To many people, social media is the best thing since the abacus, transforming the way we live and do business. It offers us a world of knowledge with the stroke of a few keys and the briefest of pauses.
Of course, social media can be both a tool and a crutch that leads to sloppy habits. With the advent of clinician-centered discussion groups on Facebook and other online and social media sites that cater solely to clinical professionals, clinicians are posting an increasing amount of client-related information, sometimes going beyond what the ACA Code of Ethics and relevant laws allow. These clinicians are potentially leaving their clients vulnerable, while leaving themselves and their employers open to ethical complaints and legal suits.
The discussions that were once the domain of individual or group supervision now can be found on any number of social media platforms designed for counselors. Some of these posts come from clinicians from large programs, while others originate with those who are in private or small group practices. Perhaps this shows a lack of experience and knowledge combined with little to no supervision or oversight. I haven’t been able to find a comprehensive study that helps shed light on this topic.
Whatever the cause, accusations that a client’s privacy has been violated can lead to charges of malpractice (and other charges) being filed against the clinician and his or her employer. Comprehensive training followed by regular refreshers could do much to reduce this type of liability.
A problem since the early days of the internet
Since the advent of the internet and online bulletin boards (the precursors to Listservs, social media and online groups), there have been issues trying to balance new technology with privacy. About a decade ago, I briefly ran an online group for clinical professionals that was designed so that we could discuss general issues and concerns related to the counseling profession. Sometimes the discussion turned to challenging client cases. Several people, including David Kaplan, chief professional officer of the American Counseling Association, raised questions about this issue. A good-hearted, if sometimes heated, debate took place on these threads, and some very differing opinions were presented. It ultimately did little, however, to change the content of the postings. Within months, I was no longer affiliated with the online discussion group, in large part because of concerns I had about potential ethical violations.
I recently contacted David Kaplan again (he is still in the same role with ACA) to get his opinion on this topic. He agreed that it has been a long-standing issue and that, for both ethical and legal reasons, client information should never be posted on social media. To me, the most powerful thing he said was, “The key for me is the statement at the end [of the ACA Connect site rules and etiquette page]: ‘Please ensure that you phrase your post in a manner that does not describe an actual client.’”
Rather than listing several pages of links to ethical codes, state and federal laws, and the like, I will share the applicable rules and etiquette section from ACA Connect, ACA’s online communities that encourage discussion between counseling professionals.
“Do not present aspects of a case even if the client’s name is not given. Posts that give details about a specific client will be removed. Due to the potential violation of both the ACA Code of Ethics, state and/or federal law, case consultation is not allowed on ACA Connect. It is not permissible to present aspects of a case on a counseling listserv or online forum even if the client’s name is not given. Information shared by a client and clinical impressions must be afforded the same level of confidentiality as the name of the client. Describing a client’s presenting problem, diagnosis, or clinical treatment approach through listservs or online forums – even if the client’s name is not given – is a violation of confidentiality. It is perfectly fine to discuss issues (e.g., asking, ‘Does anyone have any resources on eating disorders in male wrestlers?’ or, ‘Does anyone have a referral to a specialist in PTSD in the Boston area?’), but please ensure that you phrase your post in a manner that does not describe an actual client.”
Owners, overseers, monitors and associated workers of online professional sites, Listserves, groups on social media and other platforms, be they volunteer or paid, could benefit greatly by posting rules that are similar to those above. The enforcement of those rules would prove invaluable.
Examples of violations
What follows are some examples of posts that, although they are well-meaning, could potentially lead to ethics or legal charges. (These examples are inspired by actual posts but are not being shared verbatim because I do want not to spread liability or bring possible embarrassment to the original posters; this article is about education, not shaming or embarrassing my fellow clinicians who work hard daily to assist those in their care).
- “Hi all. I’m looking to make a referral for marriage counseling for a couple that has been married for 14 years. There have been multiple affairs by the stay-at-home husband while his wife was working in the insurance industry. She works till 6 p.m., so evening sessions are a must. They are in the Springfield area and have XYZ insurance.”
- “I have a client who is 14 years old, has a history of cutting and has recently regressed after her parents told her and her twin brother that they are divorcing. She had also disclosed that she feels she may be bisexual. Any resources that may assist me in treating her would be greatly appreciated.”
- “OK, so I have this client I’ll call ‘Will.’ I’ve worked with him for several years in my private practice in Newport News. He’s a retired steamfitter and the father of three young adults — two male and one female. Recently, the daughter called me to tell me that she noticed that some of her underwear is missing and suspects that he may have taken them and is possibly wearing them. She doesn’t want to talk to him about this but wants me to explore this in my next session with him. Any suggestions as to how I should approach this with him?”
Ways to avoid a violation
- “Hi all. I’m looking to increase my referral list and am looking for clinicians in the Springfield area who have evening session times and take XYZ insurance. Experience with familial issues would be a plus.”
- “I’m looking for resources for working with teens who cut and also for sexuality related issues. Thanks!”
- In my opinion, the third example is beyond paraphrasing. It shows the need for good supervision even when in private practice. The information provided would make it easy to identify this family, even in a city that has a large shipyard.
Social media is not a replacement for supervision
In an increasingly connected world, it is important to remember that social media cannot replace the ethical requirement for supervision and it should not be treated as such. Joining these online/social media discussion sites for clinicians can make us feel more connected and less isolated professionally. They can help build a referral base and can help us to plan social events, but they are simply unsuitable for case consults.
Many of us employ a “we are all on the same team” mindset, and that can do much to help our profession. At the same time, we need to remember that seeking advice on these online/social media websites will never be the equal of calling the clinician in the office next to you and doing a case consult. Our clients are counting on us to keep their lives private; our ethics code and laws related to our profession are here to ensure that we do just that.
If you are in a small practice, be it group or individual, for-profit or nonprofit, be sure to have a solid source for clinical supervision and consultation that falls well within industry standards. This not only helps protect our clients, but also protects us against potential legal and ethical violations.
“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at firstname.lastname@example.org. Additional resources related to nonprofit design, documentation and related information can be found at docwarren.org/supervisionservices/resourcesforclinicians.html.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.