Professionals - Paper Answers

See the articles attached. In recent years, the psychology profession has been greatly influenced by various forms of technology. The prevalence of psychology professionals using technology to market themselves and engage, socialize, and interact with others has created new opportunities and challenges. This is particularly true with regard to potential interactions with clients via these technologies. Given the exponential growth with which these technological advancements are permeating our world, we expect to see the proliferation of new issues, challenges, and opportunities within the realms of psychological research and practice.PLEASE ADDRESS ALL THE FOLLOWING POINTS(1)Provide an overview of the relevant issues, ongoing trends, challenges, and future opportunities for psychology professionals and the populations they serve(2)Explain how the APA’s Ethical Principles of Psychologists and Code of Conduct can be used to guide decisions in the ethical application of these technologies(3)Construct clear and concise arguments using evidence-based psychological concepts and theories to explain how current technological and policy shifts may influence trends in psychological research and practice(4)Evaluate potential work settings where the use of technologies promotes ease and convenience for both psychology professionals and the populations they serve(5)What are the potential responsibilities of the psychology professionals as providers of care with regard to the use of these technologies? (6)Does the increase in ease, convenience, and experience satisfaction for the parties involved outweigh any potential negative outcomes?

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendments.

(Links to an external site.)

Retrieved from http://www.apa.org/ethics/code/index.aspx

Bratt, W. (2010). Ethical considerations of social networking for counsellors. Canadian Journal of Counselling and Psychotherapy, 44(4),335–345. Retrieved from http://cjc-rcc.ucalgary.ca/cjc/index.php/rcc

DiLillo, D., & Gale, E. B. (2011). To Google or not to Google: Graduate students’ use of the Internet to access personal information about clients. Training and Education in Professional Psychology, 5(3), 160–166. https://doi.org/10.1037/a0024441

Kaslow, F. W., Patterson, T., & Gottlieb, M. (2011). Ethical dilemmas in psychologists accessing Internet data: Is it justified? Professional Psychology: Research and Practice, 42(2), 105–112. https://doi.org/10.1037/a0022002

Kolmes, K. (2012). Social media in the future of professional psychology. Professional Psychology, Research and Practice, 43(6), 606.

Lehavot, K., Barnett, J. E., & Powers, D. (2010). Psychotherapy, professional relationships, and ethical considerations in the myspace generation. Professional Psychology, Research and Practice, 41(2), 160. https://doi.org/10.1037/a0018709

Tunick, R. A., Mednick, L., & Conroy, C. (2011). A snapshot of child psychologists’ social media activity: professional and ethical practice implications and Recommendations. Professional Psychology, Research and Practice, 42(6), 440.

Van Allen, J., & Roberts, M. C. (2011). Critical incidents in the marriage of psychology and technology: a discussion of potential ethical issues in practice, education, and policy. Professional Psychology, Research and Practice, 42(6), 433.

Critical Incidents in the Marriage of Psychology and Technology:
A Discussion of Potential Ethical Issues in Practice, Education, and Policy

Jason Van Allen and Michael C. Roberts
University of Kansas

We identified critical incidents in psychologists’ use of technology in their service provision with clients.
Study coordinators sent messages out to various listservs requesting that practicing psychologists respond
to an online survey for their reports of how the integration of certain technology advances (e.g., e-mail,
electronic health records, social-networking websites, etc.) may have compromised client privacy or
confidentiality. Twenty-eight participants responded to the survey and noted a variety of concerns,
including themes of (a) unauthorized access to electronic client records, (b) inappropriate dissemination
of client information via technology, and (c) unique client concerns associated with social-networking
websites (e.g., Twitter, Facebook, etc.). We discuss ramifications and strategies related to these ethical
concerns in education, practice, and ethical standards and principles.

Keywords: technology, critical incidents, ethics, confidentiality, internet

Psychologists today utilize a vast array of technological ad-
vancements in their interactions and service provision with clients
(McMinn, Bearse, Heyne, Smithberger, & Erb, 2011). These ad-
vancements (e.g., electronic medical records, e-mail communica-
tion, telemental health, etc.) have proved beneficial in many ways,
because they have the potential to make clinical settings more
efficient, to improve psychotherapy services, to provide services to
underserved populations (e.g., in rural areas), and to facilitate
communication between health professionals in a variety of set-
tings. Unfortunately, professional psychologists have also identi-
fied a number of disadvantages associated with the increased use
of technology in psychological practice, including difficulties in
managing electronic database and communication security, unau-
thorized access to client data, inappropriate disclosures of identi-
fying information, and unethical interactions in the social-media

context (e.g., Facebook, Twitter, etc.), among others (Barnett &
Scheetz, 2003; Koocher & Keith-Spiegel, 1998; Lehavot, Barnett,
& Powers, 2010).

In response, organizational leaders have been warning psychol-
ogists about these challenges for years in publications on profes-
sional ethics and conduct. For example, more than a decade ago
Koocher and Keith-Spiegel (1998) noted some of these
technology-related concerns and reiterated similar concerns more
recently (2008):

Modern telecommunications and computers have substantially com-
plicated matters. Massive electronic databases of sensitive personal
information can easily be created, searched, cross tabulated, and
transmitted around the world at the speed of light. Even prior to the
Internet and the World Wide Web, mental-health professionals ex-
pressed concerns about the threats posed to individual privacy and
confidentiality by computerized data systems (Sawyer & Schecter,
1968, p. 192).

They further described how these technological advancements
can create ethical and legal concerns, especially in terms of pro-
tection of confidentiality and privacy of clients. Noting the impor-
tance of these issues, the 2009 Presidential Task Force on the
Future of Psychology Practice (American Psychological Associa-
tion, [APA], 2009) recommended that psychologists be specifi-
cally trained “to use and integrate technologies to provide quality
services” (p. 5). Although these warnings and recommendations
are helpful, imbalance between technological applications and
ethical standards may persist until the ethical and competent use of
technology becomes integrated within instruction at the graduate
education and professional levels (e.g., as part of continuing edu-
cation).

To further complicate matters, regulatory, ethical, and legal
standards in psychology are not advancing at the same rate as
technological advances. This technological adoption and infra-
structure mismatch is associated with a variety of potential chal-
lenges and concerns (e.g., psychologists operating without guid-

This article was published Online First October 31, 2011.
Editor’s Note. This is one of 19 accepted articles received in response to
an open call for submissions on Telehealth and Technology Innovations in
Professional Psychology. Jeffrey Barnett served as the action editor for this
article.—MCR

JASON VAN ALLEN received his MA in clinical child psychology from the
University of Kansas. He is a graduate student in the Clinical Child
Psychology Program at the University of Kansas. His areas of research and
practice include professional issues, technology in psychology, clinical
child/pediatric psychology, and positive psychology.
MICHAEL C. ROBERTS received his PhD in clinical psychology from Purdue
University. He is director of the Clinical Child Psychology Program at the
University of Kansas. His areas of research and practice include profes-
sional issues, therapeutic outcomes and program evaluation, mental health
and service delivery, and clinical child/pediatric psychology.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Mi-
chael C. Roberts, 2009 Dole Human Development Center, Clinical Child
Psychology Program, 1000 Sunnyside Avenue. University of Kansas,
Lawrence, KS 66045. E-mail: mroberts@ku.edu

Professional Psychology: Research and Practice © 2011 American Psychological Association
2011, Vol. 42, No. 6, 433– 439 0735-7028/11/$12.00 DOI: 10.1037/a0025278

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ance from the professional organizations or with a consensus of the
professional community). The ethical standard 4.02 (c), Discussing
the Limits of Confidentiality, of the American Psychological As-
sociation’s Ethics Code (APA, 2010) states: “Psychologists who
offer services, products, or information via electronic transmission
inform clients/patients of the risks to privacy and limits of confi-
dentiality” (p. 7). This standard refers to direct psychological
services through technology, but does not address the extent to
which psychologists should inform clients/patients (or be knowl-
edgeable about) how technology can influence privacy and confi-
dentiality in other ways, outside of direct communication between
the therapist and the client/patient.

As an analogy, this technology/regulatory–infrastructure mis-
match has been likened to citizens of the 1880s waking up with
shiny new sports cars, but being forced to drive them on the
transportation infrastructure in place at that time (e.g., grass and
dirt roads; Maheu, 2010). In this example, the psychologist
“driver” has the tools to do exciting new things, but the current
infrastructure is not developed in a way to support “testing” these
tools without considerable risk. The analogy extends further, in
that technology (like many brand new cars) can be difficult to
completely understand without some training, but that does not
always prevent drivers from using the new car anyway. In the same
way that one might worry about endangering oneself and the new
car on an underdeveloped surface, many psychologists worry
about the potential harm to clients inherent in the use of technol-
ogy. This potential harm is significantly increased when the pro-
vision of psychological services using technological advances is
conducted without the same regulatory depth offered within other
contexts.

Behnke (cited in Martin, 2010) stated that the APA Ethics Code
was written in a broad enough way to indicate that the same ethical
standards apply in technology settings (e.g., social media) as they
do in traditional contexts of practice; in the Introduction and
Applicability section of the APA Ethics Code (APA, 2010), it
states that the Ethics Code applies to activities “across a variety of
contexts, such as in person, postal, telephone, Internet, and other
electronic transmissions” (p. 1). However, the application of these
ethical standards can be more challenging when the psychologist
may be inexperienced with an advancing technology and therefore
does not understand some of its inherent risks. Some psychologists
may be less adept at utilizing new computer applications or slow
to adopt new web-based features developed for psychological
practice. Even those experienced in certain digital media and
electronics may have a poor understanding of the potential for
problems. Emerging generations and early career psychologists,
because of their comfort level and familiarity with online applica-
tions, may have less caution or suspicion. Having grown up with
technology is no guard against its misuse, however. In our expe-
rience, naı̈veté is demonstrated daily by psychologists in the post-
ing of personal information on social-networking websites, for
example, including potentially compromising photos and com-
ments that might harm job prospects or psychotherapeutic rela-
tionships. Whatever the generation, psychologists cannot be ex-
pected to be skilled experts in all technology applications, or in
technological security. Nonetheless, standards within the Ethics
Code could suggest and outline appropriate consultation between
psychologists and technology experts, or appropriate education
from psychology organizations or institutions (such as universities

or hospitals) regarding how various technological applications
may affect health care providers and their adherence to ethical
standards.

Despite the above-mentioned concerns, few investigations have
attempted to more directly assess the primary areas of technolog-
ical concern among psychology professionals. In one of the few
investigations in the literature, McMinn, Buchanan, Ellens, and
Ryan (1999) surveyed psychologists about the rate of occurrence
for a number of technology-related events in their practice (e.g.,
faxing client information to the wrong location, exchanging
e-mails with clients), as well as their ethical evaluation of those
events when they occur. Results from this survey suggested that
professionals utilized technology frequently in their service provi-
sion, and that the majority of this technology use occurred in the
administrative activities of a psychological practice rather than
using technology for direct psychotherapy. However, much has
changed in many ways since the late 1990s. Professionals and
health care organizations and institutions are increasingly commu-
nicating and sharing documents and personal health information
electronically because it provides a fast, efficient, and more cost-
effective method of information sharing than facsimile or postal
services. In addition, the number of professionals using technology
for direct psychotherapy has increased significantly (e.g., the in-
creased use of telemental-health services; Reed, McLaughlin, &
Milholland, 2000; Van Allen, Davis, & Lassen, 2011).

Although an extensive updated survey by McMinn et al. (2011)
has recently been conducted to help identify common technology
uses for psychologists, identifying critical incidents of problems
should be (a) useful for practitioners as cautionary examples; (b)
important to potentially make future research more parsimonious
and targeted to significant situations; (c) useful for providing
helpful information for guiding training offered to graduate stu-
dents and professionals; and (d) helpful to future revisions of the
Ethics Code and other regulatory efforts. As called for by Baker
and Bufka (in press), this critical-incidents survey is designed to
gather information about problems that health professionals are
encountering in their use of technology. For example, issues re-
garding client confidentiality and privacy are likely common eth-
ical issues related to technology (as alluded to by Koocher &
Keith-Spiegel, 2008), and such confidentiality issues have been
reported as the area of greatest concern in certain therapeutic
contexts (Barros-Bailey & Saunders, 2010). Considering that
e-mail consultation, teleconferencing and videoconferencing, elec-
tronic client records, flash drive storage, Internet-based storage,
and the use of social-networking media are very common today,
new opportunities arise for violations of confidentiality and pri-
vacy that are directly related to the technology itself.

We report here a qualitative survey study to identify critical
incidents that elucidate areas of concern among psychology pro-
fessionals in regard to the integration of technology in their daily
occupational activities. We expected that participants would most
often report technology issues related to their or others’ activities
that involved interactions with clients or client data; therefore,
initial study questions were focused on such instances. Nonethe-
less, we also noted the possibility of other technology difficulties
that could interfere with professionals’ service provision, so we
included such possibilities in the survey. In addition, this study
questioned participants on their experiences with clients and
social-networking websites (e.g., Facebook and Twitter). The eth-

434 VAN ALLEN AND ROBERTS

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ical issues associated with such websites have been discussed in
detail by Lehavot et al. (2010), but that survey only included
graduate students. The present report uses survey responses to
identify critical incidents in order to raise ethical implications,
develop possible quantitative research to establish prevalence
rates, foster discussions among professionals about more effective
or safe technological options in various contexts, and evolve more
specificity in the Ethics Code.

The Survey

Recruitment and Participants

Participants included 28 individuals recruited from a variety of
listservs, including practice listservs and listservs of state psycho-
logical associations. Following listserv approval, a message was
sent out to each listserv that described the purpose of our survey,
noted institutional review board approval, and provided a link to
the Qualtrics web-based survey. Consent was obtained from their
participation in the anonymous survey. The e-mail solicitation for
the survey of critical incidents asked for responses only from those
who had technology issues to report. The e-mail solicitation re-
quested participation from practicing psychologists and their inci-
dent responses indicated situations in practice settings. In an effort
to keep the survey as brief as possible, demographic questions
were not included and we did not solicit information regarding
each participant’s employment setting.

Questions

This survey and subsequent response-evaluations were con-
ducted using the Critical Incident Technique (CIT), which has
been used in numerous investigations as an effective small-sample
methodology to identify important points of consideration for
future research, regulations, and education (Bedi, Davis, & Wil-
liams, 2005; Patrick, Scrase, Ahmed, & Tombs, 2009; Schluter,
Seaton, & Chaboyer, 2007; Woolsey, 1986). The CIT is especially
advantageous for areas of inquiry that are not yet well established,
that would benefit from exploratory theory development, and that
include a wide range of potential circumstances and responses. A
large sample of participants is not necessary to generate a range of
critical incidents to analyze and discuss in terms of ethical impli-
cations. Strategies of the CIT used in this study include (a) estab-
lishing inclusion criteria for responses, (b) reviewing all responses
before establishing general themes, and (c) sorting responses into
identified themes. Inclusion criteria for responses in this survey
required that responses referred to behaviors of a psychologist
working in the field and that the behaviors were related to the use
of technology (broadly) or social-networking websites, and that the
behavior involved a psychologist’s client(s) in some way. Given
the introductory nature of this survey, the questions were very
broad and psychologists were asked to describe their experiences
in an open-ended format if they responded “Yes” to any of the
questions listed below:

1. “Have you had any experience with client information being
compromised through technology? In other words, do you know of
any times in which someone has seen your client’s information
who was not authorized to see it through a breach in technology of
any kind? A breach of technology may include someone accessing

a file electronically when they were not authorized, someone
accessing an e-mail regarding a client that they were not autho-
rized to access, someone purposively breaking into the network/
client database that holds your clients’ information, and so forth?”

2. “Have you ever heard about situations in which another
professional’s client information has been compromised?”

3. “Have you experienced any technology-related issues with
clients other than the potential issues mentioned above?”

4. “What experiences have you had with Facebook, MySpace,
Twitter, and so forth with regard to clients? Any experiences with
these websites would be helpful, considering the recent emergence
of these websites as potential concerns regarding privacy, confi-
dentiality, and professional interactions.”

Results for Category Selection

Similar to other surveys utilizing the CIT methodology (as
described above), responses to the above questions were subse-
quently grouped into categories that may elucidate common areas
of concern among respondents solicited via psychology listservs in
the context of technology and client information or interactions.
The most common concerns expressed by participants included (a)
experiences— either personal or relayed from a colleague—in
which client data were compromised (generally as a result of
unauthorized access to patient information); (b) inappropriate
e-mail communication regarding clients; and (c) unique challenges
or concerns with social-networking websites. The discussion that
follows focuses on each of these common concerns expressed by
participants.

Discussion

Overall, survey responses suggest a variety of technology-
related concerns among practicing psychologists. Responses were
frequently associated with inappropriate access and/or dissemina-
tion of client data, and challenges with the use of social media.
Although APA has noted that general ethical standards apply to the
provision of psychological services in all contexts, psychology’s
governing body has not provided explicit standards associated with
the advancing and permutating hi-tech world.

In order to promote discussion and research, and to help identify
particular contexts noted as challenges in regard to technology, we
have included some verbatim responses and descriptions of situ-
ations noted by the participants of this survey. Following each
response and description is a summary of its unique challenges and
suggestions for appropriate response.

Compromises to Client Data

Example 1 (Inappropriate E-Mail Communication
Regarding Clients)

I sent an e-mail to a custodial caseworker regarding a minor child/
client. Within a couple days I was receiving e-mails from people I did
not know regarding the client. Apparently, the caseworker had for-
warded the e-mail to others, who then forwarded it to others, and so
forth The information in the e-mail was only intended for the case-
worker.

435SPECIAL ISSUE: CRITICAL INCIDENTS IN THE USE OF TECHNOLOGY

In this example, one can see how easy it is to have confidential
client information inappropriately disseminated via e-mail.
Though it is more efficient for health professionals on busy sched-
ules to utilize e-mail for interdepartment communication, the
above situation demonstrates the inherent challenges of electronic
communication that is exacerbated by its convenience and haste.
Although professional psychologists cannot control the behavior
of others with regard to e-mail (or removing confidential papers
from an office two decades ago), psychologists can ensure that
they only exchange confidential e-mails with other professionals
they trust, they can remind each person they communicate with
that the information is confidential and for “their eyes only,”
and they can conservatively communicate with outside profession-
als via telephone or postal services. Although telephone and postal
service communications are subject to compromises as well (e.g.,
mailed letters can be copied and disseminated inappropriately, and
telephone conversations can be recorded or misinterpreted), it is
likely that the convenience of e-mail makes such compromises
more likely, especially in situations that involve unintended com-
promises (e.g., sending a message via “reply to all” vs. “reply”
when responding to a listserv communication or an departmental
e-mail).

Example 2 (Unauthorized Access to Patient
Information)

We had a suicide at a hospital where I recently worked. The news
spread through the hospital (patients and staff) like wildfire and before
IT services could lock down her chart, several people had entered into
her chart, ‘to see what happened.’

In this example, a dramatic event led to increased interest in a
particular patient’s file and numerous hospital employees accessed
this patient’s file to appease their own curiosity. It is likely that
some of these staff members were not part of this patient’s treat-
ment team, and there was no need or authorization for this specific
access. Examples such as these elucidate the importance of infor-
mation technology (IT) departments and effective software that
can serve as effective “gatekeepers” for client records (cf., Rich-
ards, 2009).

Example 3 (Inappropriate E-Mail Communication
Regarding Clients/Technology Policy Not Discussed
Proactively)

Client finds my e-mail address online and sends me an e-mail regard-
ing an update on status or to ask a question. There is a procedure for
information going out from my [institution] (“PHI” in the subject line
allows the message to be encrypted), but not coming in. Also, my
Blackberry is not equipped to encrypt messages from patients so if a
patient sends me one, anyone can open the message on my Black-
berry.

This example illustrates the ways in which clients themselves
can pose risks to their own confidentiality. Obviously, it is not
reasonable for psychologists to be without e-mail addresses in
order to avoid these types of interactions. However, it is possible
for psychologists to keep their personal e-mail addresses private;
in addition, some psychologists have more public e-mail ad-
dresses, but explicitly note that clients should only e-mail the

psychologist for appointments because they do not deliver psycho-
logical services via e-mail. It may also be beneficial to tell clients
before the start of treatment that e-mail exchanges can compromise
their confidentiality, as this may not be readily apparent to them.
In addition, this example describes the dangers of interacting with
clients via “Smartphones” or other portable devices with Internet
access, because confidential information could easily be accessed
by anyone who picks up such a device and the data can be
“hacked” through cell provider networks and/or wireless Internet
networks.

Concerns With Social Networking

Example 1

Have a Facebook account, but don’t use it frequently. But have seen
the sites of some people I work with. If I was working with them
professionally, I would feel embarrassed or even shocked at some of
the personal information available.

As previously mentioned, there are many challenges associated
with Facebook and other social-networking sites (such as My-
Space and Twitter) in regard to client and psychologist interaction.
A psychologist’s reputation and credibility could potentially be
harmed in situations similar to that described above, based on the
material posted to various websites. Psychologists should assume
that their clients will search for their profiles on social-networking
websites, and take the necessary precautions to ensure that they
have effectively privatized their profiles to the degree that they
desire.

Example 2

Patients have tried to find me on Facebook. If they mention that they
use the site or ask if I do, I tell them to not attempt to “friend” me as
I do not accept patients as “friends” on that site. I explain how their
confidentiality could be compromised and that usually takes care of it.
As an added measure, I don’t have my actual picture as the findable
picture.

Even when psychologists have adequately addressed their de-
sired privacy settings, they may still receive “friend requests” from
clients. These possibilities force psychologists to accept, reject, or
ignore the request, each presenting unique challenges of their own
in a psychotherapeutic relationship. In this example, the psychol-
ogist takes a conservative approach by not accepting patient friend
requests and is up front with clients and patients regarding the
reasons for such an approach.

Implications for Psychologists

The above examples demonstrate the vast array of potential
compromises to client data that might be directly related to psy-
chologists’ use of technology. This survey provided critical inci-
dents for ethical consideration in mental-health situations involv-
ing electronic records, e-mail, social networking, and others. Many
of these ethical issues can be attributed to the swift adoption of
new technologies without evaluating their potential risks; still,
others may be aware of the risks, but partially dismissive of the
likelihood that they themselves will face such consequences. Al-

436 VAN ALLEN AND ROBERTS

though the base rate occurrence of such events is unknown, it is a
psychologist’s responsibility to limit potential risks to clients that
can be attributed to their own actions; it may be a mistake for a
psychologist to assume that such ethical concerns are rare, and thus
that they do not need to attend to such risks.

