Epic Supervision Fail


This past week social work colleagues Ericka Kimball and JaeRan Kim had an article published in Social Work entitled: “Virtual Boundaries:  Ethical Considerations for Use of Social Media in Social Work.”  It’s a good article, and more importantly it’s a nice start.  The article discusses if, when and how to use social media ethically.  The authors don’t purport to have a solution to every potential problem that social media poses clinicians, but they have some good suggestions.

I have mixed feelings about the constant yoking of “technology” to “ethics” in our profession.  (In general, not specifically the article above.) It always seems to imply that social media and ethical problems go hand-in-hand.  No other ethics issue, even patient abuse by psychotherapists, gets as much play in our current professional development course offerings, and the irony is that there is evidence to support the much higher prevalence of the latter than the former.  It seems the only way the majority of psychotherapists can get curious about social media is if somebody scares them with the idea of ethical or legal violations.

Is there an ethical dimension to integrating technology into psychotherapy?  Absolutely.  It’s just not the only dimension.  And the problem with always focusing on ethics is it often encourages fear-mongering and contempt prior to investigation.  Part of the problem is that most of the people talking about ethics and technology in clinical practice have little to no experience with the technology side of things.  And as a result, they can’t engage us with ideas and brainstorming, but instead often adopt the fall-back of “you need to be careful.”

The result is that many clinicians get understandably scared:  You told me something is dangerous, and that the only solution is to be careful.  So seasoned clinicians often adopt what I call the “just say no” attitude.  Firewalls go up.  Patients can’t be emailed.  Agencies adopt no-Facebook policies, and in general evoke an air of monasticism.  I have even heard cases where clinicians are told they need to renounce having personal social media.  Though Shalt Not Tweet.

Into this  “just say no” milieu come our trainees.  Many of them are digital natives, and have been wired for technology in a way we digital immigrants may never be.  In many cases they are more digitally literate than we are.  They come into their supervision sessions with questions about cell phones in the office, suicide posts on Facebook, and being followed by patients on Twitter.

And they get “just say no.”

So let’s get real a sec here.

The Pew Internet Research Group states that roughly two-thirds of North Americans are on Facebook.  It, along with other social media, has become a primary source of communication and shaper of culture for our society.  This means that a majority of our trainees and their patients are probably using it.  We can’t just say no.  We can’t just say, “be careful out there.”  Our trainees look to us for supervision, and understanding social media and technology is part of 21st century clinical work.

I can’t tell you how many times I have heard horror stories in my classes about how supervisors fail their students this way.  And I get emails detailing, for example,  how a young clinician tried to bring up the positive impact of social media to a supervisor: “I thought her head was going to implode.”

Psychotherapy has a past history of using innovations in technologies to enhance our work, and our theoretical models.  Freud used the newer technologies of hydraulics to explain drive theory.  Similarly, advances in thermodynamic technology helped pave the way for family systems theory.  By now, many of the principles and parallels of those technologies have become so commonplace in our lives and understanding that we don’t even connect them with being familiar with technology.

Historically technology creates a period of suspicion and confusion before integration into culture.  A favorite example of mine is this:


Prior to the Gutenberg printing press, books were a much rarer technology.  In the 8th Century, approximately 12,000 books were published in all of Western Europe; by the 18th century that number had risen to 1 billion.  As this technology became cheaper and more easily accessible, literacy rose.  But this was also a time when things got overwhelming.  When you had a handful of books read by a handful of people, the knowledge in them was much easier to locate.  But when the number of books and readers increased, there was an overwhelming amount of information to remember and locate.  The book index was the technology we came up with to solve that problem, but we needed to experience the technology as problematic before a solution was necessary.

Today we take indices, books and literacy largely for granted.  We know how they work, we aren’t afraid of them.  If anyone wanted to hold a workshop on the “Ethical Considerations of Printing” they’d be hard-pressed (heh) to get anyone to attend.

So now we find ourselves faced with a new technology, one as revolutionary in many ways as the printing press.  Only this time we are the generations that need to get used to it and confused by it.  And it’s risky and scary, because we don’t fully understand its implications yet.  But just as we wouldn’t have wanted our ancestors to forbid us to read and write, we need to let our trainees learn how to use the newer technology of social media in our lives and work.  And to do that, we need to learn it too.

This takes time, and it takes someone with expertise to teach you.  So before you hire a consultant, keynote speaker, or workshop presenter to talk about social media or technology in general, ask yourself, and them, these questions:

1. What do you plan to teach me beyond ethics about technology?

2.What strategies can you help me and my agency deploy besides be careful or “Just say no.”

