The Psychology Council of NSW has received numerous complaints over recent years related to practitioner’s use of social media. Here are some examples.-
A complaint was received about a practitioner who disclosed the identity and diagnosis of a patient on an anonymous Google review post. Other complaints were about practitioners believing that their views posted on their personal blog were personal views and not their professional views. Other complaints involved practitioners “befriending” patients on social media platforms like Facebook and LinkedIn and blurring professional boundaries.
Psychologists are increasingly using social media as part of their professional work in a range of ways. For example, the use social media to provide useful information to others, including distributing information helpful to the community in general (e.g., through tweets or blogs) or to colleagues (e.g., as part of a social networking group on LinkedIn). Social media can also be used as a marketing strategy to communicate information about yourself and your services. This approach can help demonstrate your expertise in your field or to direct people to your website and to other sources of information.
As Psychologists have been increasingly moving into the digital world and adopting electronic and web-based tools as part of their work, social media has extended far beyond its initial role as a platform for socialising to a powerful vehicle for disseminating information and as a promotional and marketing tool.
Some of the most popular social media tools are:
LinkedIn: primarily used for professional networking with colleagues, peers, interest groups, seminars and recruitment.
Facebook: primarily used for networking with family and friends but more recently Facebook has grown to include a broad range of public and private groups as well as individuals. Most businesses now have a Facebook page.
Twitter: public messaging in 140 characters or less. Twitter is good for connecting with and commenting on news, events and issues.
YouTube: video content which could be used, for example, to post a video outlining your services or expertise.
Blog: a personal online column in which you write and interact with others.
Instagram: photo-sharing site.
These and other sites can be categorised as follows:
social networking (Facebook, Twitter, WEChat, Weibo, WhatsApp)
professional networking (LinkedIn)
discussion forums (Reddit, Whirlpool)
media sharing (YouTube, Flickr, Instagram)
content production (blogs [Tumblr, Blogger] and microblogs [Twitter])
knowledge/information aggregation (Wikipedia)
virtual reality and gaming environments (Second Life), and
booking sites and apps (HealthEngine, Whitecoat, Podium).
Ethical and professional issues:
Psychologists should keep the following in mind when using social media:
The Psychology Board of Australia defines practice as follows: Practice means any role, whether remunerated or not, in which the individual uses their skills and knowledge as a registered psychologist in the profession. Practice in this context is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on the safe, effective delivery of services in the profession.
Therefore, views expressed in personal blogs, presentations or written materials regarding professional issues cannot be deemed personal and are considered as relevant under the Law.
Although there is much to be gained in using social media, psychologists can be exposed to professional and ethical issues. The following are some points to keep in mind:
Carefully scrutinise content before posting it to ensure that it does not compromise your ethical obligations. For example, the informal communication style used in social media can increase the risk of unintentional disclosures or misunderstandings.
If you are a clinician, take care to not be drawn into providing clinical advice on a social networking platform.
Before inviting people to join your network ensure that you have an established connection with them otherwise it may be considered spam.
The Psychology Board of Australia does not allow psychologists to use testimonials if they provide a health service, so monitor any postings on your site.
Be aware of the security issues and take precautions. Use a secure computer and web system, and be careful about sharing sensitive or personal information about yourself and others.
Mistakes are permanent and can be public or easily shared.
Be aware of the ethical requirement not to claim or imply superiority over other psychologists. Social media can be particularly useful if you want to target a specific client population by becoming part of an online social networking community through vehicles such as Facebook, Twitter or LinkedIn which are amongst the most widely used social media tools.
While we often hear of high profile people posting accounts of their daily activities in minute detail, Twitter can be a useful tool for sharing psychological information or commenting on other people’s information as a way of increasing community understanding of psychological issues. This approach can benefit your professional enterprise by increasing your profile and identifying areas in which you have knowledge and expertise.
One of the key issues raised in the use of social media is being able to maintain confidentiality. Psychologists are bound by the same ethical and professional obligations in their interactions with clients online as they are in face-to-face psychological work. In seeking to use Facebook as a communication tool for your practice you will need to think about how to protect client information and your personal information. Take care when sharing information, including comments or photos, that you do not inadvertently disclose patient information. Check what is in the background of a photo before sharing it and make sure that information you share does not unintentionally disclose personal information about individuals (because someone might use available information to work out who you are talking about). Although individual pieces of information may not breach confidentiality, the sum of published information online could be enough to identify a patient or someone close to them.