Sometimes, organizations may hold significant responsibility to
reduce risks of compromises to client information. For example,
some hospitals utilize software that provides hospital administra-
tion the ability to track each instance of access to a patient’s file,
giving them a date, time, and username for each instance (Rich-
ards, 2009). Other hospitals only provide access to psychology
records to physicians and psychologists. The latter is an example
of a more proactive management strategy, whereas the former is
more reactive but still provides organizations with the ability to
address unauthorized activity if it occurs. Educational guidelines
for trainees and professionals can also significantly influence how
professionals use technology in their service provision. Training at
this level is important, because it is unlikely (and probably not
feasible) for the standards of the Ethics Code to be written with the
goal of addressing these ethical concerns with technology in great
detail. Instead, similar to other issues that are mentioned in the
standards but not comprehensively described, issues of technology
should be addressed thoroughly in graduate training, organiza-
tional training, and continuing education programs for trainees and
professionals alike. Graduate instructors could incorporate discus-
sion regarding specific issues related to technology in ethics
courses (which are required for APA-accredited graduate pro-
grams and for professional licensure), and directors of training
clinics could begin incorporating social-media policies for their
trainee clinicians and/or as part of the informed consent process for
the clients in their clinics.

At the individual level, professionals can limit their responsi-
bility and involvement in compromising client confidentiality in a
number of ways. In fact, proactive decision making and practice
standards may be the most effective risk-reduction strategy of all,
because it can provide psychologists with the opportunity to set
predetermined expectations for clients who may not realize how
their own confidential information can be compromised via tech-
nology applications. For example, psychologists could make their
e-mail communication and social-networking expectations clear to
clients during their initial visit. Kolmes (2010) has developed an
extensive social-media policy (available for adoption and editing
for other professionals at http://drkkolmes.com/for-clinicians/
social-media-policy/) that can be given to clients before they meet
with the psychologist in an effort to proactively address potential
problems (e.g., compromises to confidentiality) that arise as a
result of electronic communication. This social-media policy, and
discussion of this policy with clients, is an important aspect of the
informed consent process, because it helps clients understand the
scope of their relationship with the psychologist and the contexts
in which they can expect to receive responses and services from
their psychologist. Kolmes encourages clients to understand that
interactions via the Internet can represent information that would
be included in a client’s medical record and is available in the
public domain. Specifically, Kolmes (2010) addresses the various
challenges associated with Internet blogs and social-networking
profiles, and how such activities relate to interactions with clients.

Other methods to reduce the likelihood that psychologists face
client concerns on social-networking websites include altering

social-networking profiles in such a way to be less “visible” to a
general search of the psychologist’s name. The default privacy
settings on Facebook, specifically, allow any Internet user to view
all pictures and communications on the professional’s profile, and
there is a learning curve to effectively manage a profile’s privacy
settings separately for personal versus professional accessibility.
Psychologists may also benefit from the knowledge that many of
the social-networking sites include privacy settings that prevent
individual profiles from being displayed when someone conducts
a search under a specific name. Separate personal and professional
social-networking sites might also be a viable solution if carefully
maintained. Overall, creating blogs, social-networking profiles,
and other individual web-based forums is a personal choice, and if
maintaining privacy on any of these accounts proves difficult it
may be beneficial to consider removing some accounts altogether.

The portability of various technology applications via cellular
telephones (e.g., “smart phones”), tablets (such as the iPad), and
similar electronics have introduced other unique challenges for
psychologists in maintaining confidentiality for clients. For exam-
ple, cell phones with Internet access present the possibility that
psychologists may check their e-mail or social-networking profiles
while they are traveling or otherwise away from a computer.
However, the security infrastructure that may be available as a part
of one’s organization (e.g., e-mail encryption) may not be avail-
able on a mobile device. In addition, as discussed above, depend-
ing on one’s phone security (or one’s lack of awareness to those
reading over your shoulder out in public) anyone could potentially
see communications on your phone if it is left unattended and
accessible; this could be especially likely at home in the comfort of
family and/or friends. Psychologists should ensure that they limit
these possibilities by protecting access to their phones (requiring a
password to unlock the keys), or refraining from allowing e-mail
applications to stay logged-in for continual access.

Other issues not mentioned by participants could represent areas
of ethical concern in the use of technology. For example, video
teleconferencing has become more common within psychology
today, and downloadable data from these interactions also repre-
sent potential sources of compromises to confidentiality. Further-
more, the use of Internet-provided videoconferencing (e.g., Skype)
opens doors to other types of confidentiality compromises (e.g.,
session recording by the software providers). In response, the Ohio
Psychological Association (OPA; 2010) has established guidelines
for psychologists delivering services via teleconferencing or other
similar technologies. The OPA has noted that some state psychol-
ogy boards would pursue investigations of psychologists who have
been accused of misconduct associated with telepsychology, and
that these state boards would seek information and standards
established at national or even international levels when state
guidelines or standards have not been established. Given that the
APA has yet to create guidelines for the delivery of telepsychology
services, interpretation of ethical standards in this context may
vary greatly in parts of the country until uniform national standards
have been established. It is important to note, however, that a new
APA task force has recently been formed jointly with the APA
Insurance Trust and the Association of State and Provincial Psy-
chology Boards to establish telepsychology guidelines (noted by
Baker, 2011, and Koocher, 2011). Although the APA Ethics Code
is not likely to address technology issues in detail (as mentioned

437SPECIAL ISSUE: CRITICAL INCIDENTS IN THE USE OF TECHNOLOGY

above), the next revision of the Ethics Code may benefit from
briefly mentioning the importance of issues in technology and
from making note of the resources that will actualize from task-
forces such as the telepsychology joint taskforce. Such a revision
could fit nicely within Standard 3 (Human Relations) of the Ethics
Code, which broadly discusses a variety of interpersonal, consent,
and confidentiality standards.

Summary

These concerns for technology challenges to the ethical practice
of psychology are not just for those less knowledgeable of various
applications; even those with greater familiarity with technology
such as social networking may be inadvertently compromised by
the technology with which they engage, especially if they are
unaware of the limits of security or potential breaches of confi-
dentiality. Caution instilled through years of practice, through
education in and knowledge of ethical standards and general
principles, and skeptical adoption or rejection of some technology
may best serve the public and the profession. Summarily rejecting
technology advances seems as equally inappropriate as an enthu-
siastic and uncritical embrace of all technology, given its potential
to better serve those in need and the efficiency with which it can
deliver such services. The critical-incidents methodology utilized
here provides thematic examples for education, research, and pol-
icy considerations in this area so that psychologists can more
confidently and ethically adopt various technologies in an effective
professional manner.

This survey was not without some limitations. As noted above,
information regarding participants’ professional settings was not
assessed in an effort to keep the survey as brief as possible; such
information could provide important data regarding whether tech-
nological issues are different in certain contexts as compared with
others (e.g., in hospitals vs. group practice settings). This survey
did not aim to establish a base rate for the various ethical concerns
noted by participants; such a survey could provide important
information to identify particular issues as foci for intervention
using the current critical incidents as initial points. The field may
benefit from future research designed to more comprehensively
survey technology issues and their rates of occurrence in various
psychological practice contexts (Baker & Bufka, in press).

Overall, responsibility for ethical and professional integration of
technology in practice lies with individuals. Although psychology
governance can do more (and is taking initial steps at this time) to
provide guidance, psychologists would benefit from assessing the
security of their electronic communications, from establishing
social-media policies for themselves or their organizations, and
from proactively weighing the risks and benefits each time they
consider incorporating new technologies in their professional ac-
tivities. Graduate programs, continuing education, and organiza-
tions that employ psychologists can help foster these proactive
behaviors by addressing concerns related to technology on a reg-
ular basis in their ethics courses and training experiences. Al-
though direct writings and guidelines from the APA might benefit
the appropriate integration of technology in service provision, it is
likely that any explicit mandates or discussion in ethical standards
would reference the role of education (either personal or struc-
tured) anyway; thus, the profession may be better served by

integrating such considerations in various educational areas imme-
diately, rather than waiting for policy guidance.

References

American Psychological Association. (2009). 2009 Presidential Task
Force on the Future of Psychology Practice: Final report. Retrieved
from http://www.apa.org/pubs/info/reports/future-practice.aspx

American Psychological Association. (2010). Ethical principles of psy-
chologists and code of conduct. Retrieved from http://www.apa.org/
ethics/code/index.aspx

Baker, D. C. (2011). Leading psychology into the telehealth world: How
does it work? Available from http://apapracticecentral.org/advocacy/
state/slc-telehealth-baker

Baker, D. C., & Bufka, L. F. (in press). Navigating legal, regulatory,
reimbursement and ethical issues in an electronic age. Professional
Psychology: Research and Practice.

Barnett, J. E., & Scheetz, K. (2003). Technological advances and tele-
health: Ethics, law, and the practice of psychotherapy. Psychotherapy:
Theory, Research, Practice, Training, 40, 86 –93. doi:10.1037/0033-
3204.40.1-2.86

Barros-Bailey, M., & Saunders, J. L. (2010). Ethics and the use of tech-
nology in rehabilitation counseling. Rehabilitation Counseling Bulletin,
53, 255–259. doi:10.1177/0034355210368867

Bedi, R. P., Davis, M. D., & Williams, M. (2005). Critical incidents in the
formation of the therapeutic alliance from the client’s perspective. Psy-
chotherapy: Theory, Research, Practice, Training, 42, 311–323. doi:
10.1037/0033-3204.42.3.311

Kolmes, K. (2010). Private practice social media policy. Retrieved from
http://drkkolmes.com/for-clinicians/social-media-policy/

Koocher, G. P. (2011). APA Council of Representatives meeting summary.
Available from http://www.apadivisions.org/division-39/publications/
insight/2011/04/cor-2011-summary.aspx

Koocher, G. P., & Keith-Spiegel, P. (1998). Ethics in psychology: Profes-
sional standards and cases (2nd ed.). New York, NY: Oxford University
Press.

Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in psychology and the
mental health professions: Standards and cases (3rd ed.). New York,
NY: Oxford University Press.

Lehavot, K., Barnett, J. E., & Powers, D. (2010). Psychotherapy, profes-
sional relationships, and ethical considerations in the MySpace genera-
tion. Professional Psychology: Research and Practice, 41, 160 –166.
doi:10.1037/a0018709

Maheu, M. (TeleMental Health Institute). (2010). Online counseling and
online therapy: An overview. Available from http://telementalhealth
.com/transportation

McMinn, M. R., Bearse, J., Heyne, L. K., Smithberger, A., & Erb, A. L.
(2011). Technology and independent practice: Survey findings and im-
plications. Professional Psychology: Research and Practice, 42, 176 –
184. doi:10.1037/a0022719

Martin, S. (2010). The Internet’s ethical challenges: Should you google
your clients? Should you ‘friend’ a student on Facebook? APA Ethic’s
Director Stephen Behnke answers those questions and more. Monitor on
Psychology, 41, 32.

McMinn, M. R., Buchanan, T., Ellens, B. M., & Ryan, M. K. (1999).
Technology, professional practice, and ethics: Survey findings and im-
plications. Professional Psychology: Research and Practice, 30, 165–
172. doi:10.1037/0735-7028.30.2.165

Ohio Psychological Association. (2010). Telepsychology guidelines. Re-
trieved from http://www.ohpsych.org/professionalissues.aspx

Patrick, J., Scrase, G., Ahmed, A., & Tombs, M. (2009). Effectiveness of
instructor behaviors and their relationship to leadership. Journal of
Occupational and Organizational Psychology, 82, 491–509. doi:
10.1348/096317908X360693

438 VAN ALLEN AND ROBERTS

Reed, G., McLaughlin, C., & Milholland, K. (2000). Ten interdisciplinary
principles for professional practice in telehealth: Implications for psy-
chology. Professional Psychology: Research and Practice, 31, 170 –178.
doi:10.1037/0735-7028.31.2.170

Richards, M. M. (2009). Electronic medical records: Confidentiality issues
in the time of HIPPA. Professional Psychology: Research and Practice,
40, 550 –556. doi:10.1037/a0016853

Schluter, J., Seaton, P., & Chaboyer, W. (2007). Critical incident tech-
nique: A user’s guide for nurse researchers. Journal of Advanced Nurs-
ing, 61, 107–114. doi:10.1111/j.1365-2648.2007.04490.x

Van Allen, J., Davis, A. M., & Lassen, S. R. (2011). The use of telemedi-

cine in pediatric psychology: Research review and current applications.
Child and Adolescent Psychiatric Clinics of North America, 20, 55– 66.
doi:10.1016/j.chc.2010.09.003

Woolsey, L. K. (1986). The critical incident technique: An innovative
qualitative method of research. Canadian Journal of Counselling, 20,
242–254.

Received February 3, 2011
Revision received June 30, 2011

Accepted July 6, 2011 �

New Editors Appointed, 2013–2018

The Publications and Communications Board of the American Psychological Association an-
nounces the appointment of 5 new editors for 6-year terms beginning in 2012. As of January 1,
2012, manuscripts should be directed as follows:

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pubs/journals/xlm/), Robert L. Greene, PhD, Department of Psychology, Case Western
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ment of Psychology, University of Oregon

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Lamb, PhD, University of Cambridge, United Kingdom

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Electronic manuscript submission: As of January 1, 2012, manuscripts should be submitted
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December 31, 2011.

439SPECIAL ISSUE: CRITICAL INCIDENTS IN THE USE OF TECHNOLOGY

A Snapshot of Child Psychologists’ Social Media Activity:
Professional and Ethical Practice Implications and Recommendations

Rachel A. Tunick, Lauren Mednick, and Caitlin Conroy
Children’s Hospital Boston, Boston, Massachusetts and Harvard Medical School

In the face of the ever-growing popularity of social media, psychologists continually encounter new
dilemmas regarding our ethical and professional principles. Negotiating the balance between the
intrinsically public nature of social media participation and the highly private nature of the
therapeutic relationship can be a challenge. Psychologists working with children and adolescents are
of particular interest, given both the popularity of social media among children and teens and the
specific treatment concerns on which clinical work often focuses. The authors surveyed 246
psychologists and psychologists-in-training regarding their own blogging and social networking
practices, as well as their behavior around their clients’ online presence. A majority of respondents
indicated that they participate in some form of social media and a lesser, though sizable, percentage
reported viewing information about their clients online. Many respondents indicated that they have
encountered concerning material on their clients’ social media pages, and there does not appear to
be a clear consensus about how psychologists handle matters of Internet safety and privacy with their
underage clients. Based on the responses to this survey, a series of considerations and guidelines for
our professional practice are proposed, and psychologists are encouraged to engage in thoughtful
self-reflection as they establish their own policies regarding these matters.

Keywords: Internet, ethics, social networks, blogs, children and adolescents

It’s 10:00 on a Friday night. A child psychologist sits at her
home computer checking Facebook updates and thinking about
upcoming weekend plans. Distracted by thoughts about a par-

ticularly intense session that afternoon with a teenage client,
wherein he’d disclosed some distressing recent peer interac-
tions, she decides on a whim to try to view his Facebook page.
She finds it easily, set up without privacy restrictions, and is
troubled when she reads his latest status update: “I’m going to
sleep now . . . See you all on the other side.” The psychologist
continues to read back through her client’s Facebook wall and
is horrified to find a series of taunting and harsh comments left
by some of the client’s “friends” over the past few weeks. After
viewing this disturbing content for a short while, the clinician
feels uncertain about her professional obligation and worriedly
wonders what she should do to help ensure her client’s
safety.

In today’s Internet age such a scenario, in which psycholo-
gists may readily gain access to client information outside of
session, is becoming increasingly commonplace. Similarly, our
clients can obtain online access to our personal information via
a simple click of the mouse. This bidirectional flow of easily
accessible personal information regarding clients and clinicians
alike has the potential to lead to momentous changes in our
professional relationships and behavior. The widespread use of
social media, including social networking sites and blogs, has
led to dramatic changes in interpersonal communication in our
society as a whole. For psychologists, these changes raise
dilemmas regarding our ethical and professional principles,
particularly those pertaining to self-disclosure, informed con-
sent, and confidentiality. Moreover, for clinicians working with
children and adolescents, unique dilemmas exist concerning the
protection and safety of our clients and how to define the limits
of our responsibility to protect their welfare.

RACHEL A. TUNICK received her PhD in child clinical psychology from the
University of Denver, with a specialization in developmental cognitive
neuroscience. She is a staff psychologist on the inpatient Psychiatry Con-
sultation Service at Children’s Hospital Boston and maintains an academic
appointment in the Department of Psychiatry at Harvard Medical School.
Her research and professional practice focus on various cognitive, psycho-
logical, and ethical issues impacting patients, families, and care providers
in the pediatric medical setting.
LAUREN MEDNICK received her PhD in clinical psychology from The
George Washington University. She is on staff at Children’s Hospital
Boston, with an appointment at Harvard Medical School. Her clinical work
and research focus on helping children and adolescents cope with a variety
of chronic and acute medical conditions.
CAITLIN CONROY received her PsyD in clinical psychology from the Mas-
sachusetts School of Professional Psychology. She is a staff psychologist at
Children’s Hospital Boston, working in the Mayo Family Pediatric Pain
Rehabilitation Center in Waltham, MA. Her areas of professional interest
include clinical pediatric psychology, pediatric pain treatment and out-
comes research, and family factors in pediatric pain rehabilitation.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Rachel
A. Tunick, Children’s Hospital Boston, 300 Longwood Avenue, Main 8
South, Boston, MA 02115. E-mail: rachel.tunick@childrens.harvard.edu

Professional Psychology: Research and Practice © 2011 American Psychological Association
2011, Vol. 42, No. 6, 440 – 447 0735-7028/11/$12.00 DOI: 10.1037/a0025040

440

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The Age of the Internet and the Advent of
E-Professionalism

The past several years have seen substantial growth in the
prevalence and use of social media, including blogs and social
networking sites (BSNs), and it appears that the popularity of such
media will only continue to heighten. A recent survey of social
media use indicated that about 10% of adults and 14% of adoles-
cents maintain a personal online journal or blog, while 47% of
adults and 73% of adolescents reported participating in social
networking sites (Lenhart, Purcell, Smith, & Zickuhr, 2010). Ac-
cording to that survey, the most commonly used social networking
site is Facebook, with more than 500 million users as of June 2011
(Facebook, 2011).

In the face of this continually expanding phenomenon, there has
been recent increased focus on the intersection of online behavior
and professional practice across a range of settings and occupa-
tions. For example, several recent studies have examined social
networking practices of physicians and doctors-in-training (e.g.,
MacDonald, Sohn, & Ellis, 2010; Moubarak, Guiot, Benhamou,
Benhamou, & Hariri, 2010; Thompson et al., 2008; Garner &
O’Sullivan, 2010). These studies found that many such profession-
als participate in social media, allow their user profiles to be
accessible to the public, and display potentially unprofessional
material (e.g., photographs of the users drinking alcohol, intoxi-
cated, or in various states of undress; discussion of clinical expe-
riences with clients; membership in groups with off-color or pro-
fane names) on their sites. Such findings have led to the coining of
the term “e-professionalism” to describe a new facet of profes-
sionalism pertaining to online behavior and communication and
have prompted discussions regarding the need for guidelines
around the application of professional and ethical principles in the
digital era (Cain, 2008; MacDonald, Sohn, & Ellis, 2010).

Within our own profession, we subscribe to a set of ethical
standards and expectations for interacting with clients in a manner
that will not cause harm and which will be in their best interest
(American Psychological Association [APA], 2002). Although our
ethics code does not directly include professional guidelines spe-
cific to online behavior, the principles behind these standards can
be applied to situations involving social media. For example, while
our ethics code does not discuss interacting with clients via social
networking, it explicitly advises against engaging in multiple re-
lationships with clients when there exists the potential to cause the
client harm or to compromise the effectiveness of therapy (Taylor,
McMinn, Bufford, & Chang, 2010; Zur, Williams, Lehavot, &
Knapp, 2009). If an online relationship allows a client with poor
boundaries an opportunity to gain access to personal information
about their clinician, this can be construed as a dual relationship,
which has the likelihood to negatively impact the effectiveness of
therapy, and would be discouraged by our code of ethics. How-
ever, the “potentially ambiguous nature of the types of interac-
tions” that occur via online communication and lack of clarity
regarding the distinction between professional and personal make
it difficult to know how to apply the APA ethics code (Lehavot,
Barnett, & Powers, 2010). Such ambiguity leaves us vulnerable to
experience a host of ethical and professional dilemmas. The pre-
dicaments encountered by clinicians working with children and
adolescents are of particular interest, given the growing popularity

of BSN activity among youth and the vulnerability of this popu-
lation.

Ethical and Professional Dilemmas in the Digital Age

For psychologists who work with children and adolescents,
ethical and professional dilemmas may occur in the context of two
types of online behavior. First, predicaments may arise around the
BSN practices of clinicians themselves. In particular, such behav-
ior may open the doors to unintentional therapist self-disclosure,
which may threaten professional boundaries and, by extension, the
effectiveness of our treatment. Second, dilemmas may arise in the
context of the Internet behavior of our clients, particularly when
we choose to view this online content outside of our clients’
presence or permission (a practice that is, in and of itself, ethically
questionable). In such circumstances we may find ourselves privy
to information about our clients that we might not have known
otherwise, and this may lead to uncertainty regarding appropriate
follow-up actions.

Dilemmas Associated With Psychologists’ BSN
Practices

When psychologists maintain BSN sites, ethical and profes-
sional dilemmas may arise regarding client-therapist boundaries.
In particular, when clients can access online information about
their therapist, this may lead to irreversible changes in the nature
of the clinical relationship. An extensive body of literature sup-
ports the preservation of boundaries between clients and therapists,
for reasons including the promotion of transference (e.g., Luo,
2009), avoidance of exploitation, and maintenance of therapeutic
focus on issues relevant to the client (e.g., Taylor et al., 2010).
Psychologists vary in their views around therapist self-disclosure,
depending on factors such as their theoretical orientation, culture,
and style. Many feel that circumstances exist in which some form
of therapist self-disclosure may be beneficial (e.g., for the en-
hancement of therapeutic alliance; Zur et al., 2009) and that at
other times self-disclosure is contraindicated (e.g., when a client
has particularly poor boundaries; Taylor et al., 2010). However, it
is generally agreed upon that thoughtfulness and intentionality are
essential in the handling of issues of self-disclosure (Taylor et al.,
2010), and that when self-disclosure is used it should contain a
clinical rationale focused on the client’s best interest (e.g., Zur et
al., 2009).

The advent and continued expansion of BSNs in our daily lives
has “redefined the meaning and application of self-disclosure and
transparency in psychotherapy” (Zur et al., 2009), particularly
when clinicians themselves are active social media participants.
When clients gain access to online material about their therapist,
they may learn personal information (regarding, e.g., the thera-
pist’s religious, political, or moral beliefs, hobbies, family and
social life, etc.) that may compromise professional boundaries. In
the Age of the Internet, it is increasingly difficult for psychologists
to approach self-disclosure with the thoughtfulness and intention-
ality that is so crucial in other contexts, and we may be faced with
unfiltered, inadvertent self-disclosure by virtue of our own online
behaviors (Taylor et al., 2010).

