Season 1,
59 MIN 21 SECS

Episode 104: Social Media Ethics

September 26, 2017

Can you safely engage in social media marketing and other interactions as a mental health professional?  What are the pitfalls?  How do you avoid them? Joining them to discuss the real life situations and how to handle them is social media policy expert, Dr. Keely Kolmes .

Show Notes
  • :13

    Why Social Media Ethics?

  • 1:28

    What Is Social Media?

  • 3:56

    Primary Ethics Concerns with Social Media

  • 4:38

    Time and Space

  • 7:30

    Real World Story

  • 9:36

    How to Avoid Pitfalls

  • 11:31

    The PIT Principle – Permanence, Identity, and Transferability on the Internet

  • 17:08

    The Solution

  • 19:38

    Guest Spot – Dr. Keely Kolmes

  • 39:46

    Describe Question – Tell us about a time that you felt Lucky.

  • 46:15

    Controlled vs. Uncontrolled Web Presence

  • 53:04

    Handling Negative Reviews

  • 54:32

    Person-Centered Tech Hot Tech Tip

  • 56:25

    Crafting a Positive Web Presence

  • 59:21


Episode Transcript
Man: TherapyTech with Rob and Roy. The most fun therapists can have listening to a podcast about technology. This episode of TherapyTech with Rob and Roy is brought to you by and You have questions about technology, we have answers.  
Roy: Welcome to TherapyTech with Rob and Roy. I'm Roy from Person-Centered Tech.  
Rob: I'm Rob from Tame Your Practice. Today we're going to finally stop teasing you and talk about some ethics.  
Roy: Ethics, that's always boring Rob.  
Rob: Boring, no way. Ethics are very interesting and exciting to talk about.  
Roy: I actually love talking about ethics but it seems like I'm alone in that one.  
Rob: You're not alone, I'm right here with you, dude.  
Roy: Oh good. Oh my God, you are?  
Rob: I got your back. I'm totally about talking about some ethics. I just didn't talk about real life situations, juicy situations, where you're trying to make sure you're protecting client confidentiality and privacy while also doing the other things you need to get done. I think it's good stuff.  
Roy: That's pretty cool, yeah. Clearly, that's far more fascinating than actually helping people or something like that.  
Rob: [inaudible 00:01:17]  
Roy: Yeah, well, we have been teasing-  
Rob: How did we [inaudible 00:01:19]  
Roy: It's useful because even teasing people about how we could to some stuff about ethics and hip and all that, hip is not happening yet but [inaudible 00:01:27] some social media ethics. Maybe we should get into a little bit about why we're doing this. Can you tell us specifically, Rob, besides the fact that ethics is fascinating and fun?  
Rob: Well, I think we've got a long list of topics we want to cover and this was one of them. We have a good jumping off point from our last episode, where we're talking about internet marketing and we just repeatedly came up with well, you can do this but you have to think about the ethics. We figured it might be a good idea to go ahead and uncover that instead of making people wait five or six months.  
Roy: Yeah, that's fair. All right. It makes sense. What is social media? I'll tell you actually, I mean, I'm actually currently on a committee to make some guidelines for clinicians and social media. The first thing we did was try to define social media, is actually kind of hard to do. A lot of people have very different ideas about social media and even different ethics codes, clearly have enough different idea of what social media is. Maybe we should just set up what we mean by that is. Does the social media just mean Facebook?  
Rob: Absolutely not.  
Roy: Absolutely not.  
Rob: Absolutely not.  
Roy: It's [inaudible 00:02:29].  
Rob: I think for the purposes of our discussion, I think it's clear that we have a very broad definition of social media because it allows us to apply some of the same principles to many different situations.  
Roy: Yeah, sure.  
Rob: I think when we're talking about social media at least, we're talking about any place on the internet where people can interact and share information, have conversations, those sorts of things.  
Roy: My email is on the internet, are we talking about email?  
Rob: I think in the sense of, especially when you're involved in a listserve, that's a form of a community.  
Roy: Good point.  
Rob: Again, there's that social component, there's a group of people joined together for this purpose.  
Roy: We're talking about listservs, where people talk together and discuss things but we're not talking about, like when I email my client.  
Rob: Well, yeah, and I think a lot of the things we'll talk about me apply to email situations but it becomes different when you're talking about emailing clients. You're hopefully not going to be talking with your clients on listservs that are dedicated to therapists and sharing resources and you're not going to be talking with your client on Facebook. We're talking about primarily social groups where you're connecting with therapists but maybe some other situations as well.  
Roy: So, I shouldn't have set up that group on Facebook for all my clients to discuss how the sessions have been going with each other and they talk [inaudible 00:03:49]  
Rob: We might have to talk about you rethinking that one.  
Roy: Okay, all right. That's good. At the end of the episode, I'm sure I'll have some guidance on how to do that. Okay, cool. What kind of thing is potentially wrong with having clients interact with me on Facebook? Is there a boundary issue, a confidentiality issue? What are we talking about here?  
Rob: I think you nailed it, I think you nailed it, Roy. A lot of this stuff is going to come back to boundaries, dual relationships and privacy and confidentiality.  
Roy: Wow, okay. That's it, only those things?  
Rob: Yeah, those are tiny little things.  
Roy: Right, okay.  
Rob: Yeah, those are broad topics. That's a lot to take on and thinking about, "Wait, it's not just Facebook, it's listservs and Linked In and Instagram.  
Roy: Right, your blog.  
Rob: Yeah, but again, I think we're going to break it down to some basic principles. I think you've got a couple of stories that you can kind of bring at home and start to ground us and [inaudible 00:04:47].  
Roy: Yeah, sure. I think that it all speaks to what I think is the really vital principle when we're thinking about ethics and social media, which is that, unlike the real world, the social media world doesn't really have space and it barely has time. In the sense of like anywhere that I have a internet connected device, I have my social media. I don't have to walk somewhere or travel somewhere to see my Facebook. It's just anywhere I have an internet connection.  
It's also just there. Whatever I put there, stays there. There's no ephemeral conversations in social media. I don't go to the club and have a conversation with somebody and say something embarrassing and then think, "Oh man, I said an embarrassing thing, good thing it's behind me." If I said an embarrassing thing on Facebook, maybe I can delete a comment or something. That's possible but burning that, it's just there.  
Very importantly in public social media places, there isn't that physical barrier that makes it less likely for a client to see it. I'm in Portland, which is a decent sized city and certainly I run into client's places but not a lot. I'm not in a small town where they're everywhere, I might go do something somewhere in town and it might not be something I want clients to see me do just because it's very personal. I can just sort of depend on space separations. Be like, "Okay, they're not here in this space, they weren't here at that time that I did that thing so therefore, I know that I don't have a boundary crossing there."  
