Sunday, October 18, 2009

A Shrink's Guide to Facebook

I like Facebook. I'm not sure why-- maybe because I've reconnected with some people from my very distant past, maybe because I like the 'chat' function (I do like to chat...), and maybe because I enjoy the voyeur quality of knowing what my friends are doing. This morning, ClinkShrink had a run in with a goat. No, I'm not kidding, and yes, she posted on Facebook about it.

So what about psychiatrists on Facebook? Roy and I had a quick discussion about a psychiatrist's obligations in terms of transference. If you're a psychoanalyst, or a strongly psychodynamic psychotherapist where you believe that keeping your personal life secret is part of the 'blank screen' that propels the transference necessary to getting the work done, then are you obligated to keep your personal life quiet? Is wrong to have a public on-line presence? Roy thought doing that type of treatment requires some hesitance, I thought the psychiatrist has the right to his personal life and isn't obligated to quash how he presents himself to the world at large, as long as he's not in his patients' face with it.

Psychodynamic distance and transference issues aside, many psychiatrists, doctors, and teachers like to have their privacy, especially where family members are concerned, and many people like posting photos of family members on Facebook. There's also the uncontrolled factor that people write on your wall.....and what doc wants their patients reading "Hey I loved seeing you dance naked on the table after you did all those shots" get the idea.

So what's a Facebooking shrink to do? There's a few options here.
1) Use a fake name and a logo photo so random people can't find you. Your friends also can't find you, but you can find them and it leaves you in good control over who your friends are and aren't. This gives maximum privacy.
2) Take your name out of the public search function so that random people can't find you. To do this, go to Setting>privacy>search. I'm available on a public search.
3) Limit access to your profile to your friends, especially if you might have personal information or photos posted.
4) Keep it pretty simple and don't worry about any of it. After all, some things are only interesting if they are elusive. I've taken this tact on a lot of things. You want to see it: Go ahead, look.
5) Probably the most important thing is to just be aware that there are privacy settings and to be in control of what's out there and who can easily access it.
6) No matter how safe you think it is, don't do stupid things on-line. Nothing on the internet is really completely private, especially no if you're sharing it with 400 friends. Tell your kids that.

The New York Times had a recent article on safety and privacy on the internet. Click HERe to read it.


Catherine said...

I have to say that a while back I was (voluntarily) hospitalized for severe depression and suicidal ideation - an inability to keep myself alive independently. My treatment team included a resident who'd been trained in Ivy League schools her entire life and never presented anything that wasn't the highest degree of professionalism, from dress, to words, to movements, etc. I didn't particularly connect with her, but she was quite nice. After I was discharged, a few months later, it occurred to me to search them, why not? This particular person had - literally - pictures of her dancing naked with friends in assorted settings -- the sort of pictures that even my wildest friends back in high school would not have publicized. I was tempted to message her and let her know about privacy settings, but I figured too much would be read into my looking her up. Thankfully, I checked again maybe 6 months later and found she'd discovered the friends only setting.

My point? It didn't make me feel differently about her capability as a clinician; if anything, it made me sort of smile that she had such a DIFFERENT persona outside of her work. But....I don't think I'd be able to work with her well knowing about her extra curricular activities. So maybe it does impact, on second thought.

jesse said...

I think that type of information Catherine saw would have a big impact, certainly on a male patient who was still in treatment with this psychiatrist. Catherine's post makes Dinah's point.

Don't put up anything on Facebook that is embarrassing or overly revealing and so do not fear patients seeing it, if they stumble on it. Where you went to high school? Ages of children? Hobbies or interests? I knew all that and more about my analyst. Some analysts are famous and there is a lot known about them.

The important part is not the information known (e.g. if one is divorced) but how one handles it if it is raised in therapy. That is the key. We do not seek to involve our patients, but don't avoid living so that we can be absolutely blank slates, either.

In my own practice, which is definitely analytically oriented, I have found that to be too blank actually interferes with treatment. In analysis the analysand understands that the analyst does not reveal, but in psychotherapy, where we might be seeing patients at intervals of monthly or less, there is often more risk in being too blank. The patient finds it off-putting and there is not the time to explore it, particularly the more the patient is disturbed, very anxious, or extremely vulnerable. The patient may have gathered courage to ask a personal question and cannot take the narcissistic rejection that silence suggests.

Very complicated subject!

Unknown said...

Another complication is how many degrees of separation the doctor has from the patient. Facebook tends to close those loops publicly.

It happens frequently, agreeing to treat a friend of a friend or colleague.

Living and working in the same geographic area increases the odds.

Dragonfly said...

I don't accept everyone who adds me if we haven't stayed in contact for a reason....but I also don't have anything too personal on FB, so if my privacy settings weren't ramped up I wouldn't be overly fussed. Some people share far too much. I used to wonder about their motivation and roll my eyes. Now I just block the feed of people who do 20 quizzes a day to find out more about themselves and get on with my own life.

moviedoc said...