Two recent surveys have examined BSN behaviors among psy-
chologists and psychology trainees in the United States, with

441SPECIAL ISSUE: SOCIAL MEDIA AND PROFESSIONAL PRACTICE

particular focus on issues related to self-disclosure and boundaries
(Lehavot et al., 2010; Taylor et al., 2010). Both surveys, conducted
primarily with psychology graduate students (100% and 91% of
survey respondents, respectively; Lehavot et al., 2010; Taylor et
al., 2010), revealed that the majority of respondents participate in
online social networking (77% and 81%), with 15– 40% choosing
not to implement strict privacy settings. Lehavot and colleagues
(2010) further report that 67% of respondents use their real name,
29% post photos, and 37% include personal information which
they would not want their clients to see. Taylor et al. (2010)
conclude that unintentional disclosure is inevitable with the ease of
access permitted with the Internet and advise psychologists to
strive to exercise some control over the amount and type of
personal information to which clients may gain access by not
participating on social networking sites or by using high privacy
settings.

Dilemmas Associated with Clients’ BSN Practices

A range of ethical and professional dilemmas may also arise in
the context of the online activity of our clients, particularly when
we view such content without the clients’ presence or knowledge.
The motivation of clinicians engaging in such behavior is of
particular interest. One of the surveys reviewed above (Lehavot et
al., 2010) examined clinicians’ behavior with regard to their cli-
ents’ online activity and found that 27% of respondents sought
information about clients online, with many reporting to do so out
of curiosity or to “establish the truth.” The authors argue that
searching for information for these reasons is unethical, as it
involves obtaining information about the client without consent. In
addition, such behavior violates our ethical principles of benefi-
cence and nonmalficence (i.e., taking care to do no harm to clients
and the therapeutic process) and fidelity and responsibility (creat-
ing and maintaining a trusting relationship with clients).

Tunick and Mednick (2009) raised discussion about additional
dilemmas that may arise in the context of patient BSN activity in
the pediatric setting and reviewed four categories of such dilem-
mas. These include threats to 1) privacy/confidentiality of other
patients whose protected health information may be referenced on
clients’ BSN sites without their consent; 2) professional reputa-
tions of clinicians who may be named on patient BSNs, particu-
larly if the content is at all negative or disparaging; 3) privacy/
confidentiality of clients who do not fully appreciate implications
around the potentially very public nature of their site’s content;
and 4) professional boundaries, when clinically significant infor-
mation is obtained by the clinician without the client’s knowledge
or consent. Across these categories, when psychologists view such
material on their client’s sites, their subsequent professional obli-
gations and course of follow-up action is unclear (Tunick &
Mednick, 2009; Zur, 2010).

With the goal of gleaning information to inform and guide our
professional practice, we undertook a national survey of child
clinical and pediatric psychologists regarding their own online
practices as well as their behavior around the BSN activity of their
clients. Many of the ethical and professional dilemmas outlined
above are particularly salient for those working with youth, given
the popularity of social media use among children and adolescents,
and the vulnerability of this population as a whole. However, to

our knowledge no such study has been undertaken with child
clinicians.

Survey of Psychologists’ Online Practices

The survey was conducted via completion of anonymous online
questionnaires about psychologists’ own BSN practices and their
experiences around reading the BSNs of clients. The survey was
divided into four sections. The first section, completed by all
respondents, included 15 questions regarding demographics, pro-
fessional training, current employment setting/population, and ex-
periences regarding client BSN privacy and safety (e.g., “Have you
ever encountered a situation in which you became concerned about
the privacy of your client, related to their use of a blog/social
networking page?”). Participants were directed to complete the
remaining three sections of the survey depending on whether they
have a blog, participate as a member of a social networking site,
and/or read the BSNs of their clients. Ten questions (yes/no,
multiple choice, and Likert scale formats) were included in each of
these three sections, and many of the questions also prompted
open-ended responses.

Child and pediatric psychologists and psychologists-in-training
were recruited via online listservs for APA Divisions 53 (Child
Clinical Psychology) and 54 (Pediatric Psychology). In total, 246
participants, 83% of whom had attained a doctoral level degree,
completed the survey. At the time the survey was conducted, there
were 1627 members on the Division 53 listserv, and 1103 people
registered on the Division 54 listserv. It was not possible to obtain
an estimate of the degree of overlap between these two samples,
although it was expected that a sizable overlap did exist. Thus, a
valid response rate could not be ascertained, and potential impli-
cations of this study limitation are addressed in the final section of
this paper. However, respondents appear to be representative of
these groups, as in general the clinicians who completed the survey
largely reflect the demographics of the two APA divisions (APA,
2009a, 2009b). Specifically, the majority of participants were
female (79%), Caucasian (89%), and had an advanced degree in
clinical psychology (86%). Respondents were employed across a
variety of clinical/academic settings, and nearly all (99%) reported
being involved in clinical work with children and/or adolescents.
Of note, however, respondents to the survey were younger (M �
37.4 years) relative to the mean age of members of Divisions 53
and 54 (49.5 and 47.6 years, respectively).

Survey Results Regarding Psychologists’ BSN
Practices

Sixty-five percent of respondents participate on social network-
ing websites, whereas 9% maintain blogs. Compared with those
who don’t participate on social networking sites, social-networkers
are significantly younger, t(242) � 5.65, p � .001, more likely to
be current students, �2(1) � 11.35, p � .01, and spend less of their
time in activities related to teaching and supervision, t(204) �
2.10, p � .05. The most commonly used social networking site
was Facebook (95%), followed by Linkedin (34%) and MySpace
(16%). At the time of the survey, 56% of participants had been
involved in social networking for one year or less, and most
respondents (70%) check their site at least several times a week.
The vast majority of social networking respondents reported im-

442 TUNICK, MEDNICK, AND CONROY

plementing restrictions on who can view their page, nearly half
reported having material on their page that they wouldn’t want
clients to view, and a small percent reported knowledge of situa-
tions in which a client gained access to their page (see Table 1). A
significant relationship was not found between having restrictions
on who can access their social networking page and including
anything on your page that you would not want your clients to see
(r � .06, p � .45); however, this is likely attributable to the
majority of participants reporting using privacy restrictions.

About one-quarter of social networking respondents have been
approached by clients to be “virtual friends,” and clinicians varied
in their reported responses to such situations. The majority indi-
cated that they had rejected the invitation, but some reported either
having made different decisions “based on the situation” or having
accepted a friend request (see Table 1). Similarly, when survey
respondents were asked what they “might” do should they find
themselves in this hypothetical situation, a small percent (7) re-
ported that they would make different decisions “depending on the
situation,” while the remainder indicated that they would reject the
friend request.

Compared with those who don’t maintain blogs, bloggers were
significantly more likely to work in residential, �2(1) � 8.33, p �
.01 or community mental health settings, �2(1) � 6.13, p � .05, be
younger, t(240) � 2.53, p � .05, and read client BSNs, �2(3) �
11.93, p � .01. The majority of bloggers have been blogging for
more than one year (55%), and most (68%) reported that they
check their blog at least once a week. The majority of bloggers
reported using their real name on their blog, more than half do not
implement any restrictions regarding blog access, and about one-

quarter said that there is information on their blog that they
wouldn’t want clients to see (see Table 1). Importantly, there was
a significant positive correlation between having restricted blog
access and posting blog material that you would not want your
clients to see (r � .47, p � .05).

Survey Results Regarding Clients’ BSN Practices

Thirty-two percent of respondents reported reading client BSNs
for a variety of reasons, including curiosity (see Table 2). Simi-
larly, 32% of respondents reported that they have “Googled” their
clients. Among those who read client BSNs, more than half ask or
inform clients of this practice. Less than half of respondents
reported having encountered concerning material on client web-
sites. Notably, this correlated strongly with addressing such con-
cerns with clients (r � .57, p � .001). Among those who never
read client BSNs, the majority report avoiding reading because of
perceived boundary violations (see Table 2). Finally, only 35% of
respondents reported addressing concerns about Internet privacy
with their underage clients who participate in BSNs.

Responses to open-ended questions indicated that many clinicians
have encountered “concerning” material on their clients’ BSNs. The
most commonly described themes concerned information pertaining
to substance use, sexual promiscuity, bullying, depressive thoughts,
and suicidal ideation. Participants also described general concerns
about children and adolescents implementing no privacy restrictions
on their BSNs and revealing too much personal information about
themselves, including inappropriate photographs. Further, many re-

Table 1
Responses From Those Who Participate in Social Media

n (%)

Social networking respondents
Use a pseudonym 9 (6)
Has restrictions on who can access their SN site 154 (98)
Type of restrictions

Highest restrictions 141 (92)
Medium restrictions 13 (8)

Have photos of yourself on your SN site 143 (90)
Include personal information on your SN site 125 (79)
Anything on your SN site you would not want your clients to see 69 (43)
Learned that a client accessed your SN site 8 (5)
Been asked to “friend” a client or join their network 38 (24)
Response

Accepted the invitation 1 (3)
Made different decision based on the situation 4 (10)
Declined the invitation 33 (87)

Blogging respondents
Use a pseudonym 8 (36)
Has restrictions on who can access their blog� 10 (45)
Type of restrictions

Highest restrictions 9 (90)
Medium restrictions 1 (10)

Have photos of yourself on your blog 16 (73)
Include personal information on your blog 17 (77)
Anything on your blog you would not want your clients to see� 6 (27)
Learned that a client accessed your blog 3 (14)

Note. n (social networking) � 159 (65); n (blogging) � 22 (9).
� Strong relationship between having restrictions on access and having anything on the blog
you would not want your client to see (r � .47, p � .05).

443SPECIAL ISSUE: SOCIAL MEDIA AND PROFESSIONAL PRACTICE

spondents commented about the ambiguity of their professional role
in the face of such concerns.

Clinical Implications and Recommendations

Given the widespread, growing use of electronic communication
in today’s society, it is certain that our profession will continue to
encounter online situations that challenge our ethical and profes-
sional principles. Results from our survey suggest that a sizable
proportion of child clinicians participate in BSNs, and many of our
colleagues also read the BSNs of their clients. Overall, the major-
ity of respondents appear to consider and adhere to professional
and ethical principles regarding these practices. However, some
findings suggest that further consideration should be given to
standards pertaining to issues around privacy, informed consent,
and professional boundaries. As such, survey results were used as
a springboard to inform the considerations and guidelines dis-
cussed below.

Considerations and Guidelines Regarding
Psychologists’ BSN Practices

Consistent with two prior surveys conducted primarily with
psychology trainees (Lehavot et al., 2010; Taylor et al., 2010),
results from the current study suggest that the majority of child
psychologists participate in social media. Although most partici-
pants reported that they use high privacy settings and limit their
online engagement with clients, there remain some who do not
adhere to such standards. Further, we have reason to suspect that
the proportion of users who report implementing the highest pri-
vacy settings may be overstated, given that 24% of social-
networkers have received “friend requests” by clients. In fact, if

the highest privacy settings (i.e., rendering oneself “unsearchable”)
had been implemented, such requests would not be possible.

In the Internet age, our ethical considerations around profes-
sional relationships and boundaries remain the same as always but
are uniquely challenged when personal information regarding psy-
chologists is readily available online to clients. BSN behavior has
the potential to blur the lines between professional and personal
domains, which may impact negatively upon the effectiveness of
therapy by compromising our ability to approach self-disclosure
with thoughtfulness and intentionality (Taylor et al., 2010). The
most simple and straightforward way to avoid such dilemmas
would be for psychologists to abstain altogether from participation
in BSN activities. However, in the context of our society’s ever-
growing reliance on the Internet and the pervasive use of social
media, we recognize that such a unilateral stance is increasingly
naı̈ve and unrealistic. Hence, the following considerations and
guidelines are recommended.

Maintain Awareness

Clinicians must be aware of the potential dilemmas that may
arise when participating in social media. We recognize that psy-
chologists vary greatly in terms of their overall approach to self-
disclosure, and such practices should remain consistent whether
pertaining to in-person or virtual settings (Guseh, Brendel, &
Brendel, 2009). Thus we encourage our colleagues to engage in
thoughtful reflection regarding their own views, beliefs, and ratio-
nale underlying the choices they make around self-disclosure in
general, and be certain that this stance is reflected in their online
behavior. Psychologists are further encouraged to consider the
relative permanence of online content and potential interpersonal,
professional, and/or legal ramifications that this might trigger
(Landman, Shelton, Kauffmann, & Dattilo, 2010).

Table 2
Clinicians’ Responses About Their Practices Regarding Client BSN Activity

Item n (%)

Do you ever read the BSN sites of your clients? 78 (32)
Among those who DO read client BSN sites

Main reason for reading
Curiosity 14 (18)
Therapeutic concern 32 (41)
Request by a client or family 23 (29)
Gather treatment-related information 7 (9)
Other 2 (3)

Approach to reading
Told the client you read the BSN site 16 (20)
Asked the client for permission to read 31 (40)
Depended on the situation 17 (22)
Did not tell client or ask for permission 14 (18)

Read information on a client’s BSN that was concerning to you� 32 (42)
Addressed concerns that have arisen from reading client BSN site� 24 (31)
Read a client’s BSN site with a client 32 (41)

Among those who NEVER read client BSN sites
Main reason for not reading

It has never come up 48 (29)
It feels outside of therapeutic boundaries 104 (63)
Other 14 (8)

� Strong relationship between read information on a BSN site that was concerning and
addressed concerns (r � .57, p � .001).

444 TUNICK, MEDNICK, AND CONROY

Be Savvy and Diligent About Privacy Settings

Social networking sites offer participants a range of privacy
settings, which allows users to oversee and limit the overall audi-
ence to whom features of their page are accessible. Similarly,
many blog-hosting sites offer varying levels of privacy protection,
which users may choose whether or not to employ. However, the
particulars of these privacy settings are complex (Luo, 2009), and
the maintenance of privacy settings is a continually moving target.
For example, Facebook’s privacy policy is nearly 6000 words
long, contains distinct privacy options for each site feature, and is
regularly updated and changed (Facebook, 2010). Furthermore,
across most BSN media, the default setting typically leans toward
inclusion rather than exclusion. BSN users must remain vigilant to
such nuances and to the continual changes relevant to the settings
that they employ (McDonald et al., 2010) and recognize that
without such diligence their personal material might become ac-
cessible to viewers for whom it was not intended (Guseh et al.,
2009). As for which privacy settings to implement, psychologists
are advised to remain conscientious and choose settings in keeping
with their aforementioned stance about the level of self-disclosure
with which they are most comfortable.

Remain Transparent With Clients Regarding Your
BSN Policy

If psychologists choose to actively participate in BSNs, we
encourage them to maintain a proactive, rather than reactive,
approach regarding potential online communication with clients.
First, psychologists should carefully consider and develop a clear
and consistent policy about their approach to online communica-
tion with clients (Lehavot et al., 2010). Then, just as we routinely
review with clients other professional policies (such as those
regarding confidentiality and its limits), psychologists are encour-
aged to be transparent regarding their online policy. This might
include, for example, a clear in-person statement that you refrain
from accepting “friend requests” from current or past clients, no
matter the circumstances (Luo, 2009). In addition to engaging in
such conversations at the start of treatment, psychologists are
encouraged to engage in open dialogue with their clients in a
timely manner, should relevant issues arise over the course of
therapy.

Engage in Conversations with Trainees

Many of our survey’s respondents reported that they engage
regularly in teaching and supervisory roles with trainees. As men-
tors to future generations of psychologists, we encourage open and
thoughtful discussion regarding BSN practices in the training
context. In particular, psychologists might choose to review the
aforementioned recommendations regarding online behavior. En-
gaging trainees in such conversations is particularly important,
given that in the current survey, younger respondents and those
earlier in their careers reported higher rates of BSN participation.
As noted by Lehavot et al. (2010), supervisees may well have more
experience than their supervisors in the BSN domain, and thus
clinical supervisors may need to educate themselves about these
practices.

Considerations and Guidelines Regarding Clients’
BSN Practices

Findings from the current survey suggest that child psycholo-
gists’ behavior regarding client online information is quite vari-
able. About one third of participating clinicians reported viewing
their clients’ online information without obtaining permission to
do so. Nearly half of the respondents who read clients’ BSNs have
encountered concerning situations on their clients’ sites, and re-
spondents described a range of themes about which they had
concern. About one third of respondents have addressed concerns
regarding online privacy with their clients.

It is clear that viewing our clients’ BSN sites without their
expressed permission opens the door to many potential dilemmas
for psychologists. Such behavior exposes us to the risk of viewing
content that ranges from somewhat concerning (e.g., a teenage
client’s references to his experimentation with alcohol) to down-
right alarming (e.g., explicit suicidal ideation on a client’s BSN)
and which demands follow-up action of one type or another. When
such material is encountered in-session with our clients, our ethical
obligations and professional responsibilities are quite clear. How-
ever, in the case that such content is viewed online and outside of
direct patient contact, our appropriate follow-up course is more
ambiguous (Tunick & Mednick, 2009). This concern is well artic-
ulated by a survey respondent: “My primary concern with client
information that is discovered on the Internet is, what is my
responsibility if I do find something concerning? Am I mandated
to report blog information? Can I raise that with the cli-
ent? . . . Further, I think clinicians who read (client) blogs put the
field at risk by setting a precedent that we ought to be responsible
for that information. If we give people the idea that they can put
things on their blogs and we will read it with the intent to
intervene, what happens when they put a suicide note up at 2:30
a.m. and we do not see it?”

Furthermore, viewing online material about our clients with-
out their knowledge or expressed permission (i.e., without their
informed consent) infringes on our clients’ privacy, which
violates principles of our ethics code. Simply because so much
information is now readily available and easily searchable
online, this does not mean that obtaining information about our
clients without their permission is ethically acceptable behav-
ior. Doing so violates a client’s autonomy and has the potential
to disrupt the element of trust that is essential in a therapeutic
relationship. As expressed by a survey respondent: “I feel it
could jeopardize my therapeutic relationship with my clients if
I gained information from a Google search or social networking
site as opposed to acquiring that information directly from my
patient or a person with whom I have authorization to commu-
nicate (another doctor, family member).” Moreover, if material
encountered online is discrepant from information learned in-
session, how does one resolve this matter with a client who is
unaware that the clinician is viewing their BSN site?

Of note, however, it might be argued that under certain
circumstances there are compelling reasons for child clinicians
to view their clients’ online material. For example, as indicated
by many of our survey respondents, clients or parents may
invite our readership, which may be beneficial for information
sharing and alliance building. In addition, important concerns
might not come to our attention were it not for reading a

445SPECIAL ISSUE: SOCIAL MEDIA AND PROFESSIONAL PRACTICE

patient’s BSN. For example, a psychologist who learns about
her patient’s drug use from material within his MySpace entries
may confront the patient about this activity and follow up with
interventions as warranted.

These matters concerning psychologists’ behavior around their
clients’ online practices are certainly not straightforward. With
regard to these issues we propose the following considerations and
guidelines.

Weigh the Risks and Benefits

When we find ourselves in the position wherein we are consid-
ering viewing our clients’ online material, we urge psychologists
to engage in a thoughtful risk-benefit analysis. Clinicians are
encouraged to carefully examine their own motivation for reading
(Hughes, 2009; Luo, 2009). Are there potential benefits to be
gained, from a clinical perspective? Might we learn information,
not readily available otherwise, that will help us to promote the
safety and well-being of our clients? Or are we primarily moti-
vated by a prurient curiosity? What are the anticipated or potential
risks for harm if we choose to view, or if we choose to not view?
As one survey respondent wrote, “Ultimately, if my behavior with
my client does not serve their clinical best interest I am violating
their relationship to satisfy my curiosity.” Such careful contem-
plation may help guide psychologists’ ethical decision making.

Read Together

Should psychologists decide that the benefits of viewing client
information online outweigh the risks, we encourage our col-
leagues to be transparent about this practice. Talk with your clients
and their families about your motivation, and, prior to viewing,
request their permission to access their website. Alternatively, as
suggested by Lehavot et al. (2010), we propose that clinicians
consider reading client BSNs together with their clients. Such a
collaborative process may allow clinicians to gain new information
and insight about their client, while also potentially benefiting the
therapeutic process. This practice was supported by a survey
respondent: “I work with teens who often put much more infor-
mation in a public domain than is sometimes safe for them.
However, these situations often open lines of therapeutic commu-
nication because I usually view these pages WITH my patients
rather than on my own.”

Educate Youth About Internet Risks

Many of our survey respondents reported having viewed con-
cerning material on their clients’ BSN sites, and such concerns
seem particularly salient for psychologists working with children
and adolescents. In today’s society we often encounter situations
that remind us of potential perils associated with online activity,
such as news stories highlighting deleterious effects of cyber-
bullying. As clinicians working with underage clients, our role is
often construed to include a responsibility to help educate and
monitor clients for their involvement in concerning or dangerous
behaviors. Does this responsibility extend into the online context?
In our view, engaging in risky behavior in the “virtual world” is no
different than in any other contexts, and failure to recognize,
monitor, and discuss these potentially dangerous behaviors is

inconsistent with our ethical obligations to protect our clients from
harm (Lehavot et al., 2010). Children and adolescents are a vul-
nerable population and may minimize or not fully grasp the po-
tential dangers associated with involvement in BSN’s, and it is our
obligation to help educate and protect them. This view was ex-
pressed by a survey respondent: “I find myself often in dialogue
with young adolescents about their perceptions about visibility/
privacy and consider the issue of the enduring nature of Internet
media to be an issue that most cannot appreciate when posting to
these sites.”

Despite these concerns, there are potential benefits when chil-
dren and adolescents participate in social media. For example,
Tynes (2008) suggests that social media participation can promote
learning and have positive psychosocial benefits (e.g., increasing
social support, fostering identity exploration, and building auton-
omy). Rather than attempting to ban Internet activity, we encour-
age child psychologists to promote safe Internet behavior with
their clients. Psychologists should maintain open and honest dia-
logue regarding the potential risks and benefits of Internet use and
help young clients to develop an “exit strategy” should they find
themselves in a concerning online situation (Tynes, 2008). This is
particularly important for those working with clients whom they
perceive as more vulnerable or naı̈ve. As expressed by one survey
respondent, “I am concerned about the judgment of some of the
younger patients, as well as some of my patients with impulsivity
or social skills issues. They are at risk.”

Provide Guidance to Parents

Child psychologists regularly provide guidance and psychoedu-
cation to parents and other caretakers regarding challenging situ-
ations with their children. In a similar vein, we recommend that
clinicians working with youth engage in dialogue with parents
about matters pertaining to their children’s Internet safety. In these
discussions, parents might be encouraged to actively monitor their
child’s online activity. For example, if their child participates on
Facebook, parents may choose to “friend” their child or periodi-
cally ask their child to sign in with them so that they may
collaboratively view the child’s page.

Conclusions and Future Directions

For better and for worse, the world is a changed place in the age
of the Internet, and psychologists are certainly not immune to these
influences. The current survey offers a preliminary snapshot of the
overlap between social media and professional psychology prac-
tice. In the current context, the roles and responsibilities of child
psychologists remain largely the same. However, we are faced
with newfound challenges regarding the application of our ethical
principles in the context of online behavior and the dynamic
Internet setting.

