on what’s going on in your specialty – don’t want a client quoting research you should know about

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Ways Social Media will Change Mental Health Care continued… Allow us to create & provide simple follow up programs & protocols that can be sent out to people daily, weekly, or monthly via email, text, audio, or video Reminders to take medication, exercise, eat right, go to bed on time, use a journal, etc Greater ability to create treatment programs that clients want & need Allows us to listen & discuss with consumers what they would like in terms of service structure & offerings

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Policy for Social Media Feel free to provide a policy for clients regarding: Friending Fanning Following Interacting Use of search engines Business review sites Email Example of Keely Kolmes, Psy.D. “My Private Practice Social Media Policy”

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Overall Benefits/Advantages Convenience Client feels comfort in own chosen location (home, work, etc) Transportation not required to speak with counselor Reach Accessibility Usability Recency Instantaneous responses; participants determine delay in response Permanence Client able to read & reflect upon counselor’s words multiple times Especially useful in crisis situations Helpful in conjunction with face to face counseling

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Overall Disadvantages Techniques difficult to employ through social media Non-verbal gestures Confidentiality difficult to maintain Clients might prefer to remain anonymous How do you know you are talking to who they say they are? How do you collect payment from someone you don’t know? Valid evidence supporting efficacy of cyber-counseling is hard to come by

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Things to keep in mind Social media offers valuable tools and resources which can support face to face counseling If you want to use social media, remember to prepare the client - inform them of appropriate expectations It is important for each counselor to decide what the personal advantages & disadvantages are of using social media in their practice Also keep in mind your organization’s policy (if you do not have a private practice)

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References American Counseling Association. (2005). ACA Code of Ethics. Retrieved from www.counseling.org Barnett, J. (2005). Online counseling: New entity, new challenges. The Counseling Psychologist, November (33), 872-880. Barnett, J., Levahot, K., Powers, D. (2010). Psychotherapy, professional relationships, and ethical considerations in the MySpace generation. Professional Psychology: Research and Practice, (41), 160 –166. Echterling, L., Presbury, J., & McKee, J. (2005). Crisis intervention: Promoting resilience and resolution in troubled times. New Jersey: Pearson Education, Inc. Giurleo, S. (2010). 5 ways social media will change mental health care. Retrieved from http://socialmediafortherapists.com/social-media-will-change-mental-health-care/ Kolmes, K. (2010). Ethical framework for the use of social media by mental health professionals. Retrieved from http://www.onlinetherapyinstitute.com/ethical-framework-for-the-use-of-social-media-by-mental-health- professionals/ Kolmes, K. (2010). My private practice social media policy. Retrieved from http://www.drkkolmes.com/docs/socmed.pdf Mallen, M., Rochlen, A., Vogel, D. (2005). The practical aspects of online counseling: Ethics, training, technology, and competency. The Counseling Psychologist, November (33), 776-818. Walz, G. (2001). Cyber-counseling: A point of view. Retrieved from http://www.nbcc.org/Assets/Newsletter/Issues/winter01.pdf Wikipedia (2011). Social network service. Retrieved from http://en.wikipedia.org/wiki/Social_networking Wikipedia (2011). Social media. Retrieved from http://en.wikipedia.org/wiki/Social_media#Communication (n.d.). What is social media? Retrieved from http://static.managementboek.nl/pdf/9780470623978.pdf (n.d.). To accept or not to accept? Retrieved from http://www.zurinstitute.com/socialnetworking.html

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