If psychoanalysts were sincere about maintaining the blank screen they would wear gloves to conceal evidence of marital status. All psychotherapists, physician or not, have a right to privacy.

itsjustme said...

I enjoy FB for all the same reasons Dinah mentioned. I also agree that psychiatrists are entitled to have personal lives and they should have Facebook pages if they want. One of the things I really like about FB is that you can control who sees your page. Your patients can’t see your page if you don’t accept them as friends unless you have your security setting unlocked so that everyone can see your page. My pdoc isn’t on FB (that I know of) and I wouldn’t care if she was. I wouldn’t want to be “friends” with her. Although she is blank slate and I would like to know a little bit about her, I could do without the pics of her dancing on the table (You must be a lot of fun at parties, Dinah! LOL). Also, I don’t want to give her unlimited access to my life. I like to choose what I share with her. She doesn’t need to see the drunken pictures of me dancing on the tables or read my silly status updates. It would take the fun out of FB for me if I had to worry if whatever I posted was going to be brought up in a session.

I want to know about Clink’s run in with the goat!!

moviedoc said...

Patients and treatment providers note, too, that in my forensic practice I routinely perform searches with the names of not only the subject of the examination (the person examined), but also treatment providers and attorneys involved in each case. I assume each of these parties will search on my name as well. I keep that in mind when I decide what I post on the Web.

Dinah said...

Catherine: my life is not that exciting. Wow.

Jesse: Thanks for visiting! And thank you for being the inspiration for this post.

Tigermom: assuming the doctor isn't friending the patient, or accepting friendships from the patient if she's got racy or personal material online-- is it a problem for the the doc to simply HAVE a facebook page? I guess this is a dated question as many of my facebook friends are psychiatrists. I think the only ones with public profiles were the ones who didn't realize they needed to be set.

Dragonfly: I was really happy when I figured out how to block the quiztakers from my newsfeed. I'm with you.

Moviedoc, good point about the legal stuff. this may explain why Clink has such an odd FB profile. Oh, or it might be because I gave her the FB page as a birthday present.

Sunny CA said...

Aren't the quiz-takers 12-year kids? I only got onto FaceBook because my young niece asked me if I'd get a Facebook page so she could send me messages on it. Because she is literally a juvenile, I finally limited her feed to my page and blocked everyone else because her (awful and juvenile) posts and those of her friends were showing up on my wall and there seemed to be no way to delete them. She does quizzes all the time. I think that goes with her preteen level of development. Just not being able to deal with the unwanted comments feeding in from her page other than to wholesale block them made me hate the whole thing.

As a patient, I would not want to read my psychiatrist's FaceBook page and I think I'd be haunted by the image if pictures there showed him drunkenly dancing naked on a table. I think it would at the very least have to be discussed in a session as I'd find it disturbing. I doubt it would keep me from seeing him, but I'd not want to have to put that into my mental profile of him. I don't expect him to have to have perfect decorum all the time, but I don't want to see photos of his worst-case scenarios.

manchester fat acceptance said...

right. it's just teenagers that do quizzes. *cough*.

seriously though, the FB issue comes up in my past profession too (teaching). i didn't allow students to be my 'friends' until i finally left teaching. even now i am cautious about what comes out of my feed, i.e. i avoid quizzes like 'what sexual position are you?'.

not that i ever do any silly quizzes, of course.

Mindful said...

I too am a Facebooker for the same reasons you cite. It's also a fab way for keeping in touch with people overseas. On reading the first part of your post, I immediately tried to find you in FB and of course discovered all the privavcy settings you wrote about in the rest of the post. Btw: I love the image that you use on FB - Lucy was always one of my favourites.

Catherine said...

I agree with THA: I'm a teacher and I tell my kids that I will never add them until they are well out my class (same with their parents, some of whom I am quite close to). I also make sure I do not do any dirty quizzes and make my settings "private, friends only". Of course, there *are* leaks sometimes, but you cannot expect everything to be perfect.

Sunny CA said...

Are any of the Shrink Rappers are in one of the 14 "medical marijuana" states. If so, or theoretically, now that the federal government will allow state law to take precedence, would this affect your likelihood to prescribe medical MJ? I can speculate it might be a good anti-anxiety med or help a patient sleep or perhaps might help calm a mania or reduce symptoms of nausea that might be produced by other meds.

Anonymous said...

I really think Facebook should have multiple friending options. You can limit parts of your profile to friends, friends of friends, people in your networks, etc. There should be a specific option when you add somebody for "close friends and family" or "trusted friends." That way you can do the vague networking thing as well as the keeping-up-with-the-people-you-really-care-about thing.

Here's another good option: Friend your parents and your kids on Facebook. Don't put anything up you wouldn't want them to see, and you'll certainly catch hell for it if you do!