Week 3: Reflection Paper

Ethics

The Ethical Use of Social Media in Marriage and Family Therapy: Recommendations and Future Directions

Nickolas A. Jordan 1 , Lindy Russell

1 , Elnaz Afousi

2 , Tasha Chemel

2 ,

Melissa McVicker 2 , Janet Robertson

2 , and John Winek

1

Abstract Increasingly, people spend time online, communicating via e-mail, websites, instant messages, and various social media platforms that incorporate text, video, and online photo albums. Social media have altered the way people spend their time and commu- nicate with each other; this includes mental health professionals. It is imperative that therapists are knowledgeable about the ways social media affects clients’ personal interactions as well as the ethical implications of their own professional use of social media. Professional organizations do not provide adequate ethical guidelines for therapeutic practice regarding social media; therefore, ethical codes should be adjusted to include the new media as they arise. After reviewing related literature from other mental health disciplines, the authors offer recommendations to be integrated into the professional ethical codes for mental health pro- fessionals to ensure the ethical use of social media in therapy. The authors organize their recommendations around several key principles from various mental health codes of ethics.

Keywords ethics, marriage and family therapy, social media, online, confidentiality, professional competence, responsibility to clients

Social media such as Facebook, Twitter, eHarmony, and

MySpace have come to dominate popular culture. People have

access to friends and family through social media virtually at

all times. Whether at home on the desktop computer, in the

library with a laptop, or on the go with a smart phone, friends,

‘‘fans,’’ and ‘‘followers’’ are never more than a few clicks

away. For the purposes of this work, social media—sometimes

referred to as social networks—are defined as Internet-based

applications used in direct and indirect social interactions.

Social media have become entrenched in how many people

communicate with one another. It has even been argued that the

order of relationship development has changed (Palfrey & Gas-

ser, 2008). In the past, it would have been necessary to engage

in some sort of conversation in order to find out if a potential

partner had a pet or siblings, where he went to high school, and

what his interests and life goals are. Today, a couple on a first

date might come armed with the most insignificant and inti-

mate details of each other’s lives without ever having had a

conversation.

Not only providing new ways for friends and family or

romantic partners to connect, social media increasingly serve

as a platform for professional communication. Seemingly no

one is immune to the siren’s song of social media. For example,

on the American Association for Marriage and Family Therapy

(AAMFT) website, one can find Facebook, Twitter, and

MySpace icons at the bottom of the page; the American

Counseling Association (ACA) page links to several blogs and

an official Twitter page. The ACA, American Psychological

Association (APA), National Association of Social Workers

(NASW), and International Association of Marriage and Fam-

ily Counselors (IAMFC) all maintain active Facebook pages. In

both the personal and the professional realm, social media are

providing a new vehicle for self-promotion.

In a capitalist society, there is nothing unusual about

business self-promotion. But when it comes to mental health

professionals, even those running a private business, such

self-promotion creates a host of questions. Specific media hold

their own ethical questions. Facebook, for example, allows pro-

fessional pages—but to follow a therapist’s page, one must

‘‘like’’ the page, which creates a public record of each person

who follows a therapist’s online presence. This in itself could

1 Department of Human Development and Psychological Counseling,

Appalachian State University, Boone, NC, USA 2 Department of Applied Psychology, Antioch University New England, Keene,

NH, USA

Corresponding Author:

Nickolas A. Jordan, Department of Human Development and Psychological

Counseling, Appalachian State University, 151 College St., ASU Box 32075,

Boone, NC 28608, USA.

Email: [email protected]

The Family Journal: Counseling and Therapy for Couples and Families 2014, Vol 22(1) 105-112 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066480713505064 tfj.sagepub.com

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create a violation of confidentiality. Twitter’s 140-word

character limit creates problems in relation to language and

adequately communicating ideas. And while some ethical

boundaries may be obvious, many are unclear across the realm

of social media. In the supervision relationship, for example,

one could ask if it is ethical for supervising therapists to use

Skype in order to supervise over long distances; and if such

supervision should be able to count toward licensure. Or in the

case of a vacationing therapist, is it ethical to maintain client

contact via computer-mediated text messaging (e.g., America

Online Instant Messenger)? Are those service hours billable?