Rob: Well, and if you really wanted to take it to the extreme, you could go and wear a disguise.  
Roy: Sure. Yeah, That's true, I could.  
Rob: Which is again, not so easily done on the internet.  
Roy: Well, I could make a fake account or something like that. Strangely enough, that actually by using a pseudonym online, I think people maybe realize is not as protective as they might think it is.  
Rob: Not at all.  
Roy: No, it's not that hard for someone to get around a pseudonym or for even somebody who's not even trying to get around it, to figure out who you are. Certainly, people might use it just for casual protection from boundary crossing but it's not itself a solution. Of course, if I do the same kind of thing as going to an event and having a good time or whatever I'm doing that I don't really want clients to encounter me and I do the same kind of thing in a public social media space, the client will eventually find that, because clients google their therapists.  
That's because the online world doesn't have that space separation, doesn't have a time separation and so boundary crossings and even potentially confidentiality breaches, that sort of thing, become a different kind of risk online. I don't necessarily want to say it's a higher risk, it's just a different kind of risk. You manage it differently.  
Rob: Yes. Are you saying that you yourself have a story of encountering clients online in this way?  
Roy: Yeah, I have one. It's not my personal story and I mean that. I'm not making it up. I remember-  
Rob: I have this friend ...  
Roy: I have this friend who has a Linked In account. I don't know what Linked In is but the my friend told me about it. No, that's not true. I know Linked In. Several years ago, I was just watching one of the many therapists discussion groups on Linked In and it's a group. It's a place where you go to start discussions and people have discussions there, right? It's public and that's the important thing. Someone went there and started ... They basically did the thing which I think is going to come up a lot as we talk today and our guest is talking about it, is they were sort of seeking some consultation advice in the discussion group.  
They did a pretty good job of hiding the identity of the client. They just said a client with this condition and indicated that it's borderline personal disorder and sort of asked some general advice based on some things. Probably the people, the therapists reading the discussion wouldn't be able to figure out who the client is. Here's the kicker that I think people often forget about. In a public social media situation, it's spaceless and timeless.  
You've got to assume the client or people close to the client will see it. In this case, what happened was the client saw it and knew exactly who the therapist is referring to because it was their therapist. The first response to the therapist's question was from the client angelifying the therapist, saying like, "Oh God, thank you. That's so great that you're asking about this. I love you for just trying to figure out how to help me." I was like, "Oh, this is a cluster. I'm getting out of here."  
I just came back a couple hours later and there was this gigantic thread of just the therapist and the client where the therapist is basically trying to get the client to back off of talking in that context without upsetting her and all these things that probably should have been taken to a phone call. I mean, the therapists are doing their best. I don't want to criticize them but probably it would have been better to try to get it off of there. It was really frightening and I'm sure for the therapist, it was a really painful experience and they didn't really realize what happened.  
Rob: Right, so how can somebody avoid this?  
Roy: Well, for one, the really important thing that comes up here is that this group was an open one. There's no limitation on who can come and see this group. I'm sure what was happening is probably the client was probably following their therapist on Linked In because this client was probably following their therapist every where they could. When they found them on Linked In, they saw they made a post somewhere and they thought, "Hey, I want to check that out." And saw it was about them and started responding.  
If it had been a private situation, where you have to be allowed into the group before you can talk there, that situation most likely would not have occurred. The problem is that even then, there are still potentials for that boundary crossing to occur. It's just that making the group private reduces the potential for that boundary crossing.  
Rob: Yeah, I think that's a really important point. You and I talk a lot and I'm sure we're going to talk about it when we do cover hip about risk management. You can't always keep the risk to zero. There's still a significant amount of risk even in a group where it's semi-private.  
Roy: Basically, just creating that simple authentication layer, right? People always hear me using the terms like authentication, that simple authentication layer reduces a lot of casual boundary crossing and confidentiality breach stuff.  
Rob: Sure.  
Roy: Because it just keeps out the casual searcher. In that case, it would have made a lot of difference, I'm sure.  
Rob: Right, and to make sure people understand when you talk about casual surfer and what the connection is when you talk about things like Google Groups that are private, those aren't necessarily archived in searchable via the search engines.  
Roy: Right, so long as they're set that way. That can be the kind of PIT or trip wire because sometimes people don't know how to determine if something is closed or not.  
Rob: Right. It's interesting you used the word PIT because that's an acronym that I used to help people understand this situation.  
Roy: [inaudible 00:11:40].  
Rob: Yeah. I first used an article for counseling today in 2016. PIT stands for Permanence Identity and Transferability and it kind of sums up what you've been talking about. The permanence part being, once you've put it out on the internet, it's probably there forever. Think of this PIT as a librate [naudible 00:12:02] PIT kind of thing. You've put it out there and thousands of years later, it can still be discovered.  
If people want a tangible example of that, I encourage you to go to the Wayback Machine. Search for the Wayback Machine or you type in into your web browser. You can type in any URL, any website address that you want and see what it looked like years ago. It'll give you a little scale and you can go back, "Oh my gosh, I can still see what this website looked like in 1996." That's just an example of how all these things that are out there on the internet are archived somewhere and accessible years after they were put out there.  
Roy: This is kind of funny. I hope it's not too tangential. A number of big media figures including Dan Savage who I like to follow, talks a lot about the need for a big social change in the way we regard what people did on social media five, six, seven years ago, 10 years ago. It comes up a lot where somebody like a public figure will get criticized for having a stance now that they spoke against five years ago or 10 years ago.  
Rob: Well, it's not even just public figures, you read about people having difficulty getting a job because of something they posted on Facebook in high school.  
