Given the developments we saw in the world of social media in 2018, it’s a wonder we’re still using the big networks like Facebook and Instagram. Not only are people all over the world just as active as ever in posting dinner pics and political memes, however, but more and more therapists are using social networks to enhance and assist their practices.

On the balance, this is probably a good thing. Who couldn’t benefit from more community around their private practice?

But it has become apparent to professional associations and licensing boards that we as a field need to recognize and adhere to certain professional standards when using social media in our work. Earlier this year, I got the opportunity to work with the Oregon Psychology board’s social media guideline committee (and we produced what I think was a very fine set of guidelines. You can find the final product here.) The committee was formed because of the apparent need to provide more concrete guidance on what works and what doesn’t in social media.

I was also inspired by an article from PCT alum Aaron Good on preventing confidentiality breaches due to “overshare” in therapist-focused Facebook groups (you can find his piece in ORCA’s 2018 newsletter here.)

So as I sat to write this year’s retrospective article, it was clear what my topic would be:

2018’s Top 5 Social Media Ethics Issues

1) Oversharing client info in online forums when requesting referrals

There are currently eleventy zillion Facebook groups dedicated to helping therapists connect with each other (it’s true — I counted them myself.) Many of these groups are dominated by referral requests.

Isn’t that great?! These are Facebook groups where mental health clinicians can network while helping each other’s clients and each other’s practices at the same time. This is basically what Al Gore invented the Internet for!

There is, however, one snag that we as a field need to work on before it can be the kind of professional cyber-utopia we hope for: Oversharing.

When we meet together in real life spaces for networking and consultation, we tend to have a strong idea of how to speak about client cases and referral needs without breaching confidentiality. The online world is a very different context when it comes to privacy issues, however, and we have to be much more restrictive with the information we give.

This concern is rooted in ethical issues around confidentiality, but HIPAA is also relevant. In order to navigate this issue well, I think it would be useful for therapists to familiarize ourselves with the HIPAA Privacy Rule’s safe harbor method of deidentifying clients. HIPAA’s method is more restrictive than the classical deidentification standards we have long used in mental health (e.g. using a client’s initials instead of their full name.) For more info, see our article on HIPAA and deidentification.

Aaron Good’s article, which I referenced earlier, has a great little template for making referral requests in a way that gets what the client needs without oversharing their info. Once again, that article can be found here. The article is entitled, “Advocacy and Confidentiality.”

2) Messy email and texting boundaries

Do you have an office policy, which you give to clients at intake, which spells out how you use (or don’t use) email and texting? If you don’t have one, I recommend putting that on your 2019 practice resolutions list. You’ll probably be glad you did.

Therapist boundaries started getting pushed way back when the landline telephone became a common office item. Later, the cellular phone — and then the smartphone — came back around to give those boundaries a hearty shove of their own!

We can have a fun debate about the ways in which this is good and bad. What is clear, however, is that modern practice requires compassionate and clear boundaries around communications between sessions. We have had numerous consultations with colleagues who complain of overly long text messages from clients, expectations of instant response time, clients who never check their voicemail, and so on.

We believe that, while it doesn’t fix everything, a clear and well-conceived office policy that lays out the best ways to communicate with you between sessions is the strongest solution to these boundary problems. Our free newsletter subscribers can download our Sample Communications Policy in the free downloads area here. If you haven’t subscribed to our newsletter, you can go sign up here.

3) Using the right email or texting services

I said it in 2017, and I’ll say it again: there are not a lot of circumstances anymore where it makes sense to use nonsecure email or texting.

Sure, there are still times and circumstances where it makes sense. But the availability of inexpensive, convenient, and effective means of secure communication is so good these days that there isn’t much reason to use conventional email or SMS texting so much — unless you work with a lower SES population, of course.

Please note that I’m not saying you need to cut those technologies out completely. Do consider working to move away from them, however, towards reliably secure technology that doesn’t require clients to sign away their privacy rights. See our article on high-privacy apps and our article on favoring secure texting for more info.

4) Nonsecure “Contact Me” pages on websites

This is one of the favored pet peeves of Liath, our Deputy Director. And for good reason.

Tons of therapist websites (eleventy zillion, if I recall correctly) include a page where visitors to the site can fill out a contact form to make an initial inquiry about services. The information they provide then gets sent to the therapist.

The vast majority of these forms send the information provided by a prospective client to the therapist’s web hosting company, which then passes the information on to the therapist via conventional email. It’s a bit of a confidentiality nightmare, but it’s one that isn’t obvious unless you’re familiar with the ways in which websites work.

It is very easy to replace these nonsecure contact pages with a secure forms service from a company like Hushmail, LuxSci, or Paubox. Many practice management systems also provide something similar to these “contact me” pages.

5) Using client reviews on websites and in Google, Facebook, and other profiles

Online reviews are a very effective marketing tool, so business and marketing coaches push us to use them. The truth, though, is that even a hint of solicitation for client reviews is very clearly unethical for every mental/behavioral health profession. For citations and further discussion, see our article on local business listings and our article on colleague reviews.

This can be a big frustrator for private practitioners who avoid this ethical pitfall while working on their online marketing — only to find that a colleague in their area has a stronger web presence because they used client testimonials to boost their online marketing presence.


Social media is great and we should definitely use it to the extent that we enjoy it and it benefits our practices. Really. There is a need, however, for our field to come together on developing and following some standards and best practices for managing confidentiality and boundaries in the cyberworld. I imagine that 2019 will be a year where we start to put our backs into this effort. Stay tuned for more.

Learn more about social media ethics for therapists:

2 CE Credit Hours



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