Trust and confidentiality are both murky concepts when

social media are involved—especially in the context of a pro-

fessional therapeutic relationship. And while there is a plethora

of research surrounding social media and its widespread effect

on personal and romantic relationships, marketing, and per-

sonal development, the authors found very few articles addres-

sing social media in relation to therapeutic practice (Kaslow,

Patterson, & Gottlieb, 2011; Zur, Williams, Lehavot, & Knapp,

2009). No definitive ethical guidelines seem to exist; and we

found more questions than answers. In an almost universal

fashion, the mental health field is silent on how to—or whether

mental health professionals even should—use social media in

therapy.

Among the AAMFT, Commission on Accreditation for

Marriage and Family Therapy Education, ACA, NASW,

IAMFC, and APA, none provide officially recognized ethical

standards for the use of social media in therapeutic practice.

A serious problem arises: Therapists are using social media

without any effort on the part of professional organizations to

understand how social media are being used, to investigate and

educate about the legality of such interventions, or to provide

ethical guidance for practitioners who may not fully understand

the possible implications of their actions (AAMFT, 2011;

ACA, 2005; APA, 2010; Hendricks, Bradley, Southern, Oliver,

& Birdsall, 2011; Workers, 2008).

This work attempts to build an initial list of guidelines for

family therapists, counselors, social workers, and psychologists

to consider before integrating social media into therapeutic

practice. First, we will review applicable literature describing

the use of social media in mental health and the ways in which

various mental health practitioners manage social media. Next

we will provide recommendations for several key principles that

could be adapted and amended to each professional group’s

Code of Ethics. We do this in the hope that future mental health

professionals are more likely to practice mindfully and ethically

when incorporating social media into their practice. Finally, we

will discuss implications for future directions in research regard-

ing ethics and social media. Please note that for the purposes of

this work, we use the terms therapist, psychologist, mental

health professional, and practitioner interchangeably.

Review of the Literature

In the last two decades, the use of media technology has

increased, leading to changes in how mental health

professionals communicate with clients and each other

(Negretti & Wieling, 2001). Social media platforms have

transformed online communication and provide a new realm

for many mental health professionals to provide services

(Fitzgerald, Hunter, Hadjistavropoulos, & Koocher, 2010;

Jencius & Sager, 2001). This review focuses specifically on

work related to how mental health professionals and accredit-

ing bodies use social media and electronic forms of communi-

cation in therapeutic practice.

The increase in the use of first electronic and then social

media to provide information and enhance communication has

encouraged new forms of mental health services to develop

(Pollock, 2006). Many professionals have endorsed the use of

electronic communication in practice as a way to provide care

and services to underserved populations in a cost-effective

way, as well as a way to facilitate supervisory, clinical, and

educational opportunities (Rosik & Brown, 2001). Some use

electronic discussion groups, chat, and videoconferencing to

facilitate support groups or provide resources for mental health

concerns (Guterman & Kirk, 1999; Pollock, 2006). In addition,

e-mail, Facebook, and LinkedIn are often used to collaborate

and consult with others in the field, to share articles and

resources, and to plan meetings and workshops. Mental health

professionals have increasingly offered online services to cli-

ents (Guterman & Kirk, 1999), and with the growth of social

media applications, this trend is likely to continue.

The Internet has been used in the mental health field by the

major national professional organizations to market their

services, including the AAMFT (Guterman & Kirk, 1999), and

some organizations have begun addressing the use of Internet-

based services in practice. The ACA established standards for

the use of online counseling and communication, and the

American Mental Health Counselors Association revised its

code of ethics in 2000 to include an online counseling section,

acknowledging the considerations for the electronic transfer of

client information, confidentiality, and counselor identification

(Jencius & Sager, 2001). The IAMFC proposed revisions in

2001 to urge members to refrain from providing specific advice

to individuals through the media and other public venues, with-

out providing follow-ups or comprehensive assessments (Jen-

cius & Sager, 2001). Unfortunately, no recent revisions have

provided guidance in terms of appropriate uses for social media

like Facebook, MySpace, Twitter, and YouTube.