Roy: Right, in high school.  
Rob: Yeah.  
Roy: God, I'm so glad no employer ever knew me in high school, like seriously.  
Rob: Exactly.  
Roy: Right.  
Rob: When we come back to the PIT principal, the second one is about ... I is for identity and that's a twofold. One, when you talk about these private groups, that does add that extra layer of protection but can you be sure that that person manning the controls of that private group is really able to confirm the identity of everybody that joins that group?  
Roy: Yeah, and this goes back to the risk management principle. The private group keeps out casual searchers. There's many levels of this. If you've got a client who really wants to get into your business, they could pretend to be a therapist.  
Rob: Most of us, our license numbers are easily found online. Most licensing boards requires that your information be publicly available so how hard is it for somebody to look that up and then write to the administrator and say, "Hi, I'm Joe therapist and my license number is blah, blah, blah." I've personally witnessed these administrators saying, "That's enough to get you in."  
Roy: I don't know how many administrators even look up license numbers. Most of them just sort of say, "Are you mental health clinician?" "Yes." "Great, then you can come in. If you're not, this isn't a group for you."  
Rob: Right. You have to consider that you don't know the identity of everybody that's in this group and who might actually see the things you're posting. Which posses to the ... Go ahead.  
Roy: Identity is difficult to verify in a rigorously reliable way. We have to think about the different levels of casual, semi rigorous and rigorous. It matters because it has to be compared to the risk you're facing. If somebody really wants to stalk you, sometimes clients do that, right? If a client really wants to get in your business and they become very directed, at that point, you're looking at the rigorous level of risk analysis. If it's just an issue of you don't want clients to stumble across you talking in a private group about your favorite antiquing hobby, you only need that basic thing.  
They have moderators saying like, "Okay, are you actually someone who's interested in antiques?" "Yes." "Okay, great. You can be in this group." It's going to be a private group for people who enjoy antiquing. That will keep out the person who's stumbling across it, but not the person who's really trying to get in your business.  
Rob: Yeah, exactly. The other thing to be concerned about when you're talking about, has identity been verified, who's actually in this group, what are their motivations for being in this group and so forth is the T in PIT, which is transfer ability, and that's the concept that anything you put on the internet can then be transferred. Whether that's through forwarding of a group listserv post to somebody else, anybody really, whether that's a screen shot taken of something that you said in a Facebook group, anything you put out there, doesn't necessarily contain to the place that you put it.  
Roy: Right. Unlike in the physical real world, where something that occurs in a particular place may stay there, it maybe an ephemeral conversation but in a discussion online, it's a permanent conversation. Because of that, you can copy it and put it somewhere else.  
Rob: Right. When you talked about being out in public and having a conversation, unless somebody is standing very close to you with a tape recorder or they've got high tech spy equipment. You're not having to worry about that conversation making it past that point unless the other person you talk to decides to spread it.  
Roy: Of course, I think the conclusion you need to draw from this Rob, I assume what you want us to take away from this is never use social media, don't talk about anything professional. Actually, just bury my computer in the ground and just forget the whole thing. That's the solution, right?  
Rob: Exactly, so therapists everywhere, I need you to shut down your social media accounts. It's all over, we're going on strike.  
Roy: Oh my God, why are you even listening to this podcast?  
Rob: I think it still comes down to the risk management. What is our goal, how can we accomplish that with the least risk without putting client confidentiality and information at risk. There are certainly ways to do that.  
Roy: I think what's interesting with this one is there's a lot of opportunity for us to be doing that collegially and together. It's not up to each individual all the time. Never worry alone, console, console, console. I think this is a case where you get a lot more opportunity for that because I'm in a lot of Facebook groups for therapists that are closed like Film It and so on, The Couch and Tamar Settles Group and all these, and Julie Hank's Group. All these, there's a moderator and I had to be let in but I don't remember if they checked my license number. Maybe they did and I just didn't notice.  
People then talk about stuff and it's actually really quite easy in that environment. If somebody posts something that we think that could be dangerous, you can politely let them know your concerns. The vast majority of people are happy to hear it because they just didn't realize what they're getting into. That's a situation we can all work together collegially and politely to figure it out.  
I think it's really important in that situation to remember that if someone does something that pushes ethical boundaries or asks about an ethical issue that seems really obvious to you, the best thing you want to do is encourage each other to consult and to think about ethical issues by being kind and compassionate when someone makes a mistake or asks about something that seems obvious. It's important for us to be really compassionate with each other in that environment but also to help each other uphold the high standard that we all want to keep.  
Rob: Yeah, we've all been there, we've all made mistakes and we're going to be more effective in a more receptive to compassionate awareness raising.  
Roy: Yeah, absolutely. The moderators of all those groups definitely are, but their eyes can't be everywhere all the time. [inaudible 00:19:25] catches it, you catch it faster.  
Rob: Exactly. What would be really great is if we had somebody that could come on and talk to us more about some real life application of some of these principles.  
Roy: I know it would, God. I don't want to go [inaudible 00:19:41], "Oh, hey, who's there?"  
Rob: I don't know, let's go check it out.  
Roy: Okay. Hey, it's Keeley Kolmes. Oh man, we [inaudible 00:19:48]  
Rob: Oh my gosh [inaudible 00:19:49] our lucky streak continues.  
Roy: Hey Rob, what's this Tame Your Practice thing you do?  
Rob: The big thing we're known for are the reviews we do of the HR practice management systems and helping people identify the right technology for their practice. I also help people with marketing and business decisions, when to grow into a group, what kind of business to be, how to deal with contractors versus employees and all that fun stuff. What do you do Roy over at Person-Centered tech?  
Roy: Well, we write a ton of articles which are really free for you to go check out. We also do Person-Centered Tech support which is our full membership service, where four times a month, I get on for 90 minutes for office hours and you can ask me anything you want or you can ask me a question ahead of the time. We'll record it and you can watch the recording later. We also have nine and a half hours of CE courses, which are APA and NBCC approved.  
