Navigating Social Media as Clinicians in the 21 st Century

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

2. 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

3. 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

4. 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.”

5. 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

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

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

8. 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

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

10. 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

11. 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

12. 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

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

14. 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

15. 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

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

17. 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

18. 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

19. 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?

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

21. 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?

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

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

29. 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)

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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”

38. 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

39. 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

40. 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)

41. 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

42. Questions? Comments?Make sure we have your email address and we will email you our slides