Professional organizations provide guidelines for appropri-

ate practice through their ethical codes. Therefore, with com-

munication technology continually advancing, there is a need

for the accompanying legal standards and ethic codes to

develop at a similar pace (Jencius & Sager, 2001; Rosik &

Brown, 2001). Organizations should examine what services are

being provided through social media use and assess the risk or

liability in such practices (Rosik & Brown, 2001). In addition,

to avoid ethical and boundary violations associated with using

communication technology, mental health professionals should

develop expertise and practice with social media technologies

(Jencius & Sager, 2001). Therapists should hold up-to-date

knowledge of the social media platforms themselves, as well

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as technical and ethical issues involved prior to and while

employing them in a therapeutic context (Negretti & Wieling,

2001; Pollock, 2006). Currently, the AAMFT, NASW, ACA,

and APA do not include specific information about the use of

social media in their codes of ethics (AAMFT, 2011; ACA,

2005; APA, 2010; Workers, 2008). For this reason, we offer

recommendations for mental health professionals to encourage

mindful practice in the use of social media. We have selected

general principles from the ACA, NASW, AAMFT, and APA’s

Code of Ethics that are most representative of the issues raised

by the use of social media in mental health. Whenever possible,

case vignettes are used to illustrate some possible ethical

dilemmas therapists may face.

Ethical Considerations

As mental health professionals, supervisors, educators, and

students, we argue that the current state of ethics across disci-

plines regarding the use of social media is insufficient. The

IAMFC, the NASW, the ACA, and the APA offer no guidelines

in the specific use of social media in therapeutic practice

(ACA, 2005; APA, 2010; Hendricks et al., 2011; Workers,

2008). Even the most recent revisions of the AAMFT ethics

code which address some potential issues that arise from

computer-mediated family therapy fail to mention social media

by name (AAMFT, 2011). We believe this to be a serious

concern.

We offer guidelines for the use of social media in mental

health practice, applying them in conjunction with applicable

state and federal laws. These guidelines are not intended as

exhaustive or definitive considerations. Rather, the following

guidelines provide overarching themes to consider and act as

a beacon for mental health professionals to follow toward

mindful use of social media. The authors do not claim to know

whether using social media in mental health is, in fact, ethical

at all; rather, we begin asking the difficult questions associated

with the use of social media in therapeutic practice and encour-

age readers to determine their own sense of where social media

fit into their individual ethical practice and contribute their

perspective to the larger professional conversation.

Principle 1: Social Media in Therapy

Mental health professionals are aware that social media in

general blur boundaries (Palfrey & Glaser, 2008); therefore,

mental health professionals consider how clients may perceive

information through social media.

The rules for communicating are different through social

media than more traditional forms of expression (Zur & Zur,

2011). The odds of offense through miscommunication are

already high; communication through social media only

increases that probability. Contextual components of commu-

nication such as tone and body language are often absent. Even

the crafting of an appropriate ‘‘good-bye’’ in an e-mail could

leave writers open to unintended consequences. Much the same

way a hug, handshake, or wave signifies both a physical and an

emotional relationship; the way one closes an e-mail—‘‘Best

wishes,’’ ‘‘Sincerely,’’ ‘‘Kind regards,’’ ‘‘Warmly,’’ or ‘‘Affec-

tionately’’—provides different connotations to the interaction,

and can significantly impact relationship development between

therapist and client. Professionals wishing to use social media

in their practice must be descriptive, transparent, and aware of

the social rules that govern communication.

Principle 2: Responsibility to Clients

Guideline 1.1: Informed Consent. To avoid misunderstandings and to ensure the boundaries of the therapeutic relationship are

clear, mental health professionals inform clients of their policy

on the use of social media in therapy, including possible

risks and communication styles (sample informed consent,

Appendix A).

In order to adhere to the general informed consent guide-

lines, mental health professionals should include a section

within the document addressing social media. Such policies

should contain information about whether or not a therapist

will search for a client using social media sites or general web

searches prior to or during sessions, as such a search could be

considered an invasion of privacy; it is also recommended such

searches be discussed with clients in session beforehand. To

address client and therapist boundaries, policies should also

describe whether and how the therapist would respond to a cli-

ent on social networking sites should contact be initiated—

intentionally or otherwise. If contact is anticipated, the mental

health professional should communicate expected boundaries,

including the type of information the therapist is comfortable

sharing over social media and the therapist’s availability out-

side of sessions. For example, a policy might explain that while

a therapist will respond to client e-mails concerning the sche-

duling of appointments, he or she will not discuss therapeutic

issues over e-mail (Pollock, 2006). In addition, a professional

might detail a no-contact policy for social networking sites,

meaning he or she will not respond to clients’ requests to

connect on such sites, nor will he or she initiate such requests.