Rob: Wow, that sounds awesome.  
Roy: So does Tame your Practice. Hey everybody, I'm here with Keeley Kolmes. Wow, I'm really happy to have Keeley here. Thanks and welcome to the show Keeley.  
Keeley: Thank you so much. It's so nice to be here.  
Roy: Yeah, and it's fantastic to have you here because as you know, we're doing an episode about ethics in social media. That is basically your wheel house. That's what you're really known for.  
Keeley: That is my thing.  
Roy: Right. For everyone who doesn't know Keeley for some reason, she's a psychologist in the Bay Area in Oakland, California, correct?  
Keeley: That is correct.  
Roy: She wrote basically the social media policy. You hear about social media policies all the time because now all pretty much every guideline or ethics code, tells us to have them. I think they're a very good idea. Keeley, you started to become really well known because she wrote a comprehensive and sensible social media policy, started sharing it on Division 42 listserv, correct? That's how you got it out there?  
Keeley: I think that was the first article about it. I started sharing it on my blog and I referred people on Twitter and soliciting feedback from both clients and clinicians. I really crowd sourced it in some ways and wondered what people thought about these things and was this clear and argued with people about some of my choices. I think sometimes different points of view are really great at strengthening what feels clear to you and right for you. Then I disseminated it primarily through Twitter and Facebook and then Division 42 tracked me down and asked if they could do an article with me. [inaudible 00:22:31] how I developed it.  
Roy: Got it, okay. That explains why it seems to me to be associated with Division 42 because they probably helped launch it to be really big, right?  
Keeley: They helped the APA Insurance Trust for a while, used it on their site and I think just I'm so connected to Division 42 because it really became my home at APA and I've been on the board and working with them in various capacities since 2010. I'm probably forever going to be connected to Division 42, I think so. They did publish it and they had Jeffrey Barnett post a critique and analysis of it. It was kind of like a big boom there.  
Roy: Cool, yeah. That's great. Then after that, people started to ask you for help all over the place. You became very well known and spent a lot of time discussing and arguing about different social media topics before they got into ethics codes and guidelines. There weren't a lot of professional associations directly addressing these issues before you started talking about it online. I think that you ended up being a really big resource to people for figuring out how to navigate this stuff, before we had a lot of guidance on it. Hopefully, everyone recognizes that. That's an important thing for us to recognize about you.  
Keeley: Thank you.  
Roy: Yeah. Okay, so we've got a couple of questions we hope you can help us out with. Are you ready?  
Keeley: I am ready.  
Roy: Okay, so number one, you consult with colleagues, among all the mental health professions. We want to know what's the most common way you've seen clinicians find themselves getting into tough spots related to how they engage in social media.  
Keeley: This was an interesting question because I was thinking there is what clinicians do and what I observe and then there is what clinicians bring to me. The most common theme in my consultation calls, right now and really over time, maybe it's like 60% to 70% of my calls, are about Yelp reviews. The challenge of Yelp reviews which for most of us, that's nothing that we've gotten ourselves into necessarily. It does pose clinical, ethical, legal and risk management issues for clinicians.  
Yelp also reaches out to a lot of clinicians to encourage them to have business accounts and brief them on how they can respond to reviews, but there's a real lack of understanding about what it's like to have a confidential business as opposed to a restaurant or another service provider that's not confidential.  
The main issue that comes up in the consultation ethically is around confidentiality and people want to know can I respond to this review. It even comes up in terms of, if they want to contact Yelp to talk about the review. Are they releasing information about this person just because this person has identified them as someone who came to your business and your practice. That doesn't mean we are released to provide any information.  
I have spoken to some risk managers who say there is a concept of behavior that's inconsistent with the desire for confidentiality and that may be more of a legal kind of twist to it. That's a call that I'm not willing to make in my consultations, well, this person did this. I think we need to be very conservative and careful.  
Roy: Yeah, who wants to volunteer to be the case-  
Rob: Right.  
Keeley: Exactly.  
Rob: It gets tested in court.  
Roy: Right. Well, also, honestly, and I know we've talked about this on your blog actually, you couldn't even actually use that until you can actually confirm or prove that it was actually your client making the comment on Yelp anyways.  
Keeley: Right. Actually that leads to a really interesting new development which is I'm getting more calls of clinicians who are concerned that reviews have been left by competitive colleagues.  
Roy: Oh my God.  
Keeley: They're not able to prove it. It's so disturbing to me because this is really a place where our underbelly is exposed. This is a venue in which we have our hands tied. That could be a way that a competitive business could try to get a leg up by posting manufactured negative reviews about your business.  
Roy: Wait, people have been calling you saying they're pretty sure another therapist is doing that?  
Keeley: I have heard of incidents in which therapists have been threatened by colleagues.  
Roy: Wow.  
Keeley: That they're going to harm them with a negative review. I have heard of situations in which people who work at agencies have reason to believe that another clinician posed as a client. It's hard to tell with these situations because of course, they would have to find out the IP address and a number of things to figure out where it came from, which is in itself a headache. People are calling because they're saying, "I think this is someone else due to my interactions with that person or a threat."  
I have had a consultation with somebody whose former partner left a negative review as part or retaliation in a break up. I know in that case, it was so clear, the person identified themselves as the former partner and discussed this individual had talked unprofessionally about clients that they saw.  
Yelp actually did remove that because they said this is not a consumer of this business. That was against the terms of service. It's one thing if you can clearly and knowingly say this is not somebody who saw me. If it is someone who saw you, then you're in this position of identifying them.  
Roy: Right. Even if they are not, certainly we can’t discuss clients at all. That’s the challenge. If someone calls me and asks about Sam Smith and Sam smith isn't my client, I can’t confirm that they are not my client. That’s seems another challenge even if someone leaves a review and they were never your client. Certain things like that would put a monkey ranch even in ... Put it in every situation where somebody leaves a false review but in quite a few situations.  
