By Ofer Zur, Ph.D.
Ref: Zur, O. (2010). How Should Psychologists Respond to Online ‘Friending’ Requests? National Psychologist, March/April, 14.
Increasing numbers of psychologists have profiles on Facebook, LinkedIn or other social networking sites. While many profiles are highly personal, others are strictly professional.
Most therapists with Facebook or other social networking profiles cringe at the idea and dread the moment when a client posts a “friend request.” They wonder whether it is ethical to accept such a request and are concerned with the clinical and relational ramifications of striking the “ignore” response, which would inform the client that he or she is not welcome.
Many who read this article are likely to have a knee-jerk response of, “No way can a therapist accept a friend request from a client under any circumstance!” As with most ethical dilemmas, the avoidance response of “don’t” is not always applicable, as it is not always the correct or most helpful response.
Social Networking And Dual Relationships
Sometimes accepting a friend request on a social networking site from a client constitutes a dual relationship and other times it does not. It depends on what kind of information the clients are privy to and the nature of the therapist/client online interaction.
Scenario 1: Non-Dual Relationship
If the therapist’s profile is strictly professional or the therapist allows (through the use of privacy controls) clients to view only professional information and postings on the profile, this would not constitute a dual relationship. This is because the therapist has not established a secondary relationship, such as a social relationship. In these cases, a client can only view professional information that can probably also be viewed on the therapist’s practice website or other professional websites and online directories.
Psychologists who choose to segment lists of friends into categories must use privacy controls effectively and correctly and be sure to know how they work. This is especially important if the therapist has sensitive, personal or intimate information somewhere on the profile. Unless you are tech-savvy, I recommend that you consult with an expert – son, daughter or other “digital native” – for help in navigating privacy controls.
Scenario 2: Dual Relationship
In most cases, a client making a friend request on Facebook is asking the therapist to engage in a secondary (social) relationship in addition to the therapeutic one. If the therapist accepts and allows the client to post comments of a personal nature and be privy to personal information on the profile, this constitutes a social dual relationship.
The next question is whether a therapist should or should not engage in a Facebook-type social dual relationship with a particular client.
Before we explore this issue, I would like to reiterate that as we all know (or should know) by now, dual relationships are NOT always unethical per se. According to the ethics codes of most professional organizations, including APA, multiple relationships should be avoided if they could reasonably be expected to impair the therapist’s effectiveness or cause harm. The following is a list of questions a therapist must consider before accepting a friend request from a client:
- What is the Facebook profile? A profile that is strictly professional may be viewed differently than a highly personal profile with family pictures, vacation videos, ex-lovers’ notes, etc.
- Does the therapist use privacy controls to control access? Therapists can segment “friends” into limited, personal, family, business and client contacts, to name a few. This way, therapists can post things that pertain only to one group separately and control the postings that each group can view. If you use privacy controls to add a client to a list, such as “limited profile,” accepting a friend request does not have to mean giving the client unfettered access to your profile.
- Who is the client? Would the client be able easily to process the emotional and psychological aspects of the dual relationship? Is the client a highly functioning fellow professional or a very disturbed person? Does this client need clear limits or can he or she benefit from a more flexible approach?
- What is the meaning of the request? Does the client tend to push boundaries? Is making the link between therapist and client public a way to take healthy “ownership” of the connection? Is he/she seeking more meaningful connection with the therapist?
- What is the nature of the therapeutic relationship? Intensive or psychodynamic psychotherapy may merit different responses to a friend request than family therapy, group therapy or individual intermittent-long-term therapy where a therapist sees the client once or twice a year over a period of many years.
- What is the community location of therapy? Does the therapy take place in a small, isolated rural community where everyone already knows everyone else’s business or in an anonymous urban setting?
- What is the potential on other and potential clients? Current, past or potential clients may be, or may become, your online friends or your clients’ friends. People often get to know each other online, including through the profiles of other friends. The level of interaction you allow your clients to have on your site will affect the possibility of their getting to know your other friends. If you are going to make your friend list public (the default option on most sites), you must consider the collateral effect of your connections.
- The most important question: How might the therapist’s response to a friend request affect treatment and the therapeutic relationship? Is this request relevant to the client’s treatment goals? As with most other types of dual relationships, one must consider the potential benefits of accepting or not accepting clients’ friend requests as well as the potential risks.
Additional Considerations
Therapists do not need to have a social networking profile. Most digital natives understand that the older generation does not necessarily enjoy time online quite as much as they do. Nonetheless, it’s important for digital immigrants to understand the world that many of our clients, especially young ones, live in. An article I co-authored with my daughter on the digital-generational divide is at: zurinstitute.com/internetaddiction.html.
Some therapists may choose to add a statement to their office policies forms stating that they do not engage in social networking with clients. However, such a statement is not going to protect against the need for discussion with a client should the client send a request nor will it eliminate potential feelings of rejection by a client.
If therapists choose to interact with clients on Facebook or other social networking sites they may want to define and state the parameters of such involvement in the office policies.
Some people propose that therapists have two profiles, a professional one and a personal one. However, this can be cumbersome and unnecessary. My “digital native” expert daughter informs me that dual profiles are a “social networking no-no.”
Regardless of your decision, support your clinical rationale in the treatment records.
Ofer Zur, Ph.D., is a psychologist, writer, forensic consultant and lecturer from Sebastopol, Calif. He conducts workshops and seminars in continuing education and offers home study and online courses through the Zur Institute: www.zurinstitute.com.
Posted by Permission of the National Psychologist