Finally, a professional might also specify he or she does not

check e-mail over weekends and might take up to 24 hr to reply

to an e-mail (Negretti & Wieling, 2001).

If a mental health professional does choose to incorporate

the use of social media into therapy, he or she should conserva-

tively disclose possible risks to the client. For professionals

who conduct sessions online, it is imperative the client under-

stand the therapist will not be able to adequately respond to the

client in an emergency, especially if the client and therapist are

far away from each other. Therapists who are working with

clients using only a written channel, such as e-mail or text chat,

might also have difficulty assessing the client’s risk of endan-

gering self or others because the therapist does not have access

to nonverbal cues (Negretti & Wieling, 2001). To mitigate this

concern, the client should be informed that the therapist

requires a means of contacting him or her offline, as well as the

name of at least one other person who can serve as an emer-

gency contact. The therapist should also inform the client that

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he or she will work with him or her to make a connection with a

local treatment provider who will be able to respond promptly

should an emergency occur (Pollock, 2006).

Mental health professionals should also relay the possible

risk of unintentional breach of confidentiality. Therapists

communicating with clients over e-mail or social media should

specify whether this communication is secure (encrypted) and

should disclose the possibility of another party gaining access

to the communication, including companies such as Skype and

Facebook (Jencius & Sager, 2001). Practitioners should also

inform clients about the risks of granting access to their pages

on social networking sites for therapeutic purposes, such as the

possibility that the therapist might gain access to information

that the client did not intend to share. Clients should understand

the therapists’ status as a mandated reporter (if self-harm or

harm of another is anticipated, or if elder or child abuse is

suspected) is still applicable to information obtained from

social networking sites. Clients who choose to connect through

their professional pages on social networking sites should be

informed that there is a potential for third parties to identify

them as clients. Finally, client expectations of the mental health

professional should be discussed in session.

Case vignette. A teenager, still a minor, allows her therapist to read her blog, since she finds it easier to express herself in

writing. One of her blog entries mentions that she and her adult

boyfriend are having sex. According to state law, the therapist

is mandated to report this information, since the client is under-

age, which constitutes neglect in the therapist’s state. However,

the therapist’s informed consent document did not clarify that

mandated reporting laws are applicable to online material. The

teenager becomes angry and accuses the therapist of violating

confidentiality.

Guideline 1.2: Multiple Relationships. Mental health professionals and supervisors are aware of the impact their self-disclosure on

social media sites may have on professional relationships. The

use of social media in the professional relationship is negoti-

ated as a part of the therapeutic contract. Educators who use

social media in their instruction have a clear social media

policy integrated into their syllabi.

Professionals who include personal information and have

contact with clients on social networking sites could likely be

described as taking part in a dual relationship. Since personal

information is exchanged, professional and personal bound-

aries could be blurred, which could impair professional judg-

ment or diminish credibility among clients and colleagues

(Lehavot, Barnett, & Powers, 2010). For this reason, profes-

sionals should seriously consider how these connections can

impact their clients. While dual relationships are not inherently

negative and healthy boundary crossing can be helpful for some

clients; such relationships will not benefit all clients, and

mental health workers should be very careful to avoid boundary

violations that could negatively affect clients (Pope & Keith-

Spiegel, 2008). Therapists should remain intentional about

deciding to access clients’ personal information and how he

or she chooses to use this information in session (Lehavot

et al., 2010). The choice should not be made to access clients’

personal information unless the therapeutic benefits outweigh

the risks and never simply to appease curiosity. Further, online

searches for client information—perhaps with the aim of veri-

fying a client’s statement—could damage the therapeutic rela-

tionship if it is not done in the context of informed consent and

collaborative therapeutic work.