Keeley: Right. You could say that’s not my client but you can’t say that is or was my client.  
Roy: Right. Well, certainly we learn in ethics class. If somebody calls and tries to ask about somebody, you can’t confirm that they are not your client.  
Keeley: All right, whether or not they are a client of yours.  
Roy: Yes. That’s a challenge because then you can just see the process of elimination issue, that sort of thing. I can see some twists or room on that one, if someone leaves a fake review. It seems that way to me at least.  
Keeley: I think you have more power if it’s a fake review. Of course, people are mostly troubled by the real reviews when they know who it is. I think this raises also the clinical concern because there are a number of people who have had success following up with the client, offering them perhaps a free closure session to discuss the concerns they posted. That has worked for some people but at the same time, you have to think about it clinically.  
Will this further upset this client? Is this in the best interest of the care to the client or is this just really a self-serving desire to get the [inaudible 00:30:26] review removed.  
Roy: Yeah, absolutely. That seems to me, one of the biggest things we struggle with as private practitioners is that ultimately, you're a clinician first and you're a business person second. But being a business person is still vital to your likelihood and to your practice and all these things.  
Certainly, the care and interest of the client would have to come first but you don’t have to starve. That’s the kind of challenge we have. I know that these days I’m seeing a lot more people working hard on marketing which is wonderful but of course, they are getting a lot of the advice from people who aren't clinicians.  
I know, for example, in Portland, if you type Portland counselor into Google, the first page of results is dominated by directories, which is like, “Okay, that makes sense.” And large group practices, that also make sense. But a lot of the individual results are dominated by people who have gotten reviews.  
You're like, “Okay, it’s interesting, we don’t know where the reviews came from but we know that those reviews are part of why they’re coming up high in search results.” It’s actually starting to impact businesses whether you have reviews or not.  
Keeley: Yes. That gets into another tricky area too because some people consult with me or, “I have this product getting better which is meant to be sort of the antidote and a way for your to collect either on your clients after shipment has ended." That’s not a testimonial. But some people are trying to be pre-preemptive and I’ve done that in some ways by creating this product and also putting a disclaimer on my Yelp page before anyone could leave a review.  
I'm probably in some way, short-changing myself from getting organic reviews that someone would want to leave because I’m discouraging people. But at the same time, it just makes me more comfortable and I’ll know if someone posts the review that they read all of that and they just needed to write that review.  
Roy: I think we’ve mentioned that before and I want to thank for specifically, all the things that you’ve done Keeley, but definitely the part where you preemptively posted because I’ve done the same thing based on your template and I’ve gotten a number of people who’ve positively commented and became a client because they saw that. I don’t know that you are doing that much harm by preemptively posting something like that.  
Keeley: Yes. It is interesting because I have also had a number of clients come to me who say they read that and they appreciated it because I think again, it's transparent, it explains the situation. I do now use ... Somebody told me I should try and publish an article on hacking Yelp because I do use Yelp to link to my client satisfaction page on my website. It's kind of like I use it to bring the expansion where I want it to be, where they’re getting better, data is posted. I’ve had a lot of people actually say Yelp was how they found me, which is fascinating.  
Roy: That is fascinating, especially because I don’t get that at all but I actually use your template as well just like Rob.  
Keeley: Do either of you have reviews?  
Roy: Not on Yelp.  
Rob: Not on Yelp I’ve got, I think, one on Google for business.  
Roy: I learn health grades.  
Rob: The health grades, I think there’s a couple of hits on health grades, they are not full reviews. People can vote on health grades without putting any text in. I think I might have a couple there where there is no comments.  
Roy: That makes sense. Well, that actually brings us to the second question, which is what is your top ethical concern regarding the use of social media to promote a private practice?  
Keeley: My top ethical concern continues to be confidentiality. Certainly, I think about that on social media platforms, like Facebook or blogs or Twitter, where I’ve seen in the past people quoting clients, people identifying the issue they just worked on in the previous session, which I think if anyone knows when their friend goes to see you, you’ve just disclosed more than that friend might have told their pal about what they do during that hour.  
The one thing that I’m seeing more and more of is happening on email lists that are professional lists for people to post for referrals or consultation. I’ve seen people forwarding emails from clients looking for referrals. A couple of cases, I’ve actually written to the clinician and said, “Are you aware that you just forwarded this person’s name, email address, phone number, and the issues they are dealing with to 500 people?”  
Some of the responses I’ve gotten back are, “The client gave me permission to do so.” I cant imagine personally a situation in which I would want to ask someone’s permission to post that sensitive information to 500 people.  
Roy: Yeah, is there a need to post your identifying info?  
Rob: No.  
Keeley: [inaudible 00:35:40] is a little bit lazy. They’ve said respond directly to this person and I’m thinking, well, we can't solicit services. What does this person do when 20 therapists email them? That’s also very awkward.  
Roy: Awkward is putting it lightly. Man, you see some weird stuff Keeley.  
Keeley: I do, I see weird stuff on the internet. All of that should be ... What I mean, like your website. The other thing, I actually in, a weird way, I have compassion for whats happening with folks because I wrestle with this myself. I am constantly checking myself on whether I’m saying too much. At least for psychologists, our ethics code says that for consultation, we only share the amount of detail necessary with those who are actively involved in care.  
What I’m seeing absolutely exceeds that. I think part of our training and supervision didn’t prepare us for cutting out information when we post messages that will be archived to large groups. I think it's part of our training and we preserve it and we need to learn, “Okay, now this is a different setting. I don’t have to share every detail about this case. I just need a few things to describe the clinician who would be helpful to me or this client.”  
Rob: Exactly.  
Roy: Certainly, my perspective there is that mental health clinicians don’t have the best Masters level of training or Doctoral level training in de-identification. Basically, it's interesting, Russia really good at a lot of privacy and security things but de-identification, tends to be a weak space, I’ve noticed. That’s certainly my experience from trying to teach about security and privacy, which according to me is a big overlap of what you are talking about.  