3.What if any experience do you have with technology? Do you use social media? Professionally? Personally?

Just asking potential consultants those 3 questions could save you or your professional organization a lot of money down the line, as well as make the difference between helping you embrace innovation or stagnation.

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  1. I recently had an employee (not a therapist but a mental health worker on my team) Like a client’s Facebook post. I immediately called this out as it goes against our agency’s policy but I did talk to my supervisor about the positive effects it may have had. In this case, the client was lacking any sort of support from friends or family and was even bullied on Facebook. One day she posted a positive status update about something she was happy about and my employee (who also volunteers somewhere else from where she knew the client, before she was an agency client) Liked the post as a show of support. The client was so happy she mentioned it to me in a session. Examples like these demonstrate some of the possible benefits of creating a thoughtful technology policy instead of “Just say no.”

  2. Mike,

    Thanks for this perspective. I agree that for a supervisor to adopt a -head in the sand- approach about the place of social media in a clinical practice does little good for a supervise who has likely already been way more exposed to the tech and genuinely needs some guidance.

    I’ve always been a tech-forward geek and worked on ways to integrate tech developments into my clinical practice. Funny, my introduction to FaceBook occurred in 2007 while I was in art school and on a sabbatical from my clinical practice (and away from many of my technophobe colleagues).

    Many years before that, I was building my own practice websites while peers were asking “Why are you doing that?” (and later they asked “HOW are you doing that?”).

    My most recent social media / technology related ethical dilemma had to do with switching from a static online presence to a more *live* and dynamic 1st person presence. Yes, it was a bit nerve wracking trying to anticipate and think through this next-step of developing and marketing my practice.

    I do believe that the integration, of this technology, by any clinician should pose ethical dilemmas, but certainly not dilemmas to be avoided with an “I don’t do computers!” attitude. Here’s what I did: I stopped, again and again, mapped it out and thought it through and I got consultation from a clinician who is also an expert in web design and social media. I pressed ahead and launched the thing and then made (and continue to make) corrections along the way.

    Learning to manage our boundaries in cyberspace is a necessary next step for us professionally. It requires reason, training, consultation, courage & compassion (any of these qualities sound familiar?).

    I do *tweet* and it is most always done with an eye toward driving traffic to my website and converting some small percentage of those visitors into a potential new patient/client or a referral source. I maintain 2 separate FaceBook accounts One is for my life as a Clinician another is for my life as an Artist. I participate in discussions and make recommendations on LinkedIn (again with an eye toward marketing my practice and learning some new things along the way). I regularly work to maintain the reigns on my privacy and always try to remain conscious that what I post may escape the boundaries of FaceBook, LinkedIn and others.

    And No… I don’t accept friend requests from my patients / clients (but we do discuss and
    process this issue and work to anticipate / repair any attachment ruptures that may occur
    because of it.).

    P.S. or BTW – If you care to see my art (informed by my clinical work) I’m happy to
    give you that web address by request.

  3. Well said! This reminds me of some discussions of boundaries in general. We are often given black and white instructions about proper therapist-client boundaries without attention to context or the possibility that intentionally and thoughtfully bucking the standard may actually be therapeutic in a positive, lasting way.

    I often see that when we combine reactivity around boundaries with reactivity around tech, the result is highly conservative, risk aversive and frequently alarmist at the cost of useful therapeutic interventions at best (such as the one that Josué mentions), and harmful to clients at worst (such as missing that tweet or text that announces suicidal intentions.)

  4. I write a blog on technology and social work too, Mike. I am going to be doing research for my dissertation on technology and social work. It is time our profession acknowledge it as a cultural theme, not just about ethics.

  5. Great way to start the discussion because many of us are trying to figure out how best to utilize social media with our clients without losing our personal space. I have definitely heard the classic head in the sand warnings about social media first hand in a recent conference regarding ethics.

  6. Allie Hewitt says

    I love this post. I got a link to it from the Facebook page of the MSSW program I plan on attending in the fall. After reading this post, I browsed around the rest of your site and noticed you play WoW, which is cool because I play WoW too. In this post you discuss the potential ethical dilemmas of therapists incorporating social media into their practice as it is new territory for practitioners. Unfortunately, with social media on the rise, it is inevitable that people may post about their suicidal tendencies on their Facebook or Twitter. However, what is more unfortunate is that there is no real solution in terms of dealing with that. What also scares me is when people express these tendencies in video games, where most of the time you won’t even know a person’s real name. It will be interesting to see how this develops over the next few years, given the prevalence of social media and online video games in our society.

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