Guideline 1.3: Confidentiality. To ensure ethical violations are avoided, mental health professionals take additional care when

utilizing social media in their practice. Mental health profes-

sionals protect client privacy by using encryption software

when possible and by discussing any risk of confidentiality

breach.

Total confidentiality while utilizing e-mail or social net-

working site correspondence is almost impossible (Rosik &

Brown, 2001). In addition to disclosing risks to confidentiality,

there are measures that mental health workers can take to better

protect their clients’ privacy. E-mail hosts should employ

encryption software to maintain sole access by the client and

mental health professional (Jencius & Sager, 2001; Rosik &

Brown, 2001). For example, encryption software allows access

by the two parties by granting both parties with an encryption

key to access the e-mails (Jencius & Sager, 2001). It is up to the

therapist to explain to the client the importance of protecting

the key. This will prevent access by hackers and those who may

intercept the e-mails during transmission over the Internet

(Rosik & Brown, 2001).

Mental health workers should also use a digital signature to

ensure authenticity when sending e-mails. Some universities

and institutions may have the rights to access employees’ e-

mails. This may be unavoidable in some circumstances, so cli-

ents should be informed of the risks involved. E-mails should

include a disclaimer stating the confidentiality of the e-mail

and the recipient’s privacy rights. Access to the client’s com-

puter and network should be discussed, as e-mail correspon-

dences may be accessible by others. This should be an

explicit conversation with couples and families because

e-mails may be accessible by all members of the household.

Secure networks and password-protected screen savers should

be used at all times (Rosik & Brown, 2001). Appropriate dispo-

sal of e-mails must also be implemented because of the perma-

nency of the Internet. The California Association of Marriage

and Family Therapy has already included an ethical guideline

concerning therapy by electronic means whereby marriage and

family therapists must inform the clients of the issues of confi-

dentiality. Due to the limited nature of privacy over the Inter-

net, mental health practitioners should be transparent in

explaining all of the risks involved.

The use of social media sites and online group formats may

bring up additional confidentiality issues. Practitioners should

be aware of information that may be accessed on their own sites

that could lead to the identification of clients. Practitioners

should explain the confidentiality risks to their clients if they

are interacting in online group formats, as identities may be

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revealed if accessibility is not properly understood. Because of

the risk to confidentiality, we suggest therapists do no frame

online group formats as therapy, but instead frame them as non-

therapeutic or support groups; and billing options would

change accordingly.

At the time this work was written, the authors could find no

practical solution for messaging except for through e-mail.

Social media are inherently nonconfidential and unfortunately,

there is no practical way to encrypt communication through

social networking sites like Facebook, Twitter, MySpace, and

so on.

Case vignette. A social worker who works in a rural area returns home from a stressful day at work and posts the follow-

ing as her Facebook status: ‘‘Just got yelled at by my client with

six children for inquiring about her thoughts on birth control.

I hate my job.’’ One of her friends on Facebook is aware that

a friend of hers is currently in therapy and has six children. She

then asks her friend whether the social worker is indeed her

therapist, which her friend then confirms. She tells her friend

about the status post. The client’s trust and confidentiality has

been violated and the therapeutic relationship remains dam-

aged. The client then seeks out a new therapist but remains

scarred by the violation of trust.

Guideline 1.4: Professional Competence and Integrity. Mental health professionals receive training on the appropriate and

ethical use of social media in therapy, as well as how social

media impact individuals, couples, and families. Further, pro-

fessionals assist clients in developing their own competence

in the safe/healthy use of social media.

As it is clear that social media and other web-based commu-

nications will increasingly affect therapeutic relationships in

one way or another, it is imperative for graduate programs to

include curriculum regarding online communication and social

networking in order to educate mental health workers on ethi-

cal issues related to the Internet. Graduate programs are

advised to include a focus on social media and associated ethics

within the discussion. Additionally, practitioners should seek

out continuing education opportunities to enhance understand-

ing of social media interaction and to maintain standards of

professional competence.

Guideline 1.5: Responsibility to Students and Supervisees. Training supervisors and their supervisees are aware of the impact their

self-disclosure on social media sites have on professional

relationships.

The use of clinical supervision via the Internet has been

widely successful, and given the delicate topics and issues that

arise in training for supervisees, a set of guidelines that

includes the sphere of social media and the web would be

beneficial to trainees and clients that are in their care as well

(Fenichel, 2002).

