Social Media, Texting, Boundaries, and the Consultation Room

Not your regular therapy office nameplate. Credit: Alan Reeves, Flickr. License: Creative  Commons.
Not your regular therapy office nameplate. Credit: Alan Reeves, Flickr. License: Creative Commons.

In a world of ZocDoc reviews, where “Yelp for people” is even considered a debate, and where more practitioners are turning to an online presence for marketing, it becomes increasingly more challenging for clinicians to clarify boundaries beyond the consultation room. At the very least, maintaining the “analytic anonymity” that the early psychoanalysts encouraged their analysts to step into with their analysands, becomes extinct with a Google search a client may do while shopping around for therapists.

Sure, a clinician may not probably reveal political views on even something as innocuous as animal rights, but a simple google search can reveal you follow pug memes on Twitter (which, who doesn’t, but still). We are never as anonymous as we think, which brings us to reflect on important questions.

As a student during one of my practicums, I remember meeting a clinician who would allow her clients to text her. While this was most probably reserved for emergencies, it was at the time something I would never consider doing.

One, because with the exception of an emergency, I felt that to do good work, it would be helpful to myself and the client leave what’s in the consultation room in the consultation room. This creates a safe containment space where the client can healthily attach and detach (i.e., They can leave knowing you’ll be there next time, versus needing to grab on to an illusion of 24/7 availability), trust in their own coping skills “off hours,” and allow the therapist the processing time and ability to be fully present for the next meeting.

Two, and maybe this is the “not so therapist answer,” I avoided it because, I always thought that it might feel weird. I know I would feel weird if an “authority figure” like a teacher, supervisor, or doctor were to communicate with me in a medium considered as informal or even personal as texting (What if they send me a pug meme that wasn’t funny? Think of the major ball of awkward).

As I transitioned into doing independent contracting work, I was able to find a healthy middle and some guiding concepts.

  1. Avoiding double-relationships: Almost universally (except maybe a business page), being added or followed by clients on any social media platform would not be appropriate since it presents a conflict with the ethical spirit of avoiding double relationships.

    This can present as awkward to enforce, especially if a person is presented with something like a Facebook request. A therapist presented this dilemma to our supervision group and challenged us to find a way to act ethically, yet humanly. We have to go beyond the curt THAT IS NOT ALLOWED, and genuinely explore what the outreach means to the client (and how and if they conceptualize the therapeutic frame).

    It can be an opportunity to validate the client (e.g., assertiveness, desire for relationships, kind outreach), while maintaining the boundary (clarification), and reality-testing against perceiving as rejection what is really not. The smallest gesture, like allowing the client to remove the friend request themselves versus having you press “reject,” can be a helpful action once something like that is processed.

  2. Types of communication: With grayer areas like texting or even an online inquiry form on a practice website, it will depend on agency or practice policy. I know that for myself, a healthy medium was allowing texting only if it pertained to scheduling (and never session material), and ideally as a second resort where a phone call can’t otherwise be made (Good session question: Why can’t the phone call be made?).

  3. Safety.  It’s important to clarify at the onset of treatment your hours of availability, coverage, and alternative emergency arrangements. Setting a clear communication and social media policy protects the client and also the worker from liability by setting down a contingency plan to clarify when and how a provider is able to available and who or what resource can cover when not.

Technology will always be moving faster than we can revise a code of ethics for, but our guiding principles and clinical judgment can help us form and maintain helping relationships that are productive and enriched not despite the challenges of technology and modern communication, but because of these challenges.

Recommended Resources:

Social Media & Social Work Ethics: Determining Best Practices in an Ambiguous Reality (PDF document)

Social Work & Social Media: Where are the Ethical Boundaries?

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