Informed by survey results, we have proposed several guidelines
for our colleagues to consider in the face of the ethical and
professional challenges that the Internet in general, and social
media in particular, have prompted. We hope that our survey
findings and resultant recommendations will stimulate some
thoughtful self-reflection, as well as dialogue among our col-
leagues, and will ultimately encourage continued deliberateness
and thoughtfulness in our approach to these ever-changing phe-

446 TUNICK, MEDNICK, AND CONROY

nomena. However, caution should be taken in interpreting the
specific results of our survey, given that a precise response rate
could not be calculated. Although demographic characteristics of
survey respondents mostly mapped onto those of the APA Divi-
sions from which they were sampled, there remains the possibility
that there was a response bias, such that individuals who are more
active online were more likely to respond to the web-based survey.
This potential bias is reflected in the mean age of the survey
respondents being significantly younger than the mean age of the
members of the two listservs. However, as our survey results
suggest that younger clinicians are more actively involved in BSN
practices relative to their older colleagues, it is likely that this is the
group for whom the survey and subsequent recommendations are
most relevant.

Future research may include exploration of the potential benefits
of talking about online privacy with our underage clients. We have
speculated that there exist potential therapeutic benefits to engag-
ing in such dialogue with our clients, but this is based more on
anecdotal experience than empirical findings.

References

American Psychological Association. (2002). Ethical principles of psy-
chologists and code of conduct. American Psychologist, 57, 1060 –1073.
doi:10.1037/0003-066X.57.12.1060

American Psychological Association. (2009a). Demographic characteris-
tics of division 53 members by membership status, 2009. Available at:
Http://www.apa.org/about/division/div53–2009.aspx. Accessed Febru-
ary 20, 2011.

American Psychological Association. (2009b). Demographic characteris-
tics of division 54 members by membership status, 2009. Available at:
Http://www.apa.org/about/division/div54 –2009.aspx. Accessed Febru-
ary 20, 2011.

Cain, J. (2008). Online social networking issues within academia and
pharmacy education. American Journal of Pharmacy Education, 72,
1–7.

Facebook. (2010). Available at: http://www.facebook.com/policy.php. Ac-
cessed February 20, 2011.

Facebook. (2011). Available at: http://www.facebook.com/press/
info.php?statistics. Accessed June 15, 2011.

Garner, J., & O’Sullivan, H. (2010). Facebook and the professional behav-
iors of undergraduate medical students. The Clinical Teacher, 7, 112–
115. doi:10.1111/j.1743-498X.2010.00356.x

Guseh, J. S., Brendel, R. W., & Brendel, D. H. (2009). Medical profes-
sionalism in the age of online social networking. Journal of Medical
Ethics, 35, 584 –586. doi:10.1136/jme.2009.029231

Hughes, L. (2009). Is it ethical to “Google” patients? Psychiatric News,
44, 11.

Landman, M. P., Shelton, J., Kauffmann, R. M., & Dattilo, J. B. (2010).
Guidelines for maintaining a professional compass in the era of social
networking. Journal of Surgical Education, 67, 381–386. doi:10.1016/
j.jsurg.2010.07.006

Lenhart, A., Purcell, K., Smith, A., & Zickuhr, K. (2010). Social media and
young adults. Pew Internet & American life project. Available at:
Http://www.pewinternet.org/Reports/ 2010/Social-Media-and-Young-
Adults.aspx. Accessed February, 24, 2011.

Luo, J. S. (2009). The Facebook phenomenon: Boundaries and controver-
sies. Primary Psychiatry, 16, 19 –21.

MacDonald, J., Sohn, S., & Ellis, P. (2010). Privacy, professionalism and
Facebook: A dilemma for young doctors. Medical Education, 44, 805–
813.

Moubarak, G., Guiot, A., Benhamou, Y., Benhamou, A., & Hariri, S.
(2011). Facebook activity of residents and fellows and its impact on the
doctor-patient relationship. Journal of Medical Ethics, 37, 101–104.
doi:10.1136/jme.2010.036293

Taylor, L., McMinn, M. R., Bufford, R. K., & Chang, K. B. T. (2010).
Psychologists’ attitudes and ethical concerns regarding the use of social
networking web sites. Professional Psychology: Research and Practice,
41, 153–159. doi:10.1037/a0017996

Thompson, L. A., Dawson, K., Ferdig, R., Black, E. W., Boyer, J., Coutts,
J., & Black, N. P. (2008). The intersection of online social networking
with medical professionalism. Journal of General Internal Medicine, 23,
954 –957. doi:10.1007/s11606-008-0538-8

Tunick, R., & Mednick, L. (2009). Commentary: Electronic communica-
tion in the pediatric setting—Dilemmas associated with patient blogs.
Journal of Pediatric Psychology, 34, 585–587. doi:10.1093/jpepsy/
jsn088

Tynes, B. M. (2008). Internet safety gone wild? Sacrificing the educational
and psychosocial benefits of online social environments. Journal of
Adolescent Research, 22, 575–583. doi:10.1177/0743558407303979

Zur, O. (2010). To Google or not to Google . . . our clients? When psy-
chotherapists and other mental health care providers search their clients
on the web. Independent Practitioner, 30, 144 –148.

Zur, O., Williams, M. H., Lehavot, K., & Knapp, S. (2009). Psychother-
apist self-disclosure and transparency in the Internet age. Professional
Psychology: Research and Practice, 40, 22–30. doi:10.1037/a0014745

Received March 4, 2011
Revision received June 20, 2011

Accepted June 21, 2011 �

447SPECIAL ISSUE: SOCIAL MEDIA AND PROFESSIONAL PRACTICE

Psychotherapy, Professional Relationships, and Ethical Considerations in
the MySpace Generation

Keren Lehavot
University of Washington

Jeffrey E. Barnett
Loyola University Maryland

David Powers
Seattle University

The pervasive use of Internet technologies has created new ethical dilemmas for psychology trainees and
professionals. In particular, Web sites that allow users to post personal information have sparked
controversy regarding the amount of freedom psychologists should have in placing personal information
online and how discovering such information may impact professional relationships, including the
therapeutic relationship. Results from a graduate student survey (N � 302) address the prevalence of the
use of online social networking sites, security measure efforts that limit public access, incidents of client
access to psychotherapists’ personal Web sites and Internet use by psychotherapists to obtain client
information, and their subsequent effect on the therapeutic relationship. Using applicable ethical prin-
ciples and standards, we provide recommendations for the field in an effort to decrease potential harm
and maximize areas of opportunity for psychologists and constructive professional relationships.

Keywords: ethics, Internet, psychotherapy, professional relationships

There is little doubt that Internet technologies have led to
dramatic and pervasive changes in our culture, becoming a foun-
dational part of establishing online identity and connectivity. Ac-
cording to Internet World Stats, 22% of the world’s population and
73% of the U.S. population are Internet users (Internet World
Stats, 2008). Indeed, for the first time in Presidential campaign
history, a candidate sparked a passionate conversation with Amer-
ica by strategically relying on Internet technologies, using personal

Web sites, and having an extensive presence in social networking
sites such as MySpace and Facebook (Miller, 2008). Across the
world, Iranian protestors have recently used Facebook and Twitter
to relay information in an attempt to outmaneuver a government
that has largely shut down communication outlets (Fleishman,
2009).

For psychologists and psychologists-in-training, the Internet has
created new ease with which to communicate with colleagues,
network with others, and share information. Despite these numer-
ous advantages, however, this online medium also increases and
creates new ethical dilemmas. In particular, Web sites that allow
users to post personal information and the ease of finding such
personal information have ignited controversy regarding the
amount of freedom psychologists should have in posting personal
information online and how discovering such information may
impact professional relationships (Barnett, 2008a).

Social networking sites allow for the possibility of unwanted
personal information leaking into professional lives, which may
impact psychologists’ relationships with colleagues, faculty, stu-
dents, and clients. For example, consider a psychologist who posts
photos of her vacation to Maui, with limbo dancing contests and
romps on the beach. How would these photos impact her relation-
ship with colleagues should they discover them online, or her
relationship with a tenure committee, students in her classroom, or
clients? Suppose the individual in question is in fact a graduate
student; how then might the photos impact her professional rela-
tionships with faculty, clients, and others?

The number of potential dilemmas is endless. One thing, per-
haps, is for certain: the Internet has redefined the process of
self-disclosure. On professional listservs lively discussions have
centered on issues such as whether to include clients or former
clients as “friends” on social Web sites, how much personal

Editor’s Note. Mary Beth Kenkel served as the action editor for this
article.—MCR

KEREN LEHAVOT is a clinical psychology doctoral student at the University
of Washington, where she also received her MS. Her research interests
span the areas of psychology of women, lesbian, gay, bisexual, and
transgender issues, minority stress and health, and ethical and professional
issues.
JEFFREY E. BARNETT received his PsyD in clinical psychology from Ye-
shiva University. He is a Professor in the Department of Psychology at
Loyola University Maryland and maintains an independent practice in
Arnold, MD. His areas of professional interest include ethical and legal
issues, training, and professional development.
DAVID POWERS received his PhD in clinical psychology from Washington
University in St. Louis, MO. He is presently the Dean of the College of
Arts and Sciences and a Professor of Psychology at Seattle University. He
is the current President of the Society for Clinical Geropsychology. Along
with electronic media and professional issues, his interests include topics
within clinical geropsychology such as caregiver intervention, depression,
and advocacy for older adult mental health.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Keren
Lehavot, Department of Psychology, University of Washington, Box
351525, Seattle, WA 98195. E-mail: klehavot@u.washington.edu

Professional Psychology: Research and Practice © 2010 American Psychological Association
2010, Vol. 41, No. 2, 160 –166 0735-7028/10/$12.00 DOI: 10.1037/a0018709

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information to disclose on such Web sites (e.g., from religious
preference to favorite television shows), and the ethical use of
blogs (Barnett, 2008a). However, despite the prevalence of Inter-
net use and ensuing dilemmas, with the exception of a handful of
professional presentations and articles, little writing or research
has been done on the topic (Barnett, 2008b; Lehavot, 2007, 2009a;
Zur, 2008; Zur & Donnor, 2009). After providing data on the use
of the Internet and its implications, ethical standards relevant to
such dilemmas are examined. We also explore psychologists’
behavior on social networking sites and its impact on professional
relationships by psychologists and those in training.

Prevalence of Social Networking Site Use

It is reported that 85% of undergraduate and graduate students
own a computer, 72% of them check their e-mail at least once
every day, and 82% of undergraduate students participate in at
least one online social networking site (Caruso & Salaway, 2007).
While only 37% of individuals 30 years of age and older report
social networking site participation, 95.1% of those 18 –19 years of
age report social networking site participation, with a 26% increase
in daily use of these sites in just 2 years (Salaway, Caruso, Nelson,
& Ellison, 2008). Thus, while there are clear cohort differences,
use of the Internet in general, and of social networking sites in
particular, continues to increase dramatically.

Numerous online social networking sites exist and more are
being created on an ongoing basis. Such sites include MySpace,
Facebook, LinkedIn, Friendster, Bebo, Twitter, Gather, Hi5, Digg,
LiveJournal, Reunion, Second Life, Wee World, and others. Fa-
cebook is reported to have more than 175 million registered users
worldwide, with users spending more than 3 billion minutes on
Facebook each day and more than 18 million updating their page
each day (Facebook, 2009). MySpace reports over 185 million
users at present, with more than 350,000 new individuals signing
up as users of MySpace each day and over 10 billion active friend
relationships reported at present (Social Network Stats, 2008).

These data highlight the ever increasing use of social network-
ing sites in the lives of numerous individuals in the U.S. and
internationally. These media are becoming increasingly central in
the lives of many individuals and for a large number, they are
among the primary ways that they communicate, establish and
maintain relationships, and express themselves. For the younger
generation, these trends are especially true. Prensky (2001) has
described this phenomenon by using the terms “Digital Native”
and “Digital Immigrant.” Digital Natives are those born into a
world where the Internet and related technologies are omnipresent
and are learned along with their primary language. In fact, many of
these individuals may be considered bilingual: communicating
fluently and naturally in both their native tongue and through
computers, the Internet, text messaging, blogging, e-mailing, and
the like. Digital Immigrants are those who were born in a different
time and who have needed to learn this new language and culture
so they can become fluent in it and converse effectively with the
Digital Natives. As Prensky (2001) highlights, with each passing
day the ‘language’ of the Digital Natives becomes more a part of
our culture and how individuals communicate and relate to each
other. Therefore, it becomes increasingly important to study and
understand how these media are being used by psychologists, those

in training to become psychologists, and those to whom we pro-
vide clinical services.

Relevant Ethical Issues and Standards

The Ethical Principles of Psychologists and Code of Conduct
(American Psychological Association Ethics Code; APA, 2002)
makes it clear in its Introduction and Applicability section that the
standards therein apply only to psychologists’ and students’ “sci-
entific, educational, or professional roles” and not to their “purely
private conduct” (p. 1061). The Ethics Code also makes it clear
that its standards apply “to these activities across a variety of
contexts, such as in person, postal, telephone, Internet, and other
electronic transmissions” (p. 1061). As will be highlighted, dilem-
mas arise regarding just what is to be considered within the
professional realm or the personal realm. Further, the notion of
“purely private conduct” on the part of psychologists and students
when utilizing the Internet and social networking sites will be
challenged. In fact, as a result of the far-ranging effects of the
Internet, and consistent with the work of Pipes, Holstein, and
Aguirre (2005), the profession’s view of personal and professional
as distinct or separate entities will need to be reconsidered.

Knowing when and how to apply the APA Ethics Code (APA,
2002) may now be less clear. This is a result of the potentially
ambiguous nature of the types of interactions one may have over
the Internet and the challenges present in deciding what constitutes
professional services. For example, providing clinical services
such as counseling and psychotherapy via the Internet falls within
the realm of professional behavior, and all relevant standards of the
APA Ethics Code therefore apply. These include Standards 10.01
Informed Consent to Therapy, 4.01 Maintaining Confidentiality,
3.05 Multiple Relationships, 2.01 Boundaries of Competence, and
others. What may be less clear is how the Ethics Code applies to
activities such as posting personal information online to which
colleagues, clients, and potential clients may have access, search-
ing online for information about clients, and interacting with
clients and former clients online through social networking sites or
other means. What is clear is that a greater understanding of the
uses (and misuses) of the Internet and social networking sites is
needed, and the profession’s standards must keep pace with the
changing world within which we function.

Online Study of Psychologists’ Internet Use

There are very little data on how psychologists and psycholo-
gists in training use social networking sites, whether they post
personal information online, and what steps they take to restrict
such information. To examine these questions, we conducted an
exploratory online survey with 302 psychology graduate students
regarding their online activity. Graduate students’ Internet use
provides a good case example of behavior over the Internet for
psychology’s future, as this is a cohort who grew up with the
Internet and may thus be considered Digital Natives, or “experts”
in the area of online technologies.

To publicize the study, an e-mail advertisement was sent to
student members of Divisions 29 (Psychotherapy) and 42 (Psy-
chologists in Independent Practice) of the APA; these divisions
were used because of their large student memberships in addition
to incorporating a group of students likely interested in psycho-

161PSYCHOTHERAPY AND MYSPACE

therapy and the clinical practice of psychology. In addition, the
e-mail advertisement was sent to the Maryland, California, Texas,
Kentucky, and Ohio Psychological Associations, and graduate
students at the University of Washington. These state psycholog-
ical associations were selected since they are those associations
that have the largest and most active student organizations. Of the
302 graduate students who responded, the mean number of years
in graduate school was 3.4 (SD � 1.54). Thirty-three percent were
in a clinical Ph.D. program, 12% in a nonclinical Ph.D. program,
40% in a PsyD program, 8% in a masters program, and 7% in other
types of psychology graduate programs. Eighty-two percent con-
sidered themselves student psychotherapists (i.e., currently or in
the past having seen clients).

When asked about their online activity, 81% of students re-
ported having a personal profile (e.g., MySpace, Facebook, Friend-
ster, dating profile, etc.), Web site, or blog online. More specifi-
cally, 37% of students reported having a MySpace profile. Of these
students, 22% reported using MySpace for less than a year, 49%
between 1–2 years, and 29% between 2– 4 years (at the time of the
survey, MySpace was 4 years old). With regard to whether stu-
dents restrict or protect their information in any way, 67% reported
using their real name on their MySpace profile, with only 22%
reporting using a pseudonym. Eighty-one percent reported provid-
ing access to their profile to “friends only,” a list of people who
must be approved by the user before access is provided. However,
15% reported that anyone could have access to their MySpace
profile, and 5% were “not sure” who had access to their profile.

Facebook was used by 33% of students. Of these students, 22%
reported using Facebook for less than a year, 32% between 1–2
years, and 46% between 2–3 years (at the time of the survey,
Facebook was 3 years old). With regard to protecting their infor-
mation, 60% reported giving access to “friends only,” 34% re-
ported providing access to some or all networks of people, and 6%
were “not sure” who had access to their profile.

Twenty percent of students reported having a profile or account
on other social Web sites (e.g., Friendster) or an online blog not
including MySpace or Facebook. Of these students, 79% reported
using measures to restrict access to their postings (e.g., pseud-
onym, private or ‘friend’ only access) on these Web sites, while
21% did not.

Taken together, these data indicate that a substantial proportion
of psychology graduate students use social networking sites. Given
that both MySpace and Facebook are only a few years old, most
students began using such sites while in graduate school. More-
over, while the majority of students using these sites reported
restricting access to their information, 15% of the MySpace users,
34% of the Facebook users, and 21% of other social Web site users
reported not doing so.

Beyond examining the prevalence of graduate students’ use of
social networking sites, we asked users whether they posted any
photos and/or personal information online that they would not
want classmates, faculty, or clients to see. When it came to their
peers, 3% reported that they posted photos and 6% posted personal
information they did not want their classmates to see. These
percentages were larger when it came to faculty, such that 13%
reported that they posted photos and 11% posted personal infor-
mation they did not want faculty members to see. These percent-
ages were considerably larger still when it came to clients. Of
those who were student psychotherapists, 29% reported that they

posted photos and 37% posted personal information they did not
want clients to see.

Clinical Implications

In the same survey, we examined how the Internet enters the
therapeutic relationship for student psychotherapists. Indeed, no-
where might the risks of unwanted online disclosure be as great as
in the context of psychotherapy, where the relationship is a key
ingredient for client change and therapeutic outcomes (Ackerman
& Hilsenroth, 2003; Blatt et al., 1996; Marmarosh et al., 2009). To
explore this issue, we asked student psychotherapists whether a
client had ever informed them that he or she obtained information
about the student online, whether they had ever sought out infor-
mation about a client online, and if so, what impact this had on the
therapeutic relationship. We identified themes by categorizing
responses and present example responses for illustration (Taylor &
Bogdan, 1998).

Clients Obtaining Information Online

Seven percent of the student psychotherapists in the sample
reported being informed by a client that he or she had obtained
information about the student from the Internet. Reasons clients
gave for seeking out information varied, with one theme surround-
ing curiosity:

My client googled me and found a journal article I’d written. I was a
little taken aback, but not entirely surprised, as I have friends who
have googled their therapists. I think my client appreciated me nor-
malizing his curiosity.

Indeed, in an era of consumer-led healthcare, it may not be
surprising to find clients Googling their psychotherapist’s name
online. In one survey, for example, 8 in 10 Internet users reported
looking online for health information, including information on
particular doctors and health-care professionals (Fox, 2005). As
another student noted:

A client searched the state online listing of licensed psychologists and
told me at our next meeting. I remarked that it is good to verify
provider credentials and asked if they had any other questions about
my education or credentials that I could answer. In hindsight I could
have used the event to help that client explore issues of trust.

This statement highlights not only that clients may look up
psychotherapists online to establish their credentials, but also that
issues related to building relationships and trust may be related to
such behavior.

A client had requested that I ‘friend’ her (via the site). We discussed
in session that I only keep the site for keeping up with people that I
socialize with. I later realized that since I have a very common name,
she had to actively sort through a lot of profiles to find me, even when
restricting it by geographical area. We had already stopped treatment,
but I might have discussed her motivations in more detail had I
thought of it at the time.

In this way, recognizing clients’ online behavior as part of a
class of behaviors that may be relevant for treatment provides the
psychotherapist an opportunity to examine its function (Lehavot,
2009b). In other words, when viewed as clinically relevant behav-

162 LEHAVOT, BARNETT, AND POWERS

ior, the client’s online behavior may be used strategically in
psychotherapy to help clients reach their therapeutic goals. When
online behavior is not recognized as such, it is a missed opportu-
nity.

At the same time, while clients’ online behavior may be related
to therapeutic issues such as trust, relationship, and boundaries,
there are times when this behavior may step on the psychothera-
pist’s rights or safety:

A client found out my birth date, where I was born, my current
address, my telephone number, and personal e-mail address. In addi-
tion the client talked about me with my neighbors. I found this very
disturbing. Using an interpersonal therapeutic approach, I processed
with the client what it means for her to have more information about
me. This has been a difficult situation, since therapy with the client
terminated six months ago, yet the client continues to ‘follow’ me on
campus, drive by my house, etc.

In this scenario, basic online information about the psychother-
apist allowed the client to inappropriately invade the psychother-
apist’s personal life. This emphasizes the critical need not only to
be mindful of what we post online, but also to be aware of what
information about us is available (Zur, 2008).

Psychotherapists Obtaining Information Online

Twenty-seven percent of student psychotherapists reported
seeking out information about a client on the Internet. Similar to
clients, some students appeared to seek this information out of
curiosity:

I used MySpace and Facebook to see how [clients] were doing and
look at pictures of their friends that they talk about. I got a thrill
from it.

The above statement underscores that psychologists-in-training
may seek online information about clients automatically, in a
manner that does not consider this activity through a critical lens
with respect to relevant clinical and ethical issues. For graduate
students who have grown up with the Internet as part of their
worldview and everyday life, there may be lack of awareness
regarding the potential impact of the behavior. Indeed, the moti-
vation of personal entertainment as highlighted in the above com-
ment may be just as much of a boundary violation as a client
exploring psychotherapist information.

Beyond curiosity, a common theme student psychotherapists
gave for seeking online information about clients was to “establish
the truth”:

I’ve looked at clients’ MySpace profiles. I’ve read what they did with
their friends and if they were using drugs/alcohol. I think it allowed
me to help determine if they were telling the truth in substance abuse
counseling.

I searched MySpace, just wanted to see if the client was telling the
truth. made me have other thoughts about what was really going on,
found out she was lying in therapy sessions. wouldn’t do it again!

I have googled clients who seem to be making some outlandish
claims. I was doing this in order to gain a sense of what was ‘true’ and
what wasn’t. I found the searching to be unhelpful and inconclusive.