As in daily life, online interactions between supervisors and

supervisees—or students and professors—are not inherently

problematic. However, supervisors and educators should be

mindful of how they present themselves online and the tone

in which they interact with those under their care. In most

cases, adding a student or supervisee as a Facebook friend

should be avoided because of the risk of a potentially harmful

dual relationship. The unintended exposure of personal infor-

mation by either party could damage the relationship. Supervi-

sors should have conversations in supervision about the agreed

upon guidelines concerning supervision (Lehavot et al., 2010).

Additionally, as many students may be more informed about

the evolving technology, supervisors will need to educate

themselves about the current social media sites and their use

among students (Lehavot et al., 2010).

Videoconferencing in supervision is another area of ethical

concern. While using videoconferencing software in remote

areas, supervisors should take additional steps to ensure pri-

vacy. Supervisees need to consider whether anyone else

could potentially hear the conversation and take the necessary

steps to protect the clients’ confidentiality. There is also the

risk of third-party involvement, as the video may be stored

on the site’s database (Skype, for example, is completely

nonsecured). This should be taken into consideration by using

either initials or first names of the clients until security can

be guaranteed.

Case vignette. A supervisor posts his involvement in a rally against troops in Iraq on Facebook. A supervisee whose father

is stationed in Iraq and supports the war is offended by the

posts. The supervisor’s personal agenda has now leaked into

the professional relationship and may affect his impact on the

supervisee involved.

Guideline 1.6: Responsibility to Research Participants. Mental health professionals set up appropriate safeguards when

recruiting participants through social media sites. Further,

mental health researchers take all necessary precautions when

protecting the confidentiality of the participants.

To minimize the risks, researchers should be selective in

their choice of sites used to collect the data. If the participants

are to remain anonymous, the IP (Internet Protocol address; this

number is assigned to a specific computer on the Internet. This

number contains the location information of that computer)

addresses should be hidden from the researchers. Informed

consent should be explained in a way that participants under-

stand all the risks involved. When using social media sites,

researchers should be aware that friending participants on sites

such as Facebook constitutes a risk in the development of a

dual relationship.

Conclusion and Future Directions

The seven guidelines set forth here are meant to assist mental

health professionals in evaluating and monitoring their own use

of social media (Appendix B). Hopefully, the major mental

health professional organizations will make formal recommen-

dations soon. Until then, it is the onus of individual practi-

tioners to wrestle with the ethical implications of their social

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media involvement. Practitioners who choose to utilize social

media are encouraged to receive ongoing supervision and con-

sultation in how to do so ethically and effectively in their prac-

tice. For example, the AAMFT has an excellent ‘‘phone a

professional friend’’ program for these types of issues as well

as formal ethical consult procedures.

While mental health services continue to expand to include or

consider media use in practice, mental health organizations should

address these uses in the standards for their field. These ethical

guidelines could lay the groundwork for the revision of the ethical

codes for various professional organizations. Given the nature of

rapid change in social media and communication technology, ethi-

cal considerations should be reviewed and modified regularly.

Mental health professionals should become familiar with

media platforms and evaluate them for possible ethical issues

prior to using them in a therapeutic context. As technology

advances and is integrated into professional practice in the men-

tal health field, it is important for practitioners to stay informed

of the changes and possible impact on practice and training

needs. Furthermore, it is appropriate to explore the benefits of

Internet use and technology and to be aware of applicable ethical

standards.

Mental health professionals are encouraged to educate

themselves about the dangers and benefits of social media in

order to help clients make better choices in using them. We also

recommend that practitioners explore ethical practices regard-

ing the use of social media and that therapists provide input to

professional organizations to assist in the creation of appropri-

ate ethical guidelines.

Appendix A

Informed Consent Example/Therapist Does NOT Use Social Media

I have an e-mail associated with my position at the University.

You should assume that this e-mail is not secure; please do not

contact me by e-mail. Call me at XXX XXX XXX should you

need to discuss scheduling issues. In order to preserve your

confidence, I will not respond to e-mails sent by clients to

my university account.

