_____________________________________________________________ Managing Professional Boundaries
alike knowingly and willingly post personal information on various social media sites. Accepting a client’s “friend” request or a client “following” you on your social media accounts are potentially problematic. Loss of therapist privacy, loss of therapist objectivity in treatment, inappropriate therapist self-disclosure, or issues with power differentials may come into play. “Friending” a client may lead them to believe that a relationship exists outside of the online platform. Becom- ing social friends with a former client deprives them of the therapist’s professional services if they need therapy in the future and may create unrealistic expectations on the part of the client if they see a new therapist. Fortunately, some of the professional ethics codes do address the issue of connecting with a client on social media. • NASW (2017) states that social workers should be aware that posting personal information on media sites might cause boundary confusion, inappropriate dual relationships, or harm to clients. The code specifically states that social workers should avoid accepting requests from or engaging in personal relationships with clients on social networking sites (Standard 1.06). They should avoid communication with clients using technology such as social networking sites, texting, or online chat for personal or non-work-related reasons (Standard 1.06). • NBCC (2023) states that counselors shall avoid nonprofessional relationships with clients online, and the restriction includes connecting with or following client social media accounts (Standard 114). • ACA (2014) states that counselors are prohibited from engaging in a personal virtual relationship with current clients through social and other media (Standard A.5.e). • In contrast, the most current Ethical Principles of Psychologists (2017) does not address standards for social media use. However, when considering the principles of privacy and confidentiality and avoidance of multiple relationships, it can be inferred that social media relationships may cross that ethical boundary. PRIVACY AND SECURITY Healthcare professionals should keep separate personal and professional profiles on social media accounts and are encour- aged to objectively assess and review their privacy settings on all social media accounts and their motivations for those settings. The NBCC Code of Ethics (2023) specifically states that counselors must be familiar with the use of privacy and security settings of social media (Standard 110). It is also advisable for the therapist to always stay mindful of what they do post on their accounts, knowing that clients may be able to get around privacy settings and access the information. In addition, even with privacy restrictions, many social media
platforms allow people to tag others, which could link the profiles of close family members or friends of the therapist. Baier (2019) reports that 70% of clients surveyed in a large study admitted to finding personal information about their therapist online, but less than one quarter of them told their therapist about it. She reminds the therapist that their online information is easily available and is usually used for benign, curiosity reasons. However, in rare cases the information can be used to facilitate stalking, threatening, or harassing of the therapist or the therapist’s close relationships. Therefore, social media use poses potential problems not only to the client, but to the clinician as well. How might a client’s access to the therapist’s social media accounts, by client search or by therapist “friending,” impact therapy? Can it interfere with therapeutic progress? How does knowledge about the therapist’s personal life impact the client’s perception of, and trust in, the therapist? As examples, apply these questions to the following scenarios: • Dr. Jones is very active on multiple social media platforms and posts prolifically. He has numerous pictures of himself at parties with friends, clearly enjoying alcoholic beverages. Mr. Client has presented for therapy for longstanding issues related to alcohol abuse. When he searches and views the pictures, will it affect his trust in Dr. Jones’s ability to help him? • When Dr. Jones gets home from work, he posts
on his status update how exhausted, frustrated, and angry he is because he had a particularly difficult day at work. The post does not violate confidentiality yet how might Mr. Client, who had a session with Dr. Jones that day, interpret this post?
SETTING SOCIAL MEDIA BOUNDARIES The therapist must stay mindful to maintain patient confi- dentiality and privacy in all settings. They should maintain appropriate boundaries with clients on the internet just as they would in person and recognize that one’s online actions may affect one’s professional reputation and career. Having a clear written policy about online and social media activity should be discussed and made part of the client’s chart. If the therapist is considering a social media boundary crossing, they must first carefully examine multiple factors including the therapist’s motivation for the crossing, the level of therapist–client power differential, the extent of potential role conflict of interest, and the potential for harm to the client or third parties. Baier (2019) offers eight suggestions and guidelines for clini- cians who choose to have a presence on social media platforms: 1. Increase anonymity—Providers should explore use of pseudonyms. They should block public view of friend lists, birthday, hometown, educational background, and relatives.
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