In such instances, the psychotherapist appears to be doubting the
client’s claims and actively seeking other sources of information,

without open discussion of the issue with the client. Even if
unintentional, such behavior does not allow the client the oppor-
tunity to provide informed consent and explore, with the psycho-
therapist, the potential impact of online disclosures on the thera-
peutic relationship. There are at least two ethical principles
relevant to this behavior: Principle A: Beneficence and Nonma-
leficence, taking care to do no harm to the client and the thera-
peutic process, and Principle B: Fidelity and Responsibility, cre-
ating and maintaining relationships of trust with clients (APA,
2002).

With regard to nonmaleficence, there is reason to suspect that
clients withhold certain information from their psychotherapists
intentionally. Some research suggests that such discretion is asso-
ciated with positive psychotherapy process ratings and outcomes
(Kelly, 1998, 2000). For example, in one study, 40% of clients
reported keeping a relevant secret from their psychotherapist, and
keeping secrets was a significant predictor of having fewer symp-
toms (Kelly, 1998). Such findings support a self-presentational
perspective, wherein clients come to benefit from psychotherapy
by perceiving that their psychotherapists have favorable views of
them. Creating these favorable impressions can involve clients’
hiding some undesirable aspects of themselves from their psycho-
therapists.

The self-presentational perspective is not without controversy,
with some authors arguing that psychotherapist awareness of client
concealment with psychotherapy process and outcome is not clear
(Hill, Gelso, & Mohr, 2000) and that psychotherapists should
actively pursue material that is difficult to disclose (Farber,
Berano, & Capobianco, 2004).

Regardless of whether the actual pursuit of such material may be
harmful, however, what is also at issue with seeking information
about a client online is the way in which it is done: without the
client’s awareness or permission. Should the obtained information
influence the psychotherapist’s reactions to her or his client or the
information seeking become known, there may be an adverse
impact on the therapeutic relationship:

I obtained information through a social Web site. It caused me to
question the client’s motivation for counseling and therapeutic goals.

I started with Google. I ended up obtaining sex offender registration
information for a client. He had volunteered that this information
existed. Because he had shared the information with me willingly, it
did not really affect my perception of him.

Indeed, one might wonder how discovering this information
would have impacted psychotherapy and the therapeutic relation-
ship if the information was not shared by the client.

While actively seeking online information about clients may
thus hold certain dangers, it also provides an opportunity to further
benefit the therapeutic process, especially when done collabora-
tively:

Looked at MySpace profile of a client. I obtained more information
about her state of mind and likes and dislikes. It was beneficial to the
relationship because she had asked me to look at her profile.

I looked up adolescent clients on MySpace if they spoke about it in
session. Would confront client on inconsistencies between what they
say and what their profile conveys. It might impact how I view the
case because I could see if they were being honest and open in
therapy.

163PSYCHOTHERAPY AND MYSPACE

[Looked up on MySpace]. I felt really awkward about bringing it up
for discussion, so I never did. Felt like spying. After that, I don’t look
at profiles anymore unless a client invites me to. One in particular
wanted me to see stuff about a band that was a key component of her
identity, so we visited it together.

In these instances, the students obtained information online with
the knowledge and invitation of their clients. When done in this
open manner, the psychotherapist was able to use the information
to help clients reach their therapeutic goals; for example, by
pointing out discrepancies between a client’s values or goals and
how they actually present themselves in relationships outside of
session. In the last case, in particular, the psychotherapist used the
medium collaboratively with his or her client in the room, allowing
for a greater understanding of the client’s experience and a poten-
tial deepening of the relationship.

Finally, some psychotherapists have distinguished between
looking up information on current versus former clients:

Through MySpace I looked up past clients to see how they were
doing. I obtained info about their social lives and their personal
thoughts through their blogs. I was happy to see how well they
appeared to be doing, and it did not impact my view of my clients. I
have only looked AFTER terminating therapy. Not while seeing a
client.

Indeed, one might wonder when our obligation as a psychother-
apist ends. Nonetheless, it is important to consider that a former
client can come back to a psychotherapist as a client in the future.
Information that was learned in the meantime, or decisions about
what to share with the client on the Internet, may thus impact
future therapeutic interactions (Barnett, 2008b).

Discussion

In summary, results from our exploratory survey with
psychologists-in-training highlight the many ways in which Inter-
net technologies may encroach upon professional relationships.
Not surprisingly, a large majority of psychology graduate students
(81%) reported using some social networking sites. While many
used security measures to limit who has access to their informa-
tion, a substantial percentage of students did not. Moreover, social
network users did not want some of the material posted, whether
in the form of photos or personal information, to be seen by those
with whom they are engaged in professional relationships, espe-
cially clients.

Psychotherapists in the Internet Era: Crisis or
Opportunity?

The Internet is widely used in both the professional and personal
lives of psychotherapists. As professionals, the Internet allows for
greater accessibility and ease of communication between psycho-
therapist and client. It also affords many individuals the opportu-
nity to access clinical services that might not otherwise be avail-
able (Schopp, Demiris, & Glueckauf, 2006). In one’s personal life,
the Internet offers many individuals the means to form and main-
tain relationships, easily communicate across long distances, and
share their lives with others through visual images and text. It is
the intersection of these two realms, however, that brings with it
the greatest risks and challenges.

We have called attention to two related clinical issues: clients
accessing psychologists’ online information and psychologists ac-
cessing clients’ online information. In regard to the former, the
issue of self-disclosure is an important one to consider. Depending
on one’s theoretical orientation, the carefully planned use of self-
disclosure by the psychotherapist may be a valuable therapeutic
tool. However, the ethical and clinically effective use of psycho-
therapist self-disclosure involves the sharing of information that is
motivated by the client’s clinical needs and treatment plan rather
than the clinician’s personal needs; is consistent with prevailing
professional practice standards; is not unwelcomed by the client;
and does not result in harm to the client (Barnett, 1998; Smith &
Fitzpatrick, 1995). While numerous forms of self-disclosure exist
(Zur, 2008), psychologists’ use of intentional self-disclosure over
the Internet must be viewed with caution even when it occurs in
one’s personal life.

As has been highlighted, many clients will have ready access to
personal information shared over the Internet by their psychother-
apists. We therefore recommend that psychologists carefully con-
sider the use of privacy or security settings when using social
networking sites. The highest level of settings limit access to one’s
site to specifically authorized visitors only. Even if materials
posted online can at times be deleted, psychologists should care-
fully consider what they post knowing that at some point in time
others may have access to it. While we each have the right to
personal lives and to share what we choose with friends, family,
and colleagues, some caution is recommended. Clients may use
pseudonyms to gain access to a clinician’s social networking site
and some may have the technological sophistication to bypass
security settings. Students and trainees should consider the same
issues and precautions. Additionally, mental health professionals
should remain cognizant of the fact that what may seem very
appropriate to post online as a student sharing with friends may not
appear so appropriate if viewed in the future by a client, graduate
school admissions officer, or internship training director.

An additional challenge involves being asked by a client or former
client to “friend” you on your social networking site. Such requests
are common, since for many individuals this is a primary way of
‘keeping in touch’ and sharing about their life. However, as should be
evident, this online sharing is bidirectional. Each psychologist should
consider these ‘friend’ requests in the context of their role as a
professional psychologist. Issues to consider with making these deci-
sions include the potential impact on the client, the psychotherapy
relationship, and the profession of psychology. Further, these deci-
sions should be made in the context of the standards on boundaries
and multiple relationships provided in the APA Ethics Code (APA,
2002). As it is stated in Standard 3.05 Multiple Relationships, “Mul-
tiple relationships that would not reasonably be expected to cause
impairment or risk exploitation or harm are not unethical” (p. 1076).
It is important to engage in careful forethought so that the risk of harm
to clients can be minimized. Engaging in a secondary online relation-
ship should only occur when consistent with the primary clinical
relationship and the client’s best interests.

Any time psychotherapists access personal client information
without clients’ permission, they are doing so in a professional
role. In these situations psychotherapists must consider their obli-
gations under the APA Ethics Code’s (APA, 2002) principle of
Fidelity and Responsibility, which advises that “psychologists
establish relationships of trust with those with whom they work”

164 LEHAVOT, BARNETT, AND POWERS

(p. 1064). Further, in the ethical principle of Integrity, psycholo-
gists are advised to “promote accuracy, honesty, and truthfulness
in science, teaching, and practice of psychology” (p. 1064). Thus,
without first obtaining the client’s permission through the process
of informed consent, accessing a client’s online information may
be both inconsistent with these ethical ideals and a violation of the
client’s trust.

An alternative perspective could focus on the fact that the client
posted this information in a public domain and that all individuals
posting information online accept the risks involved. While many
clients understand and utilize appropriate security settings that help
limit unauthorized access to their online sites, not all clients possess
this knowledge or level of technological sophistication. Failure to
fully inform clients of the potential risks and benefits of certain
decisions, actions, and behaviors that may impact their emotional
functioning, well being, and the psychotherapy process seems incon-
sistent with our ethical obligations (see Standards 3.10 Informed
Consent, 10.01 Informed Consent to Therapy, and 3.04 Avoiding
Harm). In fact, Standard 3.04 Avoiding Harm explicitly states that
psychologists must “(t)ake reasonable steps to avoid harming their
clients/students, supervisees, research participants, organizational cli-
ents, and others with whom they work, and to minimize harm where
it is foreseeable and unavoidable” (p. 1067). Accessing client infor-
mation without their permission is a behavior that holds the potential
to result in harm and an action that is clearly avoidable. Psychologists
should be guided by their obligation to establish relationships of trust
and take actions to minimize the potential for harm to clients when
considering accessing clients’ online information.

When accessing a client’s Internet site is done collaboratively as
an agreed upon part of the treatment plan, it can be very beneficial
to the psychotherapeutic process. Similar to clients sharing their
poetry, journal, or artwork during a session or bringing in photos
to a session to share more about their life with the psychotherapist,
accessing a client’s Internet site collaboratively or on one’s own
with the client’s permission and informed consent may add rich-
ness to the psychotherapy process that might not otherwise be
available. Indeed, in such situations the Internet may prove to be a
medium that facilitates, rather than hinders, therapeutic goals and
the psychotherapy relationship.

Barnett (2008b) provides the following recommendations for
ethical and clinically appropriate use of social networking sites in
psychologists’ professional roles:

• Make thoughtful decisions about who you accept on your
friends list and thus grant access to your personal information.

• Consider using some form of restrictions to your online pro-
file, such as utilizing private or friend-only access or using a
pseudonym.

• Keep in mind that whatever you share online may be available
to numerous individuals and once out there, it may not be possible
to take it back.

• Consider online relationships as similar to in-person ones with
clients and former clients. Do not overlook the potential impact of
online relationships on the professional one.

• Never access clients’ personal information without first ob-
taining their permission. Ensure they understand the potential
impact of online disclosures on the psychotherapy relationship.

• Utilize the APA Ethics Code and consultation with colleagues
to guide decision making.

• Create a policy for the use of social networking sites, share
this with clients who ask, and follow it carefully.

Indeed, it may be helpful for psychotherapists to consider ad-
dressing this policy during the informed consent process to mini-
mize potential future risks and ethical dilemmas. Additional guid-
ance is provided by Lehavot (2007), who recommends asking the
following questions before making online disclosures such as the
posting of personal information on a social networking site:

• What are the costs and benefits of posting the information?
• Is there a high probability that clients will be significantly and

negatively affected?
• How will the disclosure affect my relationship with my cli-

ents?
• Does the disclosure threaten my credibility or undermine the

public’s trust in the field of psychology?

Future Directions

As standards for online mental health services and social net-
working sites evolve, it is important that psychologists play an
active role in their development. Psychologists, trainees, and stu-
dents are in need of detailed guidance that assists them in navi-
gating the ever-changing landscape of the Internet. Some profes-
sional organizations have developed standards for the provision of
online services. Examples include Ethical Guidelines for Psychol-
ogists Providing Psychological Services Via Electronic Media
(Canadian Psychological Association, 2008), Ethical Standards
for Internet Online Counseling (American Counseling Associa-
tion, 1999), and Suggested Principles for the Online Provision of
Mental Health Services (International Society for Mental Health
Online, 2000). The profession of psychology needs to participate
in the development of standards and guidance for psychologists for
the provision of online mental health services as well as for the
posting and viewing of personal information online and interacting
with clients and former clients online. Psychologists may also have
an impact on social networking technologies themselves, urging
them to provide more privacy protections. For example, Facebook
has recently made changes to their privacy provisions in response
to complaints by Jennifer Stoddart, the privacy commissioner of
Canada (Schmidt, 2009).

Colleges, universities, and training centers should develop pol-
icies and standards regarding the posting of personal information
online as well as for accessing others’ online information without
their explicit permission. For example, it may be prudent for
colleges and training sites to post on their Web site and include in
all application materials their policies regarding accessing appli-
cants’ personal information and then utilizing it during the admis-
sions process (Lehavot, 2009a).

Clinical supervisors should be included in these discussions and
be trained to address these issues with their supervisees. This is a
domain in which the supervisees are likely to have more experi-
ence than their supervisors, so supervisors may need to educate
themselves about social networking. Further, supervisors should
consider all the same issues relevant to psychotherapists and their
clients when considering sharing personal information online with
supervisees, accessing supervisees’ information online, or commu-
nicating through social networking sites with supervisees. As

165PSYCHOTHERAPY AND MYSPACE

standards for the ethical and effective practice of supervision
evolve, the role and impact of various technologies and media
should thoughtfully be considered as well.

More research is clearly needed to better understand the evolv-
ing world of the Internet, how it impacts the lives of those we work
with professionally, and how it impacts the professional therapeu-
tic relationship. The present study should be considered explor-
atory, and its limitations include only surveying graduate students
and not assessing demographic variables such as participants’ age,
gender, and race/ethnicity. Nonetheless, as a preliminary step, it
suggests the need for further research with students, trainees,
practicing psychotherapists, and psychologists working in a wide
range of settings and roles. Future studies may further explore the
impact of psychologists’ theoretical perspectives on their use of
social networking sites, and the full impact of involvement with
social networking activities. Indeed, the potential impact of Inter-
net use and social networking sites on the psychotherapy process,
in supervision, and in educational and training settings has yet to
be understood. Similarly, the potential risks and drawbacks to their
use are not yet adequately understood. Finally, models of decision
making are needed to assist professionals in making the complex
and challenging decisions that have been highlighted about the
intersection of the Internet and social networking with the practice
and profession of psychology.

References

Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist char-
acteristics and techniques positively impacting the therapeutic alliance.
Clinical Psychology Review, 23, 1–33.

American Counseling Association. (1999). Ethical standards for Internet
online counseling. Alexandria, VA: Author.

American Psychological Association. (2002). Ethical principles of psy-
chologists and code of conduct. American Psychologist, 57, 1060 –1073.

Barnett, J. E. (1998). Should psychotherapists self-disclose? Clinical and
ethical considerations. In VandeCreek, L., Knapp, S., & Jackson, T.
(Eds.), Innovations in clinical practice (pp. 419 – 428). Sarasota, FL:
Professional Resource Press.

Barnett, J. E. (2008a, August). MySpace, YouTube, psychotherapy, and
professional relationships: Crisis or opportunity? Symposium presented
at the 116th Annual Convention of the American Psychological Asso-
ciation, Boston, MA.

Barnett, J. E. (2008b). Online ‘sharing’ demands caution. The National
Psychologist, 17, 10 –11.

Blatt, S. J., Sanislow, C. A., Zuroff, D. C., & Pilkonis, P. (1996). Char-
acteristics of effective therapists: Further analysis of data from the
National Institute of Mental Health treatment of depression collaborative
research program. Journal of Consulting and Clinical Psychology, 64,
1276 –1284.

Canadian Psychological Association. (2008). Ethical guidelines for psy-
chologists providing psychological services via electronic media. Re-
trieved from http://www.cpa.ca/aboutcpa/boardofdirectors/committees/
ethics/ethicalguidelines/

Caruso, J. B., & Salaway, G. (2007). The ECAR study of undergraduate
students and information technology, 2007. Boulder, CO: EDUCAUSE
Center for Applied Research. Facebook. (2009). Statistics. Retrieved
from http://www.facebook.com/press/info.php?statistics

Farber, B. A., Berano, K. C., & Capobianco, J. A. (2004). Clients’ per-
ceptions of the process and consequences of self-disclosure in psycho-
therapy. Journal of Counseling Psychology, 51, 340 –346.

Fleishman, J. (2009). Mideast hanging on every text and tweet from Iran.
Los Angeles Times. Retrieved from http://articles.latimes.com/2009/jun/
17/world/fg-iran-image17

Fox, S. (2005). Health information online. Washington, DC: Pew Internet
and American Life Project.

Hill, C. E., Gelso, C. J., & Mohr, J. J. (2000). Client concealment and
self-presentation in therapy: Comment on Kelly (2000). Psychological
Bulletin, 126, 495–500.

International Society for Mental Health Online. (2000). Suggested princi-
ples for the online provision of mental health services. Retrieved from
http://www.ismho.org/suggestions.html

Internet World Stats. (2008). The Internet big picture: World Internet users
and population stats. Retrieved from http://www.internetworldstats
.com/stats.htm

Kelly, A. E. (1998). Clients’ secret keeping in outpatient therapy. Journal
of Counseling Psychology, 45, 50 –57.

Kelly, A. E. (2000). Helping construct desirable identities: A self-presentational
view of psychotherapy. Psychological Bulletin, 126, 475–494.

Lehavot, K. (2007). “MySpace” or yours? The ethical dilemma of graduate
students’ personal lives on the Internet. Presentation at the Annual Con-
vention of the American Psychological Association, San Francisco, CA.

Lehavot, K. (2009a). “MySpace” or yours? The ethical dilemma of graduate
students’ personal lives on the Internet. Ethics and Behavior, 19, 129 –141.

Lehavot, K. (2009b). Is being exposed all bad? Implications of Internet
self-disclosures for psychotherapists, clients, and graduate students. [Com-
mentary]. Professional Psychology: Research and Practice, 40, 22–30.

Marmarosh, C. L., Gelso, C. J., Markin, R. D., Mallery, C., Choi, J., &
Majors, R. (2009). The real relationship in psychotherapy: Relationships
to adult attachments, working alliance, transference, and therapy out-
come. Journal of Counseling Psychology, 56, 337–350.

Miller, C. (2008). How Obama’s Internet campaign changed politics. The
New York Times. Retrieved from http://bits.blogs.nytimes.com/2008/11/
07/how-obamas-internet-campaign-changed-politics/

Pipes, R. B., Holstein, J. E., & Aguirre, M. G. (2005). Examining the
personal-professional distinction: Ethics codes and the difficulty of
drawing a boundary. American Psychologist, 60, 325–334.

Prensky, M. (2001). Digital natives: Digital immigrants. On the Horizon, 9,
1– 6.

Salaway, G., Caruso, J. B., Nelson, M. R., & Ellison, N. B. (2008). The
ECAR study of undergraduate students and information technology,
2008. Boulder, CO: EDUCAUSE Center for Applied Research.

Schmidt, S. (2009). Facebook to comply with privacy recommendations: Com-
missioner. The Vancouver Sun. Retrieved from http://www.vancouversun.com/
news/vancouver/Facebook�comply�with�privacy�recommendations�
Commissioner/1935399/story.html

Schopp, L. H., Demiris, G., & Glueckauf, R. L. (2006). Rural backwaters
or front-runners? Rural telehealth in the vanguard of psychology prac-
tice. Professional Psychology: Research and Practice, 37, 165–173.

Smith, D., & Fitzpatrick, M. (1995). Patient-therapist boundary issues: An
integrative review of theory and research. Professional Psychology:
Research and Practice, 26, 499 –506.

Social Network Stats. (2008). Social networking site usage: Visitors,
members, page views, and engagement by the numbers in 2008. Re-
trieved from http://www.web-strategist.com/blog/2008/01/09/social-
network-stats-facebook-myspace-reunion-jan-2008/

Taylor, S. J., & Bogdan, R. (1998). Introduction to qualitative research
methods: A guidebook and resource (3rd ed.). New York: John Wiley &
Sons.

Zur, O. (2008). The Google factor: Therapists’ self-disclosure in the age of
the Internet. Independent Practitioner, 28, 82– 85.

Zur, O., & Donnor, M. B. (2009). Google factor: Therapists’ transparency
in the era of Google and MySpace. California Psychologist, Jan./Feb.,
23–24.

Received August 14, 2009
Revision received November 16, 2009

Accepted December 14, 2009 �

166 LEHAVOT, BARNETT, AND POWERS

Social Media in the Future of Professional Psychology

Keely Kolmes
San Francisco, California

In the past several years, the practice and profession of psychology have been greatly influenced by
digital culture and social media. The prevalence of psychologists using websites and technology to
engage, socialize, market, and interact has created new opportunities and challenges for the practitioner,
particularly in regard to potential therapeutic and extratherapeutic interactions with clients on the web.
Given the speed with which these media are permeating our world, we can expect to see a proliferation
of new issues, challenges, and opportunities for clinical practice and the delivery of services. This article
provides an overview of the relevant issues, ongoing trends, and what the future holds for psychology,
psychologists, and the populations we serve. How current technological and policy shifts may influence
clinical practice, clinical training, and our responsibilities as providers of clinical care will be addressed.

Keywords: Internet, social media, digital culture, ethics, practice

Social networking sites are becoming a standard means of living
and interacting. Two thirds (66%) of American adults use social
media sites such as Facebook, Twitter, LinkedIn, and MySpace
(Smith, 2011). Many of these sites are being accessed by mental
health professionals who are using them to connect socially with
peers, network with other professionals, and provide education to
consumers of psychological services. This article provides an
overview of the pertinent issues, continuing trends, and the future
outlook for psychology, psychologists, and the people we serve. It
will address how shifts in current and future technology and policy
may affect clinical care, clinical training, and our responsibilities
as clinicians. Applicable ethical issues as well as potential dilem-
mas for practitioners will be defined.

The primary activities that occur on social networking sites
include the exchange of messages, news items, events, photos,
videos, and the quick sharing of additional information through
“liking,” “sharing,” “retweeting,” and “�1,” actions. However, the
development of new technologies is increasing at a pace that
makes it difficult for clinicians to fully understand the ethical
implications of their activities on these sites. As a consequence,
this creates challenges for clinical training programs to provide
adequate supervision and training on how to manage the develop-
ment of trainees’ professional identities with their online presence.

This can prove even more onerous when one’s online presence
began primarily as a social one, early in life, as is the case for
many “digital natives,” (Prensky, 2001) who were born during or
after the introduction of digital technology and are entering psy-
chology programs today. At the same time, digital natives are
being taught and supervised by “digital immigrants,” (individuals
born before the existence of digital technology who have adopted
it later in life) who do not always fully perceive the nuances of
digital culture. This wave of plugged in consumers and clinicians
who are fluent in online culture and social networks will influence
our cultural understandings of digital interactions and the delivery
of services in ways that we are only beginning to comprehend and
in some other ways that are difficult to predict.