Keeley: There was something very recently in the past couple of years, where somebody posted to a localist information, "Need help for someone who was involved in a car accident three months ago and killed X, Y and Z persons related to her." It was like you could just look that up on Google and find it in the news and know who it is that's looking for therapy.  
Roy: If you were in a small enough town, everybody probably knew who it was.  
Keeley: Exactly.  
Rob: Based on that description.  
Keeley: I think it’s a combination of thinking it's a closed space but really not being aware that it's archived. Hundreds of people will see it, people who are friends with that person might see it. I think if we had to think, Imagine, this person’s best friend is on this email list, we might tighten up our descriptions of what we're looking for.  
Roy: Right, and that’s a good way to put it. Imagine the best friend is there, it can go back to the general concept which I’m sure Rob and I can talk a lot about when we do our Hip episode, just risk analysis, which is a very harsh sounding term or hard sounding term but it’s a thing we do all the time. We just tend not to think about it in the digital realm too much.  
Basically, what are the threats? The threats being the things that could make something go awry and you are like, “Well, if a best friend was looking at this, if a client was looking at this, who are the people who could see this and what would it be like if they saw it?" I think if clinicians do that little checklist of analysis before they post, they can actually end up still getting a lot of use out of posting a consultation question without putting their client’s confidentiality at risk.  
Keeley: Exactly. I do know of some folks who are now using the exercise of taking a very detailed consultation or referral post. In their ethics classes, they're having their students rewrite it to de-identify the person. I think that’s such a wonderful exercise for this digital age for people to learn how to do that and think about it.  
Roy: Yeah, that’s a great one. I like it.  
Rob: Yeah.  
Roy: All right, Rob, let’s do it.  
Man: Describe comes with over a dozen activities that can be used with clients of all ages. Find out more at  
Roy: Are you ready Keeley?  
Keeley: I really don’t know. I’m highly anxious and concerned.  
Roy: Well, the word for the day is not anxious, so you can breathe a sigh of relief. Today’s word is lucky. Today’s describe word is lucky. The question for you is to tell us about a time that you felt lucky.  
Keeley: What a sweet question. I like this question a lot actually because I have been thinking a lot about luck. I have a friend who wrote ... Actually, a couple of friends who wrote a book called Get Lucky, and that a lot of people think about luck as this thing that happens to you, whereas another way to think about it is being very prepared and noticing opportunities.  
There are lot of things that appear like luck but actually are times when we are able to harness our creativity and work on something and then a door opens where we can apply that. I absolutely feel like I felt very lucky that anyone cared what I had to say at all about social media because I definitely felt like it was a real controversial topic.  
I had tried to discuss it at internship settings and in some of my practical placements and the time was not right. People really were dismissive and had ideals that people on the internet were obese and socially isolated. I was thinking, "I’m on the internet all the time. I have a ton of friends because of it."  
I feel like I started doing this work around social media and integrating my interests in digital culture with our professional rules, at the right time and I was also in the right place, where people were hungry for it and receptive to it. I don’t think that would have been true if I had started doing it five or 10 years earlier.  
That’s what made me feel lucky but I think it was also a lot of hard work because I put a lot of time and effort into thinking through all of those ideas and relating them to our professional ethics. I think the opportunity was there. It was the right time and doors opened and people were ready to listen to it. It's not just luck, there are conditions that I think make ... Sometimes there might be real luck like that but I think there’s other conditions that create the space for luck to happen.  
Roy: Nicely said.  
Rob: Yes, and I personally appreciate you pushing ahead with that even at the time when you started it. It felt like people weren’t ready for it.  
Keeley: Yeah. Before that, a lot of my work was in alternative sexuality. I was already accustomed to people not taking me seriously. Then I felt, "Oh well, social media and the internet, it'll just be more of the same." People now actually care about the other topics that I was teaching about because I think I established a bit of credibility. No one was more surprised than me, let me put it that way.  
Roy: Well, speaking of which, now you have credibility and now you actually have some stuff to offer. Tell us about what we can find at your site?  
Keeley: Okay, well, what you can find on my site currently is I have a five CE course on digital ethics. It's all video. I offer consultation and I offer consultation packages to make it a little more economical.  
Roy: Nice.  
Keeley: I also right now have a ... This is a little off our current focus but we did release this year a three CE course on working with PDSM and Kink sexuality, which is very hard to find courses on that.  
Roy: Yes, it is.  
Keeley: I also have that product, Getting Better, which is a cycle of host treatment, psychotherapy, client satisfaction measure, which I try to provide more than Yelp or Health grades would provide while also protecting client privacy and confidentiality. By the time this airs in September, I will have an annotated social media policy on my site.  
Roy: Finally.  
Keeley: [inaudible 00:44:34] for five years and keep putting [inaudible 00:44:37] but this one is going to be lovely because it’s going to be updated to what I use now and it’s going to include all of the disciplines, ethics codes and what they have to say about each section so that people can make an informed decision and I’m going to bundle it with two CEs. You can put your set, have it and then also get continuing education credit for it.  
Roy: I’m glad you are finally doing that.  
Keeley: You’ve heard me talking about that for a long time.  
Roy: I’m like, “Why don’t you do that? That’s a perfect idea.”  
Rob: Any way we can get some kind of special deal for our listeners?  
Keeley: Absolutely. I’m going to offer a coupon code, Hugg, H-U-G-G, because it was just too cute not to use. It’s going to be good for 10% off everything in my store, including the nine ethics related courses and things, so people can use that until October 31st.  
Roy: Fantastic.  
Rob: Shopping spree.  
Roy: We're going to buy everything on Keeley’s site, fantastic.  
Keeley: Yay.  
Roy: Well, thanks so much for sharing your valuable knowledge Keeley. We really appreciate it.  
Rob: Yeah, thank you very much Keeley.  
Keeley: You are so welcome and thank you to both of you for just the chance to get on the computer and chat with you two because I really enjoyed it and I think you did great work.  
Roy: Thank you.  
Keeley: So, happy to be a part of it.  
