Friday, September 17, 2010

What to do when your Patient Friends you on Facebook or Follows you on Twitter

I participated long-distance in a social media workshop for the 2010 MedInfo conference (#medinfo2010) in Cape Town earlier this week. Kate Anthony and DeeAnna Nagel from the Online Therapy Institute were also participants, and the provided and excellent discussion of professional ethics, dual relationships, and good therapeutic behaviors as they relate to online interactions with patients and prior patients.
Jane is your client. Both of you live and work in the same community. Jane is the director of a local charity. She sends you an invitation to be one of her contacts on LinkedIn.
Marcie is a former client. She was a teenager when you treated her. Several years later she has friended you on Facebook with a private message thanking you for being such a positive influence in her life. 
John is a current client who has begun following you on twitter.  He has send you a direct message and has also sent you an @reply to one of your tweets. He recently posted a tweet stating what a great therapist you are with a link to your website.
Mary has been your client for over a year. She has a history of childhood abuse and you have encouraged her to write in a journal. You receive an email from her asking to change times for her next appointment. She closed her email with “By the way, the journal writing has been so helpful, I have decided to start a blog. Here’s the link! You open the link to discover that her first blog entry contains emotionally charged and highly graphic information about past childhood sexual abuse she has not previously revealed in therapy.
Kim was your client for over a year. You have not heard from her in at least that long. She was often hostile during sessions and would call between sessions feigning crisis and then apologise for her behavior during the previous session. The reason for termination was due to her move out of the area. Today you do an internet search for your name and you see that Kim has created a website, Your name is on the website’s blacklist with links to excerpts of verbatim chat transcripts from sessions you held with Kim online.
To listen to their responses to these scenarios, watch the video at (the weird sound effects at the beginning last about 20 seconds or so... just wait for them to stop, it's worth it... and you get to hear input from their Second Life cat, Reva).

It would be great to hear your experiences with this issue in the comments, whether as a patient or as a therapist.


Anonymous said...

I did DBT group in my late teens a long while ago. Some girls and guys in the group added me on facebook, when the therapists said "NO FRIENDING >>> GROUP IS NOT ABOUT FRIENDS!" ... I didnt friend them, but they friended each other.

The only proffessional relationships I've friended were teachers from long ago who are now on a mutual relationship with me (still weird not to call them Mrs lastname though).

I have sent personal messages of thanks to certain doctors/nurses/teachers/professors who I encounter only once in a crisis or special talk/class/lecture but I never friended them. I hope that is appropriate, it seems it is because they reply back!

HappyOrganist said...

oh that's easy.
Graciously accept and become their best friend!
any other questions?.. ;)

Dinah said...

Roy, your link doesn't show up well.

1. Jane: I do what I do when Roy asked me to be his LinkedIn contact: ignore it. I'm not on LinkedIn.
2> Marcie: Return the message and thank her the kind words and tell her I'm glad to hear things are going well. I'd also tell her that I'm not allowed to Friend patients or former patients. The risk management attorney at the hospital where I am on staff has flatly said "Don't Friend your patients." I have a feeling that the Risk Management staff are busy with other things today--- they didn't have a good day yesterday.

3. John: I'd do nothing about it online but might mention it in a session.
4. Mary: I would thank her for the link and ask her about the material. I would also let her know that I'd like her to talk about this in treatment and it might be more than I could do to read daily blog posts.
5. I don't chat on line with patients. I do have a friend who is a wonderful shrink who had a bad rating put up about her by an anonymous patient (she doesn't know who). She did nothing.

Sunny CA said...

I am a teacher, and I think it is simpler for me. As soon as I got the first FaceBook "friending" from a student in my new school, I made my site completely hidden from view and eliminated all acquaintances as "friends" leaving just family. When I was student teaching 8th graders a group of girls kept phoning me (as a group). One would say something stupid and the whole group would explode in high-pitched 13-year old giggles. It was kind of cute, but I still felt invaded to a certain extent because they had found my phone number and hence also knew where I live. I also, while on a long-term sub assignment (the next year) was the victim of a prank FaceBook page. One of the students snapped a photo of my overly-ample butt when I bent over to get supplies from a bottom cupboard presumably with a cell phone. The photo was posted and kids then posted nasty comments below my picture. Middle-schoolers are so cruel.

Dinah said...

I seem to have some memories of being a middle schooler who made prank phone calls to teachers with my friends and erupted into high-pitched giggles. Please don't tell anyone.

It's good we grow up.

Sunny CA said...

I felt somewhat complimented by the calls from the girls, so I doubt your teacher was upset by it. Definitely a "tween" thing to do. I could recognize at least 2 of the voices and they were a couple of girls I really liked who were hated by my master teacher, but who I had taken under my wing and protected to a certain extent (as much as I was able) in the face of the awful temper of the master teacher.

I remember that my sister and her best friend used to call random names in the phone book. Sometimes when I was very young (less than 10 years old) and home alone because I was a latch-key kid before they invented a name for it, I used to carefully lift the phone off the hook and see if any of the people on our party phone line were having a conversation. If they were, I'd listen. I never was caught that I know of. For those of you too young, there used to be "party" lines which were shared by as many as 4 families. Only one could make a call at a time, so out of courtesy, calls were very short and succinct, such as setting a time and place to meet. Our phone number was 2 letters and a 4-digit number Am-7991. The AM stood for Amherst. No area codes were used as long distance was done by a human operator. No answering machines either.