At the same time, technological advances are creating exciting
new ways for psychologists to offer help to their clients. Some
clinicians are using text (via blogging or e-mail), audio recordings,
and videochat (such as YouTube, Skype, or other videoconferenc-
ing systems) to provide a range of services from psychoeducation
to psychotherapy. Others are using applications (apps) and other
technological tools to augment treatment, measure progress, and
make therapeutic interventions.

The most commonly used social networking sites by Americans
include Facebook, Twitter, and LinkedIn. Facebook currently re-
ports having more than 800 million active users (Facebook, 2011).
As of November 3, 2011, LinkedIn claimed to operate the world’s
largest professional network on the Internet with more than 135
million members in more than 200 countries and territories
(LinkedIn, 2011). Twitter reported more than 300 million users as
of 2011, generating more than 300 million tweets and handling
more than 1.6 billion search queries per day (Wikipedia, 2011).

Digital Transparency

Recent research indicates that clinicians and clients are experi-
encing a different type of transparency when it comes to sharing
online spaces. In some ways, this type of visibility and accessibil-
ity mirrors the offline interactions that have been occurring be-
tween clinicians and clients in rural communities and discrete

Editor’s Note. This article is one of 11 in this special section on Visions
for the Future of Professional Psychology.—MCR

This article was published Online First September 17, 2012.
KEELY KOLMES received her PsyD in clinical psychology from CSPP at
Alliant International University in the San Francisco Bay Area. She main-
tains an independent practice in San Francisco, California. Her clinical and
research interests include legal and ethical issues, training and supervision
issues, and the provision of culturally sensitive and competent care to
sexual and gender minority clients.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Keely
Kolmes, 220 Montgomery Street, Suite 400, San Francisco, CA 94104.
E-mail: drkkolmes@gmail.com

Professional Psychology: Research and Practice © 2012 American Psychological Association
2012, Vol. 43, No. 6, 606 – 612 0735-7028/12/$12.00 DOI: 10.1037/a0028678

606

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communities within cities, where it is harder to prevent client–
psychotherapist overlaps in other aspects of the shared community
(Zur, 2006). One of the more common forms of both intentional
and accidental discovery of client information on the Internet is the
unearthing of shared or overlapping friend networks on social
media sites (Kolmes & Taube, 2010). This experience of access
and visibility may be magnified for clients and clinicians who
identify as members of shared cultural groups either through
ethnicity, sexual orientation, disability, religion, substance recov-
ery programs, or even professional networking groups.

Some have encouraged clinicians to regularly search for online
information about themselves in order to ascertain what clients
may discover about them on the Internet (Zur & Donner, 2009).
Several years ago, clinicians seemed primarily focused on con-
cerns that clients might discover information about them on the
Internet. Nevertheless, such discoveries may never be brought to
the attention of clinicians. Research on 332 psychotherapy clients
found that although 70% of clients reported finding personal
information about their psychotherapist on the Internet, only 28%
discussed these findings with their psychotherapist (Kolmes &
Taube, 2011). Most of these discoveries occurred on Google,
Facebook, and LinkedIn. Many of these clients admitted to feel-
ings of shame, discomfort, and embarrassment for seeking out
information about their psychotherapist, and they worried that
disclosing these searches to their psychotherapist would result in
judgment or rejection.

More recently, there has been a sharper focus on the ethics and
clinical effects of psychotherapists using Internet search engines
and social networking sites to seek and obtain information about
those whom they are treating. Lehavot, Barnett, and Powers (2010)
found that 27% of student psychotherapists had sought information
about clients on the Internet. Their respondents reported both
positive and negative influences of such search behavior on the
clinical relationship. Lal and Asay (Martin, 2010) reported that
22% of 193 clinical psychology graduate students had Googled
their psychotherapy clients. In a survey of 227 multidisciplinary
psychotherapists, Kolmes and Taube (2010) found that 28% acci-
dentally found information about current psychotherapy clients
online, whereas 48% intentionally sought this information. Face-
book and Google were most commonly reported as the sites of
discovery. A more recent study by DiLillo and Gale (2011),
surveyed 854 doctoral students in psychology and found that
despite their beliefs that it was usually unacceptable to use search
engines or social networking sites to find client information,
97.8% had still reported doing so at least once in the past year.

When it comes to working with younger populations, Tunick,
Mednick, and Conroy (2011) surveyed 246 psychologists and
trainees about their behavior around their adolescent clients’
online presence. Many reported being concerned about items
they found on clients’ social media profiles. Jent et al. (2011)
found that trainees are conducting social media searches on
their clients that faculty would not endorse—suggesting that
there is a divide between the beliefs and practices of trainees
and faculty, which again may reflect the distinction made
between digital natives who are growing up in a point and click
culture and digital immigrants who did not come of age at a
time when this was de rigueur.

Consumers Using Social Media To Find Health
Information

The Pew Foundation (Fox, 2011) has found that 80% of Amer-
icans have looked online for health information, whereas 34% of
Internet users and 25% of adults have read someone else’s com-
mentary or experience about health or medical issues online.
Another 16% have sought out online reviews of doctors. People
are seeking out support groups, looking for health care providers,
and checking online reviews of providers. The issue of psycho-
therapy clients leaving online reviews of their psychotherapists is
meanwhile causing additional anxiety for mental health profes-
sionals who feel gagged by confidentiality requirements and un-
able to defend themselves against negative reviews or unable to
ask current clients for positive reviews as this violates Standard
5.05 of our Ethics Code (American Psychological Association
�APA�, 2010).

Psychologists Using Social Media

Marketing

Many psychologists are establishing a professional presence on
their own websites and social media sites as a means of directly
marketing their practices (Johnson, 2011). They are blogging and
using Twitter, Facebook, LinkedIn, and other sites to get their
message out about the services they provide and network with
other clinicians. They participate in public or semiprivate forums
such as LinkedIn groups or professional listservs in which they get
to demonstrate their expertise and increase their visibility and
credibility. Oftentimes, they use these postings to encourage po-
tential clients to make contact with them or to encourage other
clinicians to consider referring to them. Many of them provide
information about the services they provide and areas of special
interest.

Engaging Off-Duty

Others avoid establishing a formal social networking presence,
but they participate in publicly accessible web interactions such as
commenting on news stories, blogs, or listservs, sometimes with-
out full awareness that these interactions are creating public and
discoverable records of their interactions, or—what a more web-
savvy marketer would refer to as—“brand impressions.”

When a clinician posts a message or comment on a blog from
the privacy of her office, she may not consider that her students,
clients, or friends and family members of her clients may search
for her and later find this information. This can be of considerable
concern when clinicians use nonprofessional listservs in their
personal lives, sharing details they would not want clients to see,
or even just when clinicians debrief on their personal Twitter or
Facebook profiles after a long day of work, not comprehending
that they are sending distinct messages to their social communities
about how they perceive and experience their professional work.

Other psychologists may reconsider their presence on social
media sites, and they may be surprised to discover that some sites,
such as Facebook, make it difficult to delete your account and may
still retain your data, including photos and Wall postings, even
after you have terminated your account (Cheng, 2012). Another

607SOCIAL MEDIA AND PROFESSIONAL PSYCHOLOGY

new issue for psychologists to contend with is Google’s image
search feature, which provides a person the ability to upload a
photo of an individual from any website and then to drop it into the
search field to find every other website on which that photo has
appeared. A client could feasibly do this using a psychologist’s
website photo, and if this photo was also used on a dating site, or
any other social media site, all of the sites on which the photo has
appeared would show up.

Other clinicians who are not intentionally creating profiles on
the Internet are sometimes discovering their professional practices
listed on consumer review sites such as Yelp or Healthgrades,
which automatically use search engines to auto-feed business data
and create listings for health care providers on these directories.
Many of these clinicians are surprised to find their practices listed
on such sites and have reported difficulties having them removed
(Nelander, 2011). On a site like Yelp, client reviews are also
connected to their friend networks, and if someone has Facebook
Instant Personalization enabled, their review will also be an-
nounced to their Facebook contacts. When clients leave a review
of a clinician on one of these sites, it will also affect the Google
search rankings for the practitioner, and clinicians may remain
unaware that their practice is getting attention on the Internet,
whether it is positive or negative.

Some medical providers have become so anxious about the
negative impact of online consumer reviews that they have re-
sorted to seeking out companies such as Reputation Defender,
which charges a significant amount of money to help post positive
information with the goal of increasing positive search results on
Google. Others have turned to Medical Justice, which has sold gag
order contracts to doctors, designed to restrict the freedom of
speech of their clients (Masnick, 2011). These contracts assigned
the client’s copyright over to the medical provider when online
reviews have been left, allowing the doctor to request their re-
moval from the site on which they are posted. Some sites have not
complied with these requests, as recently discovered (Lee, 2011),
and due to a recent lawsuit, Medical Justice has retired these
contracts. Other similar contracts have specified that a provider
may terminate care if the client leaves a review on an online site.
Such contracts are likely illegal and unethical, and this author
would not endorse the use of such questionable infringements on
clients’ civil liberties when they are in the vulnerable position of
seeking clinical care.

Engaging On-Duty

Other psychologists are intentionally using professional list-
servs, group postings, blog comments, and such for professional
purposes. Many of these clinicians are seeking referrals or consul-
tation or are providing commentary on postings left by other
colleagues. In some cases, they may be compromising ethics codes
(APA, 2010) by providing excessive clinical details beyond the
extent necessary for the consultation or by seeking consultation
from people whose competence and expertise they cannot ascer-
tain. They are also engaging in public consultation that will remain
archived and available to hundreds or more individuals, some of
whom may have a personal relationship with the individual being
seen in therapy. Considering that many individuals may refer
friends or family members to colleagues they “know” from pro-
fessional listservs, there is an increased risk of boundary violations

when clinicians seek consultation and provide details that make
these clients recognizable to other professionals who may also be
on the listserv and who may know or may have referred these
clients.

Both Donner (2007) and Behnke (2007) have addressed the
dangers inherent when psychologists fail to use discretion when
seeking consultation or referrals via professional listservs. Clini-
cians may wish to follow Donner’s recommendation to describe
the expertise of the clinician when seeking consultation and refer-
rals, as opposed to offering up identifying details such as a client’s
exact age, ethnicity, or other distinguishing details that may in-
crease the likelihood that such a client might be recognized by
readers of the posting. Such an example would be to ask for a
clinician with expertise in working with substance abuse in LGBT
adults in New York City, rather than posting, “Need referral for a
30-year-old bisexual male living in Greenwich Village, New York,
who has substance abuse issues with cocaine and alcohol and is
engaging in unsafe sexual practices.”

Adjunct to Clinical Practice

Some clinicians may not be using the Internet to provide clinical
care, but they may be looking at the social networking profiles of
their clients, with them, reviewing exchanges that occur on these
sites to help a client gain greater insight into their relationships and
behavior. Others may willingly view photos or videos that are sent
to them by clients either during or out of session. For example, a
client who is working on anxiety around public speaking may wish
to show a clinician a YouTube video of a successful presentation
he gave, or a client who is working on de-cluttering her home may
wish to share photos with her psychotherapist on the progress she
makes toward releasing objects and clearing her space.

Other clinicians may be incorporating apps and other techno-
logical tools to collaborate with clients and help them track symp-
toms, behaviors, and implement interventions. Some examples of
such apps include MoodKit, PTSD Coach, Jawbone Up, and
FitBit. Some of these are less “social” in that the data is not shared
with other users, but can be charted and shared with the clinician.
Other sites utilize social media to create supportive online com-
munities with the goal of helping to reinforce people in changing
their health habits. Health Month, an online social game, is one
such example in which people set monthly goals and work in
teams to earn points toward reaching their goals.

Provision of Care

Many psychologists are turning to telemental health treatment
via text or video. There are compelling reasons for practitioners to
consider such technologies (e.g., enhancing services for rural pop-
ulations, increasing access to care, and treating special populations
who may not be able to find clinicians with expertise to help with
their issues in their own communities, such as transgender clients
who cannot find a clinician in their community with the expertise
to provide competent care). Although the provision of telemental
health services has been written about widely and is beyond the
scope of this particular article, it is worth noting that despite
research indicating the efficacy of such treatment, some clinicians
(Thompson & Vivino, 2011) express concerns about attunement
and attachment challenges posed by telemental health treatment,

608 KOLMES

including the lack of eye contact and the inability to perceive small
physiological shifts in clients, including changes in breathing,
flushing, tears, or body movements. However, it is possible that
such criticisms are culturally biased. We do not yet know whether
children growing up on social media and who have regular video
contact with traveling parents or relatives in other locations will
experience the same attachment lapses that digital immigrants
experience with video technology.

In addition, technology is currently being developed (Machtig &
Danto, 2011) that will allow for eye contact during video chat.
Other assistive technological developments may soon allow for
greater input than is provided by face-to-face therapy, including
accurate measurements of breathing, heart rate, skin flushing, and
other indicators of physiological arousal. Some may find the
disinhibition effects of using computer technology allows clini-
cians greater comfort in requesting that clients utilize supportive
technology during online sessions. When attachment research is
further explored for those who are digital natives, and further
technological advances are made, we may need to revise our
concepts of the attachment and attunement possibilities between
clients and clinicians using online treatments.

Infants and Children on Social Media

Many parents are now creating social networking profiles for
their infants. Some parents have created Twitter or Facebook
profiles for children yet to be born. One study of 2,200 parents
from 10 countries found that the average age for “digital birth” is
6 months old and that 92% of toddlers have an online presence by
the age of 2 years (Stamoulis, 2011). Some parents are using
YouTube to share embarrassing moments from their child’s lives
such as a well-known video called “David After Dentist,” in which
a 7-year-old child under the influence of anesthesia was filmed by
his father after dental surgery (DeVore, 2008). This video has been
viewed 103,756,845 times.

Another recent example of Mommy Blogging gone viral is
the example of Nerdy Apple Bottom, a blogger whose 5-year-
old son wanted to dress as a female cartoon character on
Halloween. Other parents raised eyebrows and she responded
with a blog entry entitled “My Son is Gay,” which went
national, winding up with news stories and TV appearances
(Howard, 2010), turning her 5-year-old son into a minor celeb-
rity. Although Nerdy Apple Bottom later deleted the post and
closed her blog to comments, the original postings are archived
on other sites, and a Google search for the item turns up over
100,000 separate entries. Other parents are blogging and post-
ing status updates about child behavioral problems or their
parental frustrations. Because these postings have the potential
to influence the social and professional lives of these children
as they get older and because children are in no position to
provide consent to the posting and sharing of this information,
this is creating interesting predicaments for which we have yet
to see outcome data or solutions.

Other concerns are that photos and details shared about children
with wide audiences on social media sites can create safety risks
for children who could potentially be preyed on by adults who can
then collect detailed information about these children. Similar
concerns have prompted the Federal Trade Commission to draft
the Children’s Online Privacy Protection Act (Bureau of Con-

sumer Protection, 2000), which is intended to give parents control
over what information websites can collect about their children.
The challenge is that many parents themselves are still sharing a
wide variety of information that may put their own children at risk,
and there is the question as to whether future policies or govern-
mental interventions will be implemented for the protection of
children or whether parents will always have the final say in what
they get to post about their own child online.

Implications of Social Media for Psychologists
Providing Clinical Care

Clinical Training

It is clear that as digital culture continues to blossom, there will
be significant influences on clinical services and the need for these
issues to be addressed in doctoral training programs. These clinical
psychology training programs would do well to first develop their
own policies about whether they obtain information about appli-
cants on the Internet and whether trainee Internet behavior will be
subject to review by peers and instructors. Some schools or super-
visors may wish to incorporate the review of the social media
profiles of students as part of professional development and dis-
cuss what kind of information would be appropriate or inappro-
priate to share in status updates on such sites. There will be an
increased need for supervisors to include questions about online
extratherapeutic encounters that may occur as a part of trainees’
clinical relationships and to update their own knowledge so that
they can provide culturally competent supervision.

Professors and supervisors will also need to be able to supervise
students about how to manage clinical exchanges that address the
online transparency of both psychotherapist and client, including
revelations about social proximity, and the discovery of other
personal information. Clinicians may need increased coursework
in crafting an online professional identity and managing the clin-
ical challenges that may arise. However, problems may arise when
professors and supervisors are less facile than their students in
understanding the use and implications of newer technology,
whereas students may be less perceptive about the nuances of
managing one’s professional identity.

The Ethics Code for psychologists may need to be updated to
reflect how psychologists represent themselves on the Internet and
the potential blurring between personal and professional informa-
tion that is occurring. In effect, the Internet is turning many
clinicians unwittingly into media psychologists without proper
training. It is turning other clinicians into detectives, who use
online searches to verify information provided by clients in psy-
chotherapy or simply to seek information about clients out of
curiosity. Some of these activities would already be addressed by
our current Ethics Code which says that we enter into relationships
of trust and fidelity with our clients and inform them of our
policies and procedures early in treatment. A number of authors
are beginning to acknowledge how clinicians need to address the
ethical issues related to the Internet and our clinical relationships,
many beginning with the informed consent process (Barnett, 2009;
Clinton et al., 2010, Kaslow, Patterson, & Gottlieb, 2011; Kolmes,
2010; Lehavot et al., 2010).

609SOCIAL MEDIA AND PROFESSIONAL PSYCHOLOGY

Search, Transparency, and the Crafting of an Online
Identity

The research has clearly indicated that both clients and psycho-
therapists are finding information about one another via search
engines and social networking sites. Even photo albums of family
vacations and social outings can be exposed simply by failing to
stay up-to-date on changes in privacy settings on Facebook. Social
sharing on social media sites is opening up our behaviors and
activities to wide audiences when we read articles, watch videos,
comment on the Walls of our friends, or purchase items. These
data trails are creating opportunities for both clients and psychol-
ogists to obtain personal information about one another. Other
public records sites such as Intelius, Spokeo, Pipl, and DexKnows
enable people to search for addresses, family members, home
values, and other information such as criminal records and divorce
or marriage histories. Psychologists have been reporting using
information obtained about clients to inform clinical decision-
making and assessment. What some clinicians may fail to under-
stand is that some individuals who are fluent in social media may
be crafting online personae for particular audiences. Taking all
information found at face value can fail to take in the complexities
of crafting a digital identity (Marwick & Boyd, 2011).

Social Media Policies

Meanwhile, clinicians and training sites should also be imple-
menting social media policies (Barnett, 2009; Kolmes, 2010) that
specifically address intern conduct and clinician conduct and ex-
plain how interactions between clinicians and clients will be han-
dled. Such policies would be included as part of the informed
consent process early in treatment. They would include informa-
tion such as the clinician’s posting of status updates, management
of friend or contact requests from clients, whether a clinician
responds differently to these requests if they come from current
versus terminated clients, clarification that a clinician’s presence
on a consumer review site is not a request for a testimonial, and
whether the clinician uses search engines to obtain information
about clients in her care. Such policies can also serve as a way of
normalizing clients’ curiosity about their psychotherapist, which
may lead some clients to engage in Internet searches. Having these
discussions as part of informed consent may decrease the shame
and stigma experienced by clients when they imagine bringing
Internet search behavior back into treatment, and the clinician will
have an opportunity to manage these issues with greater sensitivity
and compassion.

Developing Clinical Competence

Clinicians will need to gain a deeper understanding of how
clients use and experience social networking sites. Just two de-
cades ago, having an active Internet presence was considered a
potential sign of antisocial or addictive behavior, but it is now a
widely accepted form of personal and business networking. The
cultural divide between digital natives and digital immigrants may
make it more difficult for some clinicians to understand individ-
uals who are dealing with challenges related to the merging of
social, professional, and support networks in online spaces. So-
cially networked clients may struggle with painful emotions re-

lated to viewing or monitoring the online activities, photos, or
interactions of ex-relationship partners. Asking a client to simply
stay off of the Internet may not be practical when an individual’s
work and social life is enmeshed with their online life. The ability
for a clinician to be knowledgeable enough to work with a client
on developing strategies for blocking individuals and screening
and filtering information may be extremely useful for some clients.

Individuals working with adolescents may need to be aware of
the self-harm behaviors that are occurring on sites such as Face-
book and Formspring. Digital bullying and self-harm (Boyd, Ryan,
& Leavitt, 2011; Schrock & Boyd, 2011) are new issues for
today’s youth, and it will be essential for clinicians to explore
whether adolescents are participating in attacks on their own
reputations. There is also the danger of taking information found
on social media profiles at face value. Young people on social
media are usually crafting identities for particular digital audi-
ences, which may include crushes, friend groups, teachers, parents,
and ex-boyfriends or girlfriends. If clinicians intend to incorporate
the social media profiles of their teen clients into treatment, they
should ask questions to help them understand what kind of a digital
identity this client is looking to construct, and for whom, rather
than assuming that information on the profile should all be taken
at face value (Marwick & Boyd, 2011). Good questions can
include, “Who would you like to see this?” “What would you like
them to believe about you?” and “What are you choosing to
conceal?” Understanding an individual’s thinking in regard to the
construction of an online identity can be illuminating.

Other clients will experience cyberstalking, cyberharassment, or
cyber-bullying. Research has indicated that online harassment is
more psychologically harmful than offline harassment because of
its ongoing nature, difficulties evading the abuse (it may reach the
victim via mobile devices and in the home), and the ability for the
abuser to remain anonymous (Lakhani, 2011). Clinicians need to
better understand the use of location-based services (LBS) and
how they work, particularly when working with clients who are
victims of stalking or online harassment. These clients may have
their location data shared by others, which may pose safety risks,
or they may be accidentally sharing such data with others by
having passive LBS enabled on their devices.

Those providing couples counseling will need to have an un-
derstanding of the multiple meanings of sexual and emotional
connection with others on the Internet for their clients. Some
partners have differing understandings of what constitutes “real”
intimacy or even evidence of infidelity. Others are interested in
negotiating emotional or sexual relationships outside of their pri-
mary relationship with one another. The meanings of these ex-
changes are personal and vary between individuals. Some clients
will be coming to therapy for help negotiating sexual contact with
others on the Internet, whether this involves “sexting” (exchanging
sexually explicit messages or photos via mobile devices) or other
erotic exchanges (Blue, 2008). Clinicians have an opportunity to
help such clients create better agreements and understand their
respective values and meanings around online sexuality. If a cli-
nician rushes to the assumption that these behaviors automatically
indicate compulsive or addictive behavior, they may be failing to
be helpful to some clients.

Other challenges may include the management of online data
belonging to the deceased (National Public Radio, 2011). There
are sites that may serve as useful resources both for terminally ill

610 KOLMES

clients and their surviving family members. When someone with
an active Internet life passes away, there are those who are left to
manage social media profiles that often serve as a form of online
memorial, but these individuals may get locked out because of
privacy restrictions.