Roy: Great. Well, hopefully we'll have you again at some point in the future and we'll see you next time.  
Keeley: Okay, take good care.  
Rob: You too.  
Keeley: Bye.  
Rob: Wow, that was great. That was a great follow up to what we’ve been talking about. Keeley, obviously, has extensive experience working with people on this situation.  
Roy: Yeah, and she's seen some weird stuff that I haven’t even seen.  
Rob: Yeah, I’m glad I haven’t seen some of that stuff.  
Roy: Yeah, me too. I'll just deal with people’s massive confidentiality breaches. I’m more comfortable with that, which is less uncomfortable, less dramatic, I guess. Keeley’s comments got me thinking about some kind of studying and thinking I’ve been doing over the years about how we can model in our heads the ways that information is safe or not safe or protects boundaries or puts boundaries at risk online. Would you like to hear about it?  
Rob: Yeah, you've telling me a little bit about this and very intrigued. Let’s get into it.  
Roy: Let’s get into it, all right, yeah. Here is the way I like to think of it, this is my model. It's a good compliment to your PIT model, which is to think about your web presence. You have a web presence and I don’t just mean a website, I mean just your presence on the in the World Wide Web. That includes listservs and all that stuff.  
If you take every single thing that refers to you or is by you or is about you, all put together, that’s your web presence. Within that, there are pieces of your presence that you control, that you certainly control, and that you don’t control. This is really important because uncontrolled web presence is largely something you just kind of got to accept. Practice a radical acceptance go with it, just know that’s just part of life in the modern world. There are some stuff out there that you can’t control.  
Rob: What would be an example of that?  
Roy: Well, uncontrolled could be things like, the great example I always liked was the college newspaper or high school newspaper that was just on paper back when you were in college or high school, has been digitizing all their archives. Now, there is all this, something you wrote, or something that was written about you or pictures of you from that period that are now online. If someone searches for you name, it comes up. Or maybe it’s a archive of your town newspaper about an event that occurred, that involved you, that was really bad.  
These are all stories I’ve gotten from people at training. It’s about real things in their lives. Another more common one is review sites. Talking about what Keeley was getting into, review sites, if you don’t take control of them, they are completely uncontrolled. The review sites says, "This is who you are and this is where you practice." Then all the reviews on there say how good you are or how bad you are.  
For example, a long time ago, health grade, which we mentioned, I’ve got a review on health grades, but before I even got the review, heath grades had added me to their database but they said that I was a psychiatrist in Portland Main. That’s what they recorded.  
Rob: You're moving up.  
Roy: I know. I was like, "Well, can I get paid more? Can I get paid like a psychiatrist?" That would be fantabulous. Unfortunately, it didn’t work out that way and so I had to try to correct that. That’s the thing with review sites, is that they can become semi controlled if you take over the profile.  
Rob: Got you.  
Roy: Yeah, you can claim the profile, Health grades, it doesn’t work that way. That's not how they do it there but you can probably correct wrong information, of course. But with Yelp or Google or whatever, Yelp will create a profile for you, if someone wants to leave a review of you. In which case, you should just take control of that and just start a profile like we talked about with Keeley. I think you can control the text in there and discourage those people from making reviews at all or from making a review that’s negative rather than talking to you, that kind of thing.  
Rob: Right. You and I have both done that.  
Roy: Yup, we sure have.  
Rob: When you talk about this own controlled stuff, now I’m thinking you are not safe from the things you did in high school.  
Roy: Yeah, I don’t think we are as safe as it used to be, in that way. Depending on what’s out there, and what kind of sucks is, actually it sucks a lot I think, is high schoolers now have that to worry about. I don’t think it’s right. I think it’s a lot of pressure they don’t need but it's smarter in life and as grownups, we should try to help them through it. That’s what I think.  
Rob: Growing pains. What’s an example of a controlled situation?  
Roy: Well, I think the ideal, the plutonic ideal of your controlled web presence is your website. Your website is exactly what you make it. I haven't talked about this one forever, how you website is the hub of your practice online. I don’t just mean your marketing, it means the hub of your practice.  
My website’s also place where clients can download intake forms and if they need to, they can contact me securely through my security contact form. All that can go through there and if I want to go hang shingle for an online practice, it can all work through there. Your website is yours and you control it. Even your psychology today profile, a good therapy, that work profile is really only semi-controlled because most of what's on there is made by the website owners not by you.  
Yeah, we talked about this and we were talking about internet marketing and I was thinking about how, even when I ask of my clients, and potential clients how they found me and they may say, they found me on psychology today, or they may say they were referred to me by a physician or a friend. I always followed that up with, "Have you been to my website?" And almost invariably they have. Regardless of how they initially hear of you, they usually end up on your website.  
I’ve only talked to one person who was referred to me, who didn’t look on my website before they caught me. In that case, it kind of made sense. It was a particular referral situation where it made sense. They never looked at the website but everyone else, they knew exactly what was there.  
That’s the most controlled. We talked about that in terms of marketing last time but it also matters for ethics because your web presence, the more uncontrolled your web presence is, the more it can say, “Look unprofessional.” Or the more it could be a mixture of personal and professional things in one place which increases risks of boundary crossing.  
Some of that you can’t avoid. Some of that personal stuff maybe you can’t do anything about it and you just got to accept that. But your controlled presence is where you can take ownership of any of those things. For example, if there is some new story for my hometown that makes me look bad, maybe I should write a blog post or two about my responses to that.  
I don’t mean refuting the story, I mean talking about my experience at that time when that occurred. It depends on what the story is about but that could be the kind of thing you do. I’m actually giving a colleague's story from those training, that’s actually happened to her and that’s what she did. She wrote blog posts about her experience at the time, so that if someone finds that original news story that makes her look weird, is not living in a vacuum.  
Rob: Right. It’s the opportunity to see both perspectives out there.  
Roy: Exactly, right. Yeah. A Google search will show that new story as well as the blogs about it and people can check that out.  