I do not accept clients as contacts on any social media plat-

forms. I will not respond to any communication other than

phone or in-person contact. I will not attempt to find any infor-

mation you put online nor will I read anything you may send

via e-mail or social media platform.

Informed Consent Example/Therapist DOES use social media

I use e-mail for scheduling and occasional between-session

contact. I will respond to e-mails within 1–7 days. Do not use

e-mail to contact me about urgent matters. If you have an emer-

gency, you should use the contacts described below (under

Your Responsibilities). If you would like to schedule an

appointment with me more than 1 week in advance, you will

need to call me at XXX XXX XXXX. My e-mail account is

secure and encrypted. However, while my e-mail is secure,

yours may not be. You should be aware that third parties,

including your e-mail or Internet provider, may have access

to e-mails you send, meaning they are not confidential. Also,

be mindful of who else may have access to your e-mail if you

have a shared computer, shared e-mail account, or may leave

your e-mail account open on an unattended computer.

I use a professional Facebook page for the purposes of

advertising my services, connecting with colleagues, and inter-

acting with community agencies and professional organiza-

tions. I do not offer online therapy. If you post a message on

my Facebook page, or send me a personal message or e-mail,

I will not respond online. Instead, I will discuss such contact

with you in person at our next session. Further, you should

be aware that if you ‘‘Like’’ my page, others will be able to see

this connection and may make assumptions about our relation-

ship, or may ask you directly about what our relationship is. If

you make a public statement about your relationship with me, I

will not be able to confirm or deny that relationship due to con-

fidentiality issues.

I also have a professional LinkedIn page in order to con-

nect with colleagues and professional organizations. I do not

accept clients as connections on my LinkedIn profile; if you

try to add me as a connection, I will ignore that request. I

have this policy for two main reasons. First, I believe there

is a need for healthy boundaries regarding my personal and

professional life, and while LinkedIn is a professional web-

site, there is a blurring personal and professional exchange

which I would like to avoid. Second, in order to avoid com-

promising your confidentiality, I do not publicly link myself

to my clients in any way.

In addition, I do have a personal Facebook profile; however,

I do not accept friend requests from clients. If you do find my

personal profile and attempt to contact me, I will not respond to

any information I receive from you. If we have mutual friends

and happen to view each other’s information, we can discuss

possible implications and how we prefer to proceed at our next

session.

Be aware that any information you post on social media,

including Facebook or LinkedIn—even in a personal mes-

sage—is not confidential, and is considered part of a public

forum. This means anyone can legally access and share any-

thing you post on these forums. Further, as in a therapy session,

I am required by law to report anything I learn that leads me to

believe that you are a danger to yourself or others; a child is

being abused or neglected; or an elderly person is being abused

or neglected.

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Appendix B

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to

the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, author-

ship, and/or publication of this article.

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Principle I: Social Media

Mental health professionals are aware that social media in general blur boundaries (Palfrey & Glaser, 2008); therefore, mental health professionals consider how clients may perceive information through social media.

1.1: Informed consent. To avoid misunderstandings and to ensure the boundaries of the therapeutic relationship are clear, mental health professionals inform clients of their policy on the use of social media in therapy, including possible risks and communication styles (sample informed consent, Appendix A).

1.2: Multiple relationships. Mental health professionals and supervisors are aware of the impact their self-disclosure on social media sites may have on professional relationships. The use of social media in the professional relationship is negotiated as a part of the therapeutic contract. Educators who use social media in their instruction have a clear social media policy integrated into their syllabi.

1.3: Confidentiality. To ensure ethical violations are avoided, mental health professionals take additional care when utilizing social media in their practice. Mental health professionals protect client privacy by using encryption software when possible and by discussing any risk of confidentiality breach.

1.4: Professional competence and integrity. Mental health professionals receive training on the appropriate and ethical use of social media in therapy, as well as how social media impact individuals, couples, and families. Further, mental health professionals assist clients in developing their own competence in the safe/healthy use of social media.

1.5: Responsibility to students and supervisees. Training supervisors and their supervisees are aware of the impact their self-disclosure on social media sites have on professional relationships.

1.6: Responsibility to research participants. Mental health professionals set up appropriate safeguards when recruiting participants through social media sites. Further, mental health researchers take all necessary precautions when protecting the confidentiality of the participants.

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