Some of the basic things to consider include having the highest level of security, having a unique and sufficiently complex password to access your Facebook page, and logging in using only trusted computer sources (e.g., not from your local coffee shop). Other aspects for consideration are what Facebook features you will use (e.g., posting on the wall, private messaging), being vigilant about professional boundaries and the content of your online communication, and having a social media policy which makes clear to clients exactly how the system might be used as part of your work as well as the potential risks related to their personal information. It is vital when using any online forum that you do not share or seek more information than is necessary.
Blogs and online forums are vulnerable to external attacks so it is important to have a high level of security in place. It is also important to think about what you see as the purpose of the blog. For example, you should have a process to filter comments to ensure that the comments are appropriate and add value to the online discussion, but you may also decide to include some negative comments because they provide you with an opportunity to respond, rather than refusing the comment, which may lead the person to post it elsewhere. It might be beneficial therefore to have a policy on the use of the blog, in particular information on what you include or exclude from postings.
Keep in mind that if a client posts a testimonial about your service on your website, you must have this removed to comply with the Guidelines for advertising regulated health services issued by the Australian Health Practitioner Regulation Agency.
While the use of Facebook as a tool can be useful for psychologists, accepting current or past clients as ‘friends’ can be problematic because it can lead to a blurring of professional and personal boundaries. If you are going to use social media it is important to have a formal policy outlining what is considered acceptable as part of your practice. The policy should be provided to clients as part of the informed consent process. As part of this policy you could cover issues such as ‘friending’, posting of information on online forums, and the viewing of people’s online profiles. Having a policy which informs clients of your position at the beginning of the professional relationship will avoid issues like the one you describe and provide a basis for rejecting such requests.
What should you do if a previous client has posted something negative about a clinician’s services on a website for example on Whitecoat or Google review?
Ideally this issue should be addressed initially by seeking to resolve the concerns or dissatisfaction experienced by your previous client. This may require you to meet with the client to listen to his or her issues related to your service. Whether you consider the client’s concerns valid or not, it is important to seek to address these where possible. If a resolution cannot be reached and the client is not willing to remove the negative information, then you might consider other options for removing the client’s post. Removing information from the Internet can be an extremely difficult process and may depend on a number of factors including whether the information is seen to be libellous, who has posted the information and who has ultimate control of the website. In reality, information posted on the Internet is largely considered permanent.
Increasingly websites offer the opportunity to rate and comment on services, including psychology services. It is important therefore to ask yourself whether the information posted is libellous or is a personal account of the client’s experience with your service. The APS is not generally supportive of websites that allow open comment about psychologists given the confidential nature of the work and the potential difficulties associated with particular types of clients. Nevertheless, the placement of such comments may also be seen as reflecting freedom of speech principles.
If you believe that the information about you is inaccurate, libellous or offensive, and the client is not willing to remove it, you can try contacting the web host (the company that provides the server on which the website sits), or even go directly to Google or another search engine and ask for the information to be delisted so that it does not come up in a search. Google’s policy for removing information has centred around issues associated with invasion of privacy, but a recent European court determined that Google should remove an individual’s personal information when requested. Finally, you may need to consider litigation which is likely to be an expensive process.
There are no rules about psychologists’ personal use of Facebook. However, there are important potential boundary implications. For example, the incidental communication style that is characteristic of social media can lead to a risk of boundary lapses that can impact on your professional life. There can be an increased risk of inappropriate self-disclosure and the potential for dual relationships if clients come across your Facebook page.
Strategies you might consider to overcome this include having a social media policy for your practice which makes clear that you do not communicate with clients on any personal social media sites and strictly adhering to it, using a Facebook pseudonym that only family members and friends will recognise, and having the highest level of security in place.
As a registered health practitioner, your views on clinical issues are influential. Comments in social media that reflect or promote personal views about social and clinical issues might impact on someone’s sense of cultural safety or could lead to a patient/client feeling judged, intimidated or embarrassed.
While you may hold personal beliefs about the efficacy or safety of some public health initiatives, you must make sure that any comments you make on social media are consistent with the codes, standards and guidelines of your profession and do not contradict or counter public health campaigns or messaging. A registered health practitioner who makes comments, endorses or shares information which contradicts the best available scientific evidence may give legitimacy to false health-related information and breach their professional responsibilities. Practitioners need to take care when commenting, sharing or ‘liking’ such content if not supported by best available scientific evidence.
While there is much to consider when using social media, by adopting a professional approach and adhering to the profession’s Code of Ethics and Ethical Guidelines will guide its ethical use to help avoid the aforementioned pitfalls.
APS articles: Benefits and Pitfalls of Social Media.
How to Use Social Media.
AHPRA: Guidelines for Advertising Regulated Health Services.
Social Media: How to Meet Your Obligations Under the National Law.
Psychology Council of NSW