Rob: You have something that is kind of parallel to that and how you can address review sets. Can you share that?  
Roy: Yeah, right. I think the thing that ... I know Keeley mentioned this because she gets these calls all the time, I know Oprah is there, she gets these calls all the time. People are asking what to do when they get a negative preview. It could be not even just a negative review, it could be like the other story of the person who’s got the bad news story about them.  
Whatever it is, there's something negative, It makes you look bad or unprofessional, could not just hurt your marketing, also it could potentially hurt your relationship with clients even. One thing to do is to counter with stuff that looks good. The problem is we can’t-  
Rob: You mean get all your friends to come on and give you positive reviews, right?  
Roy: Well, not really. We do have to be honest, right? Our friends haven’t worked with us.  
Rob: Your friends probably think you are awesome.  
Roy: They think I’m awesome but that’s not an honest review of my services as a counselor. I actually do a lot of obligation to be honest about that and be honest [inaudible 00:54:06]. This is something else we can’t do like other businesses do?  
Rob: That’s right, exactly. We can’t do that the way other businesses do. Actually, it’s in the codes of ethics. The ACA and SWAPA codes of ethics, all, its in some way or another, referenced the idea that you have to be honest in the way you portray yourself. Which includes things like, if you ask someone to make reviews of you. Which brings us to this episode's Hot Take Tip.  
Man: It’s time for the persons in a Take Hot, Take Tip.  
Roy: This episode’s Hot Take Tip is about getting reviews from colleagues. That’s the thing, you can’t get clients to review you. You can’t solicit testimonials and actually we’ve seen a lot of examples of professional association ethics committees being pretty serious that if they start seeing testimonials from clients, that makes them worried.  
Of course, we all get testimonials spontaneously and that’s great. I don’t see why we are supposed to not have those. But if you really need to bring in some positive review of you, ask colleagues about it, especially colleagues who have actually, has some real experience with your work.  
In my case, I know that one person I’ve talked to about this, we haven’t done it but we’ve talked about it, was someone I did practicum with in grad school and who I have followed since then with a lot of cross-referral. Not only do we actually see each other work through the glass when we were young and new to this, but since then, we’ve seen the results of each other’s work through intern for our clients.  
We also a common supervisor and so our supervisor can talk to us as well. We also have those group supervision sessions where we had work together and talk together about cases. In that case, this is a person, where I can actually speak honestly about their work and they can speak honestly about mine.  
They’ve seen the results as well and so they can speak honestly in their review about me to talk about the positivity of my practice in the way I work. Some things you want to keep in mind, if you're going to ask colleagues to review you, one, make sure it's honest. Make sure it's someone who really can talk about you.  
They should say what their relationship to you is, that they are a colleague, that they are not a former client, which means that in some sites, you won’t be able to do this. Tell people not to make an account just to review you. The reason for that is because the sites don't like it when people do this kind of thing and so they'll look for that kind of pattern. If they see that somebody made an account apparently just to leave you a review, they may actually cancel the review or penalize your profile because of that.  
Rob: Yeah, and just to follow that up Roy, another reason not to have somebody create an account just to review you, is it doesn’t look as legitimate to anybody looking at it.  
Roy: That's true.  
Rob: If somebody's reviewed 14 different places, you got a good idea that, "Hey, they are a real person." If they've only reviewed one thing, you start to wonder, “Okay, were they just here for this?”  
Roy: Right, makes a lot of sense. That actually also detected, actually, these and some other stuff which is just a great way to take control of your overall web presence, is to just create a lot of professional activity which is discussions, social media, twitter, blogs. In the public social media stuff, having activity, that’s professional.  
Now you discussing with colleagues, talking about professional issues. I don’t necessarily mean consulting on cases, which is something that obviously we’ve been talking about being a delicate subject but certainly just talking about professional things that to a client, they look at it and go, “Hey, that Rob guy, he spends time on social better getting better at his job.”  
Rob: That Roy guy who has the school podcast.”  
Roy: Yeah, right, listen to this podcast.  
Rob: With that same Rob guy.  
Roy: Yeah.  
Rob: It’s crazy.  
Roy: It’s crazy. That kind of stuff is good. You fill up your presence with that and even though something kind of unprofessional looking or negative looking comes up, there’s always positive stuff. Let’s say, it was the image, and it’s not just marketing. That’s ethical as well. If you look on professional, that can damage therapeutic relationships or damage the reputation of your profession, which we don’t want to do.  
Rob: I don’t believe we do. Roy, we're about out of time and I feel like there’s other things we could talk about. Should we probably do another episode on this some time?  
Roy: You think so? Yeah, maybe about the ... Yeah, I think we probably should. That would actually make a lot of sense to me. I feel like a lot of things we talked about could be applied. We didn’t talk about things like, LinkedIn and Pinterest and Twitter and Instagram and chat programs and Venmo. I don’t know, what do you think? I think we did a pretty good job and most of the things we talked about could be applied across the board.  
Rob: I think so. I think we laid a good foundation here. We're house builders and we just pour that concrete right on now, renaissance move.  
Roy: As always, we welcome questions. If you feel like there’s something that we missed, write in. We’ve already started to craft what our next step is. It's going to based on feedback we’ve been getting so we’d love to hear from you.  
Rob: Yeah, please tell us.  
Man: Thank you for tuning in to therapy tech with Rob and Roy. This episode has been sponsored by and, helping you choose and implement technology that benefit your practice and your compliance plan. Episode notes and helpful resources can be found at Until next time, may all your internet interactions be delightful.  

Photo by jens johnsson on Unsplash


  1. Suzanne B. Casey, PhD, LMFT, LPC says:

    I am so grateful for your help! Your articles, episodes, and CE webinars supply crucial information to professionals and are delightfully entertaining to boot. I’ve already enjoyed many of them and plan to continue to do so. Thank you!

    1. RobReinhardt says:

      Dr. Casey

      Thank you for taking a moment to share that you’re finding our podcast both helpful and entertaining! We’re really big on the entertaining part so that’s especially heartening to hear.

      If you plan to continue enjoying, we’ll plan to keep on, keepin’ on!

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