Lastly, by being visible on social networking sites and the
Internet, clinicians will need to establish clear communication with
clients about when the patient–provider relationship actually be-
gins. Clients may believe that sending e-mail or notes on social
networking sites establishes a clinical relationship. Clinicians who
enable Wall postings or blog comments on their sites may need to
create clear disclaimers to help guide those who participate in
these forums who may be seeking care (Recupero, 2006).

Policy Changes

A number of significant questions become apparent when one
considers the upsurge in digital culture and social media. Sites
such as Yelp have paved the way for social sharing of consumer
information, even when that information is health care related. If
cultural notions about privacy are shifting, does it stand to reason
that this may eventually have the power to change laws, ethics, and
standards related to privacy or confidentiality in clinical care? Will
the transparency of digital payment data being shared on social
networks change people’s views about the stigma related to seek-
ing psychological care? Such changes might carry enough weight
to change some of the more ingrained assumptions we hold about
patient privacy and confidentiality. If there is a strong trend of
clients behaving in ways that are inconsistent with an expectation
of confidentiality, this might potentially influence the behavior and
expectations of those providing treatment. One example of this
could be that in the next decade, clinicians may no longer be
prohibited from requesting client testimonials on review sites or
asking for other kinds of endorsement from clients.

Given that so many parents are creating online accounts for their
infants and children and sharing so much personal and private
information without the child’s control or consent, there may also
be the potential for the scope of mandated child abuse reporting
laws to expand based on discovery that parents are sharing infor-
mation about their children that has the potential to harm them.
Further research on the effects of parental sharing about children
on social media sites will likely influence future policy and pro-
cedures about this.

Lastly, there may be changes and new pressures placed upon
clinicians who observe unethical online behavior by other practi-
tioners on listservs and other social media sites. The American
Medical Association (2011) issued a report on Professionalism in
the Use of Social Media, which requires physicians to address this
with the individual or report it to authorities. Similar policies for
psychologists may place a burden on some clinicians given how
frequently such ethical misconduct can occur.

Cultural Shifts Influencing Provision of Services

There is great potential for technology enhancements to improve
to the extent that providing telemental health services will be more
appealing to more clinicians. Will face-to-face services, rather than
becoming outdated, be a higher value service than online treat-
ment? Will the technological enhancements and ability to tran-

scend time and space make online treatment more appealing? Will
there be psychological differences in who prefers which type of
service?

When treatment moves into the digital realm, there is also the
likelihood that this will shift our concepts of time and frame in
reference to the therapy hour. Clients may book segments of time
that do not even happen during a specific time slot, but which, are
adaptable and accessed at different points in the day. How this may
change the treatment relationship and theoretical frameworks re-
mains to be seen.

Conclusion

We, as a profession, need to brace ourselves for new under-
standings and flexibility as to how social media and online culture
are influencing our field. New services and technologies may
contradict our current understandings of privacy, confidentiality,
and the need to conceal ourselves outside of the clinical relation-
ship. It is possible that privacy and confidentiality in the future of
professional psychology may take a new shape.

However, psychologists are also going to have to become much
more savvy about privacy settings and be much more aware of
how they wish to shape their professional (and personal) identities
in a world in which we can be easily accessed and recognized
without our awareness. There will need to be more research on the
effects of whether finding this information is harmful or beneficial
to treatment and under which conditions and for which popula-
tions.

With the new openness that the Internet is bringing to us, we can
expect to see more open source collaboration and sharing in terms
of psychoeducation and resources for clients who may also be-
come more autonomous in seeking support, sharing resources, and
engaging in self-care via technology and peer groups. Consumers
will likely experience greater empowerment regarding the demys-
tification of the range of services they may access and the choices
they have in shaping their treatment, as well as the ability to attach
and connect to providers of choice who previously may have
remained a mystery to them until they showed up for an initial
session.

References

American Medical Association. (2011). Opinion 9.124 Professionalism in
the use of social media. American Medical Association Code of Medical
Ethics. Retrieved from http://www.ama-assn.org/ama/pub/physician-
resources/medical-ethics/code-medical-ethics/opinion9124.p

American Psychological Association. (2010). Ethical principles of psy-
chologists and code of conduct. Retrieved from http://www.apa.org/
ethics

Barnett, J. (2009). Social networking sites, clients, and ethics: Dilemmas
and recommendations. Presented at the International Conference on Use
of the Internet in Mental Health, Montreal, Canada. Retrieved from
http://bcooltv.mcgill.ca/Viewer2/?RecordingID�27892

Behnke, S. (2007, July). Ethics and the Internet: Requesting clinical
consultations over listservs. Monitor on Psychology, 38, 62. Retrieved
from http://www.apa.org/monitor/julaug07/ethics.aspx

Blue, V. (2008, July 17). Is cybersex cheating? Violet Blue investigates the
outer limits of cybersex and monogamy. San Francisco Chronicle, 1–3.
Retrieved from http://www.sfgate.com/cgi-bin/article.cgi?f�/g/a/2008/07/
17/violetblue.DTL

Boyd, D., Ryan, J., & Leavitt, A. (2011). Pro-self-harm and the visibility

611SOCIAL MEDIA AND PROFESSIONAL PSYCHOLOGY

of youth-generated problematic content. I/S: A Journal of Law and
Policy for the Information Society, 7, 1–32. Retrieved from http://
www.danah.org/papers/2011/IS-ProSelfHarm

Cheng, J. (2012). Over 3 years later, “deleted” Facebook photos are still
online. Arstechnica. Retrieved from http://arstechnica.com/business/
news/2012/02/nearly-3-years-later-deleted-facebook-photos-are-still-
online.ars

Clinton, B. K., Silverman, B. C., & Brendel, D. H. (2010). Patient-
targeted Googling: The ethics of searching online for patient infor-
mation. Harvard Review of Psychiatry, 18, 103–112. doi:10.3109/
10673221003683861

Bureau of Consumer Protection. (2000). Children’s privacy. Retrieved
from http://business.ftc.gov/privacy-and-security/children%E2%
80%99s-privacy

DeVore, D. (2008, January 30). David after dentist. YouTube. Retrieved
from http://www.youtube.com/watch?v�txqiwrbYGrs

DiLillo, D., & Gale, E. B. (2011). To Google or not to Google: Graduate
students’ use of the Internet to access personal information about clients.
Training and Education in Professional Psychology, 5, 160 –166. doi:
10.1037/a0024441

Donner, M. (2007). The ethical use of the listserv: Privacy and professional
conduct. The California Psychologist, November/December, 22.

Facebook. (2011). Press room: Statistics. Accessed from http://
www.facebook.com/press/info.php?statistics

Fox, S. (2011, May 12). The social life of health information, 2011. Pew
Internet & American Life Project. Retrieved from http://
www.pewinternet.org/Reports/2011/Social-Life-of-Health-Info/
Summary-of-Findings/Section-1.aspx

Howard, C. (2010, November 5). “My son is gay” is a lesson in bad
mommy blogging. Forbes. Retrieved from http://www.forbes.com/sites/
carolinehoward/2010/11/05/my-son-is-gay-is-a-lesson-in-bad-mommy-
blogging/

Jent, J. F., Eaton, C. K., Merrick, M. T., Englebert, N. E., Dandes, S. K.,
Chapman, A. V., & Hershorin, E. R. (2011). The decision to access
patient information from a social media site: What would you do? Journal
of Adolescent Health, 49, 414 – 420. doi:10.1016/j.jadohealth.2011.02.004

Johnson, L. (2011). Clients, connections, and social media. Annals of the
American Psychotherapy Association, 14, 10 –11.

Kaslow, F. W., Patterson, T., & Gottlieb, M. (2011). Ethical dilemmas in
Psychologists accessing Internet data: Is it justified? Professional Psy-
chology: Research and Practice, 42,105–112. doi:10.1037/a0022002

Kolmes, K., & Taube, D. O. (2010). Findings on therapist-client interac-
tions on the Internet: Boundary considerations in cyberspace. Retrieved
from http://drkkolmes.com/research/

Kolmes, K., & Taube, D. O. (2011). Summary of client-therapist encoun-
ters on the web: The client experience. Retrieved from http://
drkkolmes.com/research/

Kolmes, K. (2010). Social media policy. Accessed from http://
drkkolmes.com/for-clinicians/social-media-policy/

Lakhani, N. (2011). Cyber bullying more harmful. Retreived from http://
www.ict.sislerhightechnology.com/archives/3552

Lee, T. B. (2011). Patient sues dentist over gag order, gets Medical Justice
to backtrack. Ars Technica. Retrieved from http://arstechnica.com/tech-
policy/news/2011/11/patient-sues-dentist-over-gag-order-causing-
medical-justice-to-drop-it.ars

Lehavot, K., Barnett, J., & Powers, D. (2010). Psychotherapy, professional
relationships, and ethical considerations in the MySpace generation.
Professional Psychology: Research and Practice, 41, 160 –166. doi:
10.1037/a0018709

LinkedIn. (2011). About us. Accessed from http://press.linkedin.com/
about/

Machtig, J., & Danto, D. (2011, November 20). The importance of eye
contact in visual communications. IMCCA. Retrieved from http://
www.imcca.org/news/the-importance-of-eye-c o n t a c t – i n – v i s u a l –
communications

Martin, S. (2010, August 13). More than one-fifth of grad students have
Googled their clients. 2010 APA Convention Blog. Retrieved from
http://apaconvention.typepad.com/2010_apa_convention_blog/2010/08/
more-than-onefifth-of-grad-students-have-googled-their-clients
.html#more

Marwick, A., & Boyd, D. (2011). I Tweet honestly, I Tweet passionately:
Twitter users, context collapse, and the imagined audience. New Media
and Society, 13, 96 –113. doi: 10.1177/1461444810365313. Retrieved
from http://www.tiara.org/blog/wp-content/uploads/2010/07/marwick_
boyd_twitter_nms

Masnick, M. (2011). Doctors who ask patients to sign over copyright on
any online reviews are only harming themselves. Techdirt. Retrieved
from http://www.techdirt.com/articles/20110524/07250114411/doctors-
who-ask-patients-to-sign-over-copyright-any-online-reviews-are-only-
harming-themselves.shtml

National Public Radio. (2011, January 10). After death, protecting your
“digital afterlife.” Retrieved from http://www.npr.org/2011/01/10/
132617124/after-death-protecting-your-digital-afterlife

Nelander, J. (2011). Feedback: What can you do about damaging online
“reviews?” Psychotherapy Finances. Retrieved from http://www.psyfin
.com/articles/0411_yelp_attack.htm

Prensky, M. (2001, October). Digital natives, digital immigrants. In On the
horizon, 9. 1-6. Lincoln, NE: MCB University Press.

Recupero, P. R. (2006). Legal concerns for psychiatrists who maintain
websites. Psychiatric Services, 57, 450 – 452. doi:10.1176/appi.ps
.57.4.450

Schrock, A., & Boyd, D. (2011). Problematic youth interaction online:
Solicitation, harassment, and cyberbullying. In K. B. Wright & L. M.
Webb (Eds.), Computer-mediated communication in personal relation-
ships. New York, NY: Peter Lang. Retrieved from http://www
.danah.org/papers/2011/CMCPR-ProblematicYouthInteraction

Smith, A. (2011, November 15). Why Americans use social media. Pew
Internet & American Life Project. Retrieved from http://pewinternet.org/
Reports/2011/Why-Americans-Use-Social-Media.aspx

Stamoulis, K. (2011). The digital lives of babies. The Amplifier, Spring/
Summer, 4 –5.

Thompson, B. J., & Vivino, B. L. (2011). The intimacy of a computer
screen: Musings from the therapy office. Pyschotherapy Bulletin, 46,
23–26.

Tunick, R. A., Mednick, L., & Conroy, C. (2011). A snapshot of child
psychologists’ social media activity: Professional and ethical practice
implications and recommendations. Professional Psychology: Research
and Practice, 42, 440 – 447. doi:10.1037/a0025040

Wikipedia. (2011). Twitter. Accessed from http://en.wikipedia.org/wiki/
Twitter

Zur, O. (2006). Therapeutic boundaries and dual relationships in rural
practice: Ethical, clinical and standard of care considerations. Journal of
Rural Community Psychology, E9, 1–12. Retreived from http://
www.marshall.edu/jrcp/9_1_Zur.htm

Zur, O., & Donner, M. B. (2009, January/February). The Google factor:
Therapists’ transparency in the era of Google and MySpace. The Cali-
fornia Psychologist, 42, 23–24.

Received December 21, 2011
Revision received April 9, 2012

Accepted April 18, 2012 �

612 KOLMES

Ethical Dilemmas in Psychologists Accessing Internet Data: Is It justified?

Florence W. Kaslow
Florida Couples and Family Institute, Palm Beach Gardens, FL

Terence Patterson
University of San Francisco

Michael Gottlieb
Independent Practice, Dallas, TX

Many psychologists search the Internet for both personal and professional information. Although various
guidelines have been proposed for psychologists regarding therapeutic services provided over the Internet, few
address the ethics and efficacy of gathering information about clients, students, or employees on the web. As
quickly as guidelines are written, new technologies create new challenges. With the advent of social
networking sites and numerous free and paid data search engines, unique dilemmas have arisen. The ready
access of voluminous personal information raises perplexing questions for clinician psychologists, instructors,
supervisors, and employers. An overarching consideration addressed in this article is whether in the course of
one’s professional activities it is ethically appropriate to conduct intentional Internet searches for information
about patients, students, or employees. We discuss ethical dilemmas such as right to privacy, trust, confiden-
tiality, informed consent, boundary violations, and best interest of the client, student, or employee. Next we
provide a list of some extant electronic sources of information and offer case examples. The article concludes
with recommendations that we hope will generate further dialogue and research on these perplexing issues and
provide guidance on balancing situationally appropriate flexibility with the need for adopting wise parameters
of professional behavior in regard to social networking activities and Internet “investigations.”

Keywords: ethics, Internet, professional practice, patient privacy, boundaries, trust

Ethics codes cannot do our questioning, thinking, feeling, and
responding for us. Such codes can never be a substitute for the
active process by which the individual therapist or counselor
struggles with the sometimes bewildering, always unique constel-

lation of questions, responsibilities, contexts, and competing de-
mands of helping another person. Ethics must be practical. Clini-
cians confront an almost unimaginable diversity of situations, each
with its own shifting questions, demands, and responsibilities.
Every clinician is unique in important ways. Every client is unique
in important ways. Ethics that are out of touch with the practical
realities of clinical work, with the diversity and constantly chang-
ing nature of the therapeutic venture, are useless. (Pope &
Vasquez, 1998, xiii–xiv)

Current Internet Practices by Psychologists

We agree with Pope and Vasquez and use their statement as a
starting point. What they have posited is equally applicable to
professor/student, supervisor/supervisee, psychologist/client1, or
employer/employee relationships in the broad field of psychology.
Below we address all four as these constitute our target audience.
First we consider a number of issues pertinent to telehealth and
Internet searches as well as selected ethical principles that arise in
these areas of practice. The next section lists various sources of
electronically available information and some relevant case exam-
ples. We conclude with recommendations we hope might stimulate
continued dialogue on this topic and perhaps be included in future
guidelines.

Telehealth

Many psychologists wonder how far they should go ethically
and professionally in using the Internet to post and obtain infor-
mation. In the past decade, professional associations such as the
American Psychological Association have developed guidelines

This article was published Online First February 21, 2011.
FLORENCE W. KASLOW received her Ph. D. from Bryn Mawr College. She is
President of Kaslow Associates and Director of the Florida Couples and
Family Institute in Palm Beach Gardens, FL. She is also a visiting Professor of
Psychology at Florida Institute of Technology in Melbourne, Florida. Her
areas of practice encompass executive, career, relationship and life coaching,
and family business consultation; her current research is in the area of Di-
vorced Dads and International Couples and Family Psychology.
TERENCE PATTERSON is Professor and former Director of the University of San
Francisco Doctoral program in Counseling Psychology. He is a licensed
psychologist in independent practice, Board certified in Family Psychology
with the American Board of Professional Psychology, and a Fellow of the
American Psychological Association. He also chairs the USF Institutional
Review Board for the Protection of Human Subjects. He is currently a member
of the American Board of Couple & Family Psychology and the Ethics
Committee of the California Psychological Association and a former president
of the APA Society for Family Psychology and the Association of Family
Therapists of Northern California.
MICHAEL C. GOTTLIEB received his PhD in Counseling Psychology from Texas
Tech University. He is a forensic and family psychologist in independent
practice in Dallas, TX. He is board certified (ABPP) in Family Psychology, a
Fellow of the American Psychological Association, and a Clinical Professor at the
University of Texas Health Science Center. He is a past member of the APA
Committee on Professional Practice and Standards and its Ethics Committee. His
interests surround ethical decision making and the psychology/law interface.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Florence W.
Kaslow, 128 Windward Drive, Palm Beach Gardens, FL 33418. E-mail:
drfkaslow@bellsouth.net

Professional Psychology: Research and Practice © 2011 American Psychological Association
2011, Vol. 42, No. 2, 105–112 0735-7028/11/$12.00 DOI: 10.1037/a0022002

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for those who are considering offering professional services using
electronic media. The delivery of such services is referred to as
“telehealth” (APA, 2003), or “telepsychology” (Ohio Psycholog-
ical Association, 2010). APA recently published a Social Media
Policy Guide (APA, 2010) that states that the Internet is not a
secure space, that it should be used judiciously, and that social
media can only be considered to reflect APA policy if it has been
officially sanctioned and designated by the APA and carries its
logo. Yet, a superficial examination by those who contemplate
offering such services reveals the enormous ethical complexity
entailed in matters such as ensuring confidentiality; performing an
adequate assessment; dealing with the absence of visible, nonver-
bal communication; dealing with the lack of in-person contact;
delivering competent service; and practicing across state lines
without a license in the state where a patient or client resides. Such
dilemmas may leave clinicians wondering how appropriate it is to
treat clients using the medium of telehealth. In her article on risk
management when practicing telehealth, Maheu (2001) provides
eight guidelines to include on informed consent disclosure forms
for clients in order to be practicing in accord with standard ethical
guidelines. Ragusea and VandeCreek (2003) discuss the numerous
situations that can be encountered when psychologists use the
Internet and indicate that there is no consensus on how to deliver
services ethically. They even question if that is in fact possible. As
a result of these hazy issues, many have chosen to avoid practicing
over the Internet, but such a decision does not end the ethical
dilemmas posed by other kinds of Internet usage.

Obtaining Personal Information in Cyberspace

Authors such as Zur, Williams, Levahot, and Knapp (2009) have
explored the kinds of problems that may arise when clients obtain
electronic information about their therapists. A psychologist who
has posted information on Facebook or MySpace about private
events, social relationships, or family photos may elicit questions
and/or transferential responses that would not have arisen from
clients who did not acquire this information. The psychologist’s
personal life is irrelevant to the client’s treatment and may, in fact,
pique the client’s interest in the therapist, shifting it from the
reasons for seeking treatment and compromising the therapist’s
stance of neutrality and objectivity. It can change the very essence
of the therapeutic relationship. Zur, Williams, and Levahot caution
the psychologist to think carefully before placing personal infor-
mation on Internet sites that may be visited by clients, students, or
supervisees. Behnke (2008) discussed a case in which a client had
an erotic transference to his therapist. Then, while performing an
Internet search, the client discovered some highly personal infor-
mation and moderately revealing photos of her and arrived at the
conclusion that therapy with her would no longer be viable
(Behnke, 2007b). Excursions into social networking sites blur the
boundaries in the therapeutic relationship and play havoc with the
long held therapeutic principle that the therapist’s personal life is
not germane to the therapeutic dialogue unless he or she chooses
to disclose some facts he or she considers relevant to the therapy
because this will contribute to its progress.

In another context, the San Francisco Chronicle (Egelko, 2009)
reported that a federal judge was admonished for posting sexually
explicit material on a private web site, stating that his conduct
“created a public controversy that can reasonably be seen as

having resulted in embarrassment to the institution of the federal
judiciary.” Similarly, providing such personal information can cast
the psychologist and the field of psychology in a negative light.
Behnke (Martin, 2010, p.32) has recently reiterated, “In today’s
age of email, Facebook, Twitter and other social media, psychol-
ogists have to be more aware of the ethical pitfalls they can fall
into by using these types of communications.”

Theoretical orientation can be a major factor in determining the
level of disclosure of the therapist’s own personal information, as
well as whether the decision to seek client information on the
Internet is concordant with the theoretical foundations of the
psychologist’s practice. For example, in psychodynamic therapies,
patients and therapists often develop a strong transference as part
of the relationship. Information that is known or sought about one
another from outside sources may be thought to contaminate the
therapy; what is important is that which is conveyed in the therapy
between patient and clinician. In treatment with psychologists of
humanistic orientations, disclosures of personal information may
be more acceptable, but even here the level of disclosure may also
be affected by the client’s status and the objectives of therapy. The
transference phenomenon of psychodynamic therapy or the uncon-
ditional acceptance basic to client-centered treatment may be ir-
relevant in brief behavioral treatment of a specific phobia. In each
of these instances, the clinician must consider that the client’s
perception of the relationship may become a more casual or even
social one that may violate the boundaries or context of therapy as
a sanctuary for exploring personal issues. However, therapists of
diverse orientations communicate online through e-mail and may
view web diaries as useful. Thus we find divergent viewpoints
depending upon the psychologist’s foundational beliefs which
undergird practice.

Seeking Consultations on the Internet

Behnke (2007a) discussed consultations sought by psycholo-
gists on listservs. He indicated that consultation is a dynamic
process and that ethics are a developmental process. Therefore,
any single reply to an issue raised is open to being misunderstood
or applied inappropriately unless a detailed dialogue ensues. While
such a request may seem innocuous, it poses the risk of violating
client confidentiality unless identifying information is well cam-
ouflaged, and it increases the possibility of inadequate and sim-
plistic solutions being offered. Furthermore, unless the person
seeking consultation knows the psychologist who is responding, he
or she has no assurance about the efficacy, accuracy, validity, and
soundness of the information provided.

Below, we address some of the ethical considerations involved
in the seeking of information by therapists, supervisors, trainers,
and employers without the knowledge or consent of clients, train-
ees, and employees. We explore some of the ethical and relational
issues that follow from engagement in such activities, discuss
some types of information currently available on the Internet, and
proffer several examples. We conclude by offering recommenda-
tions we hope will be useful to those seeking more explicit guid-
ance.

Ethical Principles and Legal Requirements

The issue of seeking information without permission of the
“other” in professional relationships raises a plethora of ethical

106 KASLOW, PATTERSON, AND GOTTLIEB

concerns. In this section, we focus on what we consider to be the
most salient.

Privacy and Confidentiality

All psychologists have an overarching ethical obligation to
uphold the basic principles of respect for autonomy, non-
malfeasance, beneficence, and justice, and avoid harm (Beau-
champ & Childress, 2009). They are expected to “benefit those
with whom they work (APA, 2002, Principle A, Section 8.03–
8.06). A fundamental precept of such professional relationships is
confidentiality. There is general consensus that we cannot be
effective unless clients, students, and supervisees are assured that
their privacy and identity will be protected. But what happens
when information comes to us indirectly from other sources? For
example, what if a psychologist attends a public gathering and sees
a client highly inebriated, even though the client has consistently
denied any alcohol relapse? Such circumstances rose long before
the advent of the information superhighway, and clinicians dealt
with them in accord with their own theoretical and philosophical
orientation. In such instances, the therapist obtained this knowl-
edge by happenstance, and the client could have no reasonable
expectation of privacy.

A similar situation arises when a supervisor inadvertently finds
troubling information about a supervisee on a social networking
site or on a blog. When posting on publicly accessible sites, a
supervisee should make no assumption of privacy. Yet, even
though many are familiar with the phrase, “nothing on the Internet
is confidential,” the practical reality is that many people willingly
post personal information based on a mistaken assumption of
privacy.

By contrast, we believe a professor or supervisor who deliber-
ately searches for information risks breeching the student’s expec-
tation of privacy in relation to the university or internship site if
their brochure does not explicitly state that they reserve the right to
conduct such searches. The consequences for a professional rela-
tionship when a trainee expects a zone of privacy, yet the trainer
presumes that what is posted is “fair game” can result in a serious
erosion of trust that may damage professional relationships. The
trainee can challenge the supervisor’s role as a detective or accept
the behavior and later emulate it, or they can jointly explore their
differing assumptions and try to find a resolution acceptable to
both so they can work together. Certainly, the age of the respective
individuals involved may influence their views about the validity
of such Internet searches as much as the Code of Ethics does
(APA, 2002).

Informed Consent (APA, 2002, 3.10)

The principle of informed consent can be derived from the
concept of respect for autonomy (Beauchamp & Childress, 2009).
Psychologists, supervisors, instructors, etc. have an affirmative
obligation to inform their clients about the rules that will apply to
their respective relationship at the outset, preferably in written
contractual form. State statutes generally require that mandated
reporting be included in informed consent, although there are times
that critical action must be taken even if informed consent has not
been provided. These include the need to adhere to mandated
reporting statutes on child or elder abuse; or to release a patient

from a psychiatric inpatient unit and inform a community facility
of the person’s prior history of child molestation; or future intent
regarding dangerous behaviors, such as homicidal intent (see Tara-
soff v. Regents of University of California, 1976). In some psychi-
atric ER and inpatient units, information may be needed quickly
about a patient at the time of admission and may be acquired by
using a search engine if the patient is unable to give permission
and/or there is grave concern about the safety of staff and other
patients. Information obtained in this way may be deemed essential
for patient management, and these factors trump concern over
informed consent.2

Otherwise, clients and students should have a reasonable expec-
tation that they will be the ones providing information, and that
what is conveyed is within their control and kept private. None-
theless, in the era of readily accessible Internet data, what if a
psychologist decides to seek information about a client over the
Internet? Does s/he have an affirmative obligation to inform the
client and seek permission first? One must consider how a new
client may feel when reading that his/her new therapist reserves the
right to electronically investigate him or her.

According to Kohlberg’s theory of socio-moral development,
which we believe is germane to the entire discussion which un-
dergirds this article (Kohlberg, 1973), it appears that individuals
functioning at the highest level of moral development (Stage 6,
Universal Ethical Principles), would possess the attributes of uni-
versality, consistency, and logical comprehensiveness. These char-
acterize the guiding principles of one’s conscience and how one
distinguishes right from wrong (Rosen, 1980, pp. 81– 87; APA,
2002, Principle E). Therefore, seeking such undisclosed informa-
tion would not be permissible in the world view of any psychol-
ogist who purports to practice ethically and at a high level of moral
development.

In sum, although undisclosed searches may not be illegal or
deemed to be unethical, they do not constitute sound practice in
light of upholding trust within the context of a professional rela-
tionship. Such an action may well disrupt the relationship before it
even begins and destroy the possibility of establishing the kind of
safe and valued connection that clients, students, and supervisees
need and have the right to expect with a professional with whom
they are working.

Best Interest of Clients

Practice should be evidence-based (APA, 2006). A therapist’s
continually updated knowledge base should assist in the determi-
nation of whether a particular treatment regimen is appropriate for
a specific client under the given circumstances. When the inter-
vention approach selected is the “best” choice for the person(s),
problems, and situation, there is a reasonable expectation that we
can help clients resolve their concerns and achieve their objectives.
Wise decisions about client–therapist match are predicated on the
premise that information is provided directly by clients or obtained
with their explicit consent. This formulation leads us to question
how one would handle information that has been acquired surrep-
titiously because to acquire it, the therapist had to switch roles and
become an investigator.

The dilemma about knowledge obtained without a client having
revealed it or being privy to someone else’s disclosure also exists

107ETHICAL DILEMMAS

in other contexts such as in couple and family therapy, when one
partner reveals a critical secret unbeknown to the other. Consid-
ering this as somewhat analogous, it can shed light on the issue at
hand, that is, being privy to information a client does not know one
has. In such a situation, unless the psychologist has drawn up an
agreement at the outset with all members of the client unit as to
how such disclosures will be handled, the revelation of a secret
becomes problematic for all involved. The Internet provides psy-
chologists with myriad opportunities to obtain information without
a client’s knowledge. Will information obtained in this way in-
crease treatment effectiveness? If one believes that it will, how
does the value provided by such an activity weigh against viola-
tions of evidence-based practice and treatment protocols, the cli-
ent’s reasonable expectation of privacy, and the integrity of the
process? We do not think this is ethically, morally and/or profes-
sionally justifiable behavior. The ends do not justify the means.

When a psychologist suspects a client is being less than honest
and acts on those suspicions by seeking additional information on
the Internet, another form of dishonest behavior is perpetrated,
except it is on the part of the psychologist. It augurs poorly for the
building of a strong therapeutic alliance, in which trust and mod-
eling are essential ingredients. We posit that when a psychologist
does not believe what a person is telling him or her, it is essential
that he or she select a propitious time, sooner rather than later, to
explore this with the client or student, unless the person is inco-
herent or there is another compelling contraindication to doing so.
A more professional approach is to make a comment such as: “It
seems I’m missing information necessary to grasp what is going
on. I hope you will either explain the situation differently so I can
understand better or begin to trust me enough to disclose additional
sensitive thoughts, feelings, or deeds.”

Standard of Care

Psychotherapists are required to follow a standard of care that is
“the level of proficiency and care against which a therapist’s
conduct will be measured” (Stromberg et al., p. 441). This requires
conforming to what a majority of their peers would do in a similar
situation. But, it is sometimes difficult to ascertain the current
prevailing standard when no clear guidelines exist, as is true
regarding certain Internet practices. Generally it is prudent to
refrain from an action that has no clear benefit and which may be
placing the therapist or supervisor on a slippery slope.

Electronic Sources of Information

There are three major categories of information currently avail-
able on the Internet. Category 1 includes professional web sites,
blogs, business networking sites such as LinkedIn, newspapers,
and other publicly accessible and sponsored sites containing in-
formation that individuals personally post for others. Category 2 is
information that can be retrieved through search engines including
Google and Yahoo! Such resources make it relatively easy to
obtain both contemporary and historical information about an
individual. The information may have been posted by the person or
made available to such sites by newspapers, publishers, or profes-
sional organizations. Through such searches, other types of infor-
mation in the public domain may also be found, such as arrests and

other court records, marriage certificates, and divorce decrees.
Category 3 includes services such as People Search that provide
basic personal data with the option of paying for more detailed
data. This category includes social networking sites requiring
registration, such as MySpace and Facebook, which contain infor-
mation intended for friends and acquaintances. It is also possible to
obtain genealogical information [such as what might appear in a
genogram (Kaslow, 1995)] through websites such as Ancestry-
.com, Familysearch.org, and Geneology.com. These sites offer
small amounts of information for free and then encourage payment
for subscriptions.

With the proliferation of social networking sites, the boundary
between personal and professional space has become blurred.
Graduate students in professional training programs need to realize
that information they post publicly may be seen by current or
potential employers, supervisors, and/or clients. For example, a
practicum student may find herself subscribed to the same social
networking site as one of her clients, who may obtain information
about her personal life which would not otherwise be available
(Chamberlin, 2007). Such information could prove very detrimen-
tal to the therapeutic relationship in that the psychologist acquires
too much of a personal persona. This can obscure her professional
role, which is the core reason for the relationship.

The issue of “friending” those with whom we have a profes-
sional relationship has also become a concern for psychologists.
Social networking sites such as MySpace and Facebook allow
members to request others members to be “friends.” As with self
disclosure, the guiding principle is that we are never obliged to
do so.

Perhaps a connection on a professional networking site (such as
LinkedIn) would be acceptable with a former student or super-
visee. But accepting a friend request from a current or former
client or student is apt to create the impression that one has a social
relationship with them, and this may inadvertently lead to a breach
in confidentiality. It might also interfere with the likelihood that a
former client would return if he or she needed treatment in the
future. For example, if one is listed on client A’s site as a friend
and that person knows his or her client B, who is also on their site,
they may infer that B is also a client, which would constitute a
violation of the confidentiality principle (APA, 2002, 8.03– 8.06).

If one does choose to participate in such networking sites and
post comments and/or information, it is best to list only name and
professional affiliation, without including additional identifying
information. A safe approach to risk management is to accept no
requests from anyone with whom we have had a professional
relationship, other than colleagues. Indicating such a policy in our
initial contract agreement and/or informed consent form as well as
explaining it to clients who may feel offended by a refusal of such
a request can clarify one’s position and convey the professionalism
of their practice.

Clearly the blurring of the boundaries can be bidirectional. Just
as interns may not see a problem with actively participating in
social networking, they may also see no problem in using the
Internet to garner information about their clients. The core ques-
tion revolves around: Is it appropriate for them to do so simply
because they can? Some examples illustrative of where such
behaviors can lead now follow.

108 KASLOW, PATTERSON, AND GOTTLIEB

Case Examples

The Therapist as Detective

Dr. Jacinto Gomez, who had recently finished his training, was
treating a new patient, Clara. The history she gave had many gaps,
and because he suspected that she was withholding relevant in-
formation, he decided to do an Internet search rather than ask her
additional questions. Clara told him that she was excited about
getting a job as a staff member in a child care center after many
years of having been unable to obtain such a position. What Dr.
Gomez discovered in his search was that Clara had been convicted
of child abuse on two occasions twenty years earlier and had been
placed on probation for five years.

Why did Dr. Gomez not first ask Clara about the gaps in her
history? We do not know if she would have disclosed the infor-
mation, but at least he would have made a direct, therapeutically
sound, and appropriate effort to acquire it from her. It is very
tempting for those who grew up with computers and the Internet to
access information on the web. They do this not only because it is
easy, but for some it is more comfortable than confronting patients
when thorny issues such as this one arise. We believe it is not a
prudent or ethically defensible course of action.

As a result of his Internet search, Dr. Gomez found himself in a
precarious position. First, depending on the state in which he lives
(for example, California), he may be obligated to report that Clara,
who has a criminal history of child abuse, now has access to
children. Second, one could argue that even if Dr. Gomez had
stated in his informed consent documents that as a psychologist
he has a role as a mandated reporter in abuse cases, and that he
reserves the right to perform independent searches on clients, he
might still find himself in a shaky position with regard to his
client’s trust. One could justifiably argue that now that he is in
possession of this information he has little choice but to follow the
law, but such requirements seldom take into account the long term
damage that may result to the therapist–patient relationship, com-
pounding the difficulties already associated with his (unauthor-
ized) search.

A Supervisor’s Tangled Web

Dr. Yang Chin supervised the work of Rashaan, a pre-doctoral
intern in a community agency. At the outset of their relationship,
Dr. Chin discussed Rashaan’s professional interests and experi-
ence, responsibilities, obligations, agency guidelines, and they
established a written internship contract. As Dr. Chin was perus-
ing the state Psychology Board’s credential verification web site,
she was surprised to see that Rashaan had had two previous
registrations as a psychological assistant cancelled. There was no
explanation provided, and Rashaan had not mentioned this to her.3

We believe that Rashaan should have disclosed this information
at the outset of the supervision. Given that he did not, what was Dr.
Chin’s responsibility? Dr. Chin, or anyone in a similar supervisory
role, has vicarious liability for a supervisee’s client care
(Slovenko, 1980). This liability makes it imperative for a contract-
ing agency to verify credentials of all potential supervisees (and
staff) and to inform them that this will be done in accordance with
agency policy. If this had been the procedure followed, Dr. Chin
clearly would have had the right to confront Rashaan to determine

the reasons for these cancellations and for the omission of this data
to the agency.

Dr. Chin’s case differs from the example of Dr. Gomez in that
it includes an additional consideration. Dr. Chin has a fiduciary
obligation to the clients of her agency and should do whatever she
can on their behalf. However, she also has a fiduciary obligation to
her supervisee. Sometimes a conflict of interest can exist between
these distinct obligations. The example does not tell us whether
there was an inherent conflict in this case, but it behooves those in
charge to make such a determination and, if so, to take appropriate
action since client care is the agency’s primary obligation and
takes precedence in the event of such a conflict.

A Supervisor Discovers Troubling Identities

Dr. Grey interviewed Orlando for a staff position as a child
therapist at a community mental health center. Orlando was ex-
perienced, licensed, and had excellent recommendations. As part
of his regular hiring practice, Grey searched Orlando on the
Internet without first disclosing that he routinely did so. While
searching, he found a site advertising Orlando as a stripper in a
local men’s club. (If Orlando used his real name, which strippers
rarely do, then his judgment may have been severely impaired).

As a professional psychologist in an administrative role, Grey
should disclose his hiring procedures in the initial interview with
a prospective applicant. Orlando’s outside employment might not
be a disqualifying factor in and of itself, in all agencies, but once
Dr. Grey became concerned, he needed to address them with the
applicant if hiring him was being contemplated. The accuracy of
the information also needed to be checked with him. If Dr. Grey
wanted to then move ahead, he would need to discuss his possible
hiring with other staff members as well as the agency advisory
board in order to explore their concerns and reactions. Asking
Orlando to remove his picture from the web site might be an
acceptable solution. But that might not suffice if the center were in
a religiously conservative community. Would having someone on
staff who has chosen to be a “stripper” in his personal life be
consonant with the mission of the agency? It is critical to be
mindful of the fact that professional ethical behavior is also judged
by the consumers of our services, and it is affected and influenced
by the norms and values of the local community in which we
practice or teach.

It is a common practice in some employment settings to search
for information such as credit ratings, arrest records, court pro-
ceedings, and tax records, and applicants should not be surprised
by prospective employers doing so. However, potential employees
should be informed that this will occur. One could argue that such
searches are the prospective employer’s responsibility if the ap-
plicant is to have a fiduciary obligation to clients.

Stephen Behnke (2008, p. 74) has stated:
. . . there is likely far less agreement about how actively faculty

should search for information about trainees and training appli-
cants on the Internet or how information that comes to a faculty’s
attention by way of third parties should be handled. Many private
sector companies conduct Internet searches before making job
offers. There does not appear to be a similar consensus in psy-
chology . . . acting upon information that a trainee or applicant has
not provided to a program may be inconsistent with a respect for
that individual’s privacy and autonomy; information on the Inter-

109ETHICAL DILEMMAS

net is notoriously unreliable; and there is a “slippery slope” to
seeking and relying on such information that risks turning psy-
chologists into private investigators.

There may be long term relational implications of doing peri-
odic searches after people are admitted to a graduate program or
hired. The fact that such searches are conducted can foster an
atmosphere of mistrust within an agency, especially when some-
one has something they want to hide. How free will the staff feel
to share professional and personal problems with each other and
their supervisors? Since an atmosphere of trust and mutual respect
is necessary for effective mental health practice, Internet searches
may be detrimental to staff cohesiveness and trust and may neg-
atively affect the quality of care that is offered.

It is important to underscore Behnke’s (2008) point on the
unreliable, unverified nature of some of the data that appears on
Internet sites. In contrast, when data is obtained directly from the
client, student, or employee, the psychologist can accept it at face
value or explore the information or seeming gaps in what has been
presented with the individual to verify accuracy and completeness.
And, there is much to be learned from any evasiveness or omis-
sions and what they represent.

Recommendations

The Internet has provided users with countless advantages that
can make their lives easier. It is only a tool and one that can be
used in beneficial or detrimental ways in terms of professional
relationships. We have illustrated in several examples how the
Internet can be put to good use in various professional situations,
and we have discussed some potentially adverse implications of
doing so. Until the current Code of Conduct is amended to include
more detailed and contemporaneous standards, we hope to stimu-
late further dialogue that will lead to the generating of new
guidelines on the specific topics discussed herein. In this section,
we bring this information together and attempt to provide guidance
to readers.

1. The Ethical Principles of Psychologists and Code of Conduct
(APA, 2002) states that psychologists who use the telephone or the
Internet must abide by the same ethical guidelines as in-person
therapists. Unfortunately, the Code of Conduct does not specifi-
cally address the behavior of psychologists, trainers, teachers, or
employers when they wish to obtain information via the Internet.
But, the fact that there are no explicit standards in this arena does
not mean we are free to violate basic ethical principles of confi-
dentiality, informed consent, privacy, trust in relationships, and
best interest of our clients. These dicta apply in all of our profes-
sional roles, and psychologists are urged to avoid questionable
behaviors solely because they are not explicitly prohibited.

2. Policies regarding Internet searches of clients, trainees, stu-
dents, and employees should be made clear at the outset through
written contracts, informed consent forms, agency policies, and
verbal statements and/or documents. Such disclosures should be as
explicit as possible regarding how information obtained from
outside sources may be used (Martin, 2010).

3. Although Internet searches may be legal and later deemed
ethical, one should treat others as they wish to be treated. The trust
others place in the psychologist should always be a paramount
consideration. The use of current evidence based treatments is
predicated on information provided by clients, just as psychody-

namic, psychoanalytic, humanistic, existential and other ap-
proaches have been traditionally. Therapists violate the fundamen-
tal assumptions of these procedures when they use the Internet to
search for information on clients. The fact that an action may not
be prohibited does not support such behavior, nor is the argument
that the ends justify the means acceptable. Exceptions may include
forensic activities such as child custody and fitness for duty
evaluations.

4. Providing or obtaining information from outside sources
without informed consent should only be undertaken when it is
deemed absolutely essential. One example might be if a therapist
or teacher has been threatened or is being stalked by a client or
student, and they want to know if said person has a prior record of
such behavior before reporting it to the police. We think the
dangers inherent in such a situation are sufficient to trump the lack
of informed consent.

5. One should always be alert for teachable moments. For
example, therapists can model integrity and respect by having clear
disclosure policies in their informed consent documents and ver-
bally clarify whether they will search for outside information.
Clinicians should be similarly direct when they have discovered
information inadvertently. We recommend that a similar policy
apply to supervisors, employers, and, in some circumstances,
instructors. Having such an open disclosure policy establishes a
pathway toward building trust, models integrity, and teaches the
culture of our professions (Handlesman, Gottlieb, & Knapp, 2005).
This is a critical component of psychotherapy and vital because of
the public trust required of our professional roles.

6. There is a widespread realization that “nothing on the Internet
is confidential.” We believe it is prudent to function based on this
assumption. In the broadest terms, information is available in three
ways: (1) Through publicly accessible web sites. We think that
viewing this information is legitimate and in some cases unavoid-
able as part of one’s daily routine, similar to reading a newspaper;
(2) From more personal and password protected sites where access
is restricted. It is less likely that one will stumble across such
information, making such clinician-initiated discoveries more eth-
ically problematic; and (3) From sites that perform specialized
searches through data retrieval programs. These may be public or
private and fee-based. We recommend these sites should be
avoided by professional psychologists, except in urgent and critical
situations.

We believe it is important to comment on the extent to which
one should go to avoid obtaining information on the Internet. We
think there is a middle ground between pursuing one’s genuine
curiosity fostered by the Internet and deliberately conducting in-
vestigatory searches on the other. If information is public and/or
obtained inadvertently, there seems to be nothing unethical or
improper about using it. When such information is seen and read,
we recommend mentioning it to the client, student, or supervisee in
a timely and respectful manner and trying to use it in a therapeu-
tically or educationally beneficial manner. For example, suppose
that a therapist has visited a public site and learns that a client, with
whom s/he has been working on self esteem, has recently won a
marathon. The therapist can say they saw the wonderful news and
relate it to the client’s self image.

We would make a similar recommendation when information
obtained inadvertently reflects negatively on a client or super-
visee, but in such a case one might proceed differently. An

110 KASLOW, PATTERSON, AND GOTTLIEB

example would be viewing public drunkenness on a social
networking site. If the information has been widely distributed,
some clients might expect the issue to be raised. What would a
client think if a therapist failed to do so if they know the
therapist uses the same social network? Conversely, what if the
information were not widely available? In such a situation, one
must consider timing and appropriateness and handle any dis-
closure with great sensitivity. But, one might first try to elicit
the information by querying if anything very significant had
occurred since their last session.

7. Information available on the Internet may not be accurate. For
example, one of us (MCG) Googled himself and found an article
listed that he had allegedly written with a co-author with whom he
had never worked. One may discover a great deal of information
on the Internet, but it behooves us to not automatically assume that
it is true. For example, back to the case of Troubling Identities.
What if Orlando was not, in fact, a male stripper? What if someone
were playing a practical joke on him: had taken a photograph of his
face and morphed it onto someone else’s body? His supervisor
would have no way of knowing this without asking. Therefore, we
recommend a healthy skepticism when one obtains information
electronically, as well as from newsprint media.

Acquiring information through extensive, fee-based services
(except as noted above in critical situations), crosses a boundary of
privacy that we advise should be avoided. It is an intrusive and
deceptive practice. Unless a client is deemed incoherent, or is
otherwise unable to communicate rationally, he or she should
remain in control of what information is revealed and when, with
the psychologist having the right and obligation to query the client
or student for more information.

Conclusions

Careful and deliberate judgment is needed in all circum-
stances involving seeking outside information. Psychologists
find themselves in potential conflicts when they know facts
which their clients have not disclosed to them. When a psy-
chologist turns investigator, one’s professional integrity and
motivation may be called into question, and suspicion and
discomfort about intrusions into one’s personal life may seri-
ously erode the therapeutic, supervisory, or employment rela-
tionship. There are no systems of therapy, ethics codes, or laws
which explicitly define the therapist’s ability to use information
not provided directly by clients, leaving clinicians without firm
guidelines for deciding whether and how to use potentially
critical information. One should not act out of curiosity about a
client any more than one is ethically permitted to pursue a
sexual attraction. When in doubt, we believe that the best course
of action is always to consider how one would wish to be
treated in a similar situation. Would we not want our interests
to be paramount? Even though mistakes may occur, working
from this perspective minimizes risks for all concerned. Fol-
lowing ethical and legal guidelines is a key consideration, and
the maxim to seek a consultation with a senior, well-respected
colleague with expertise in professional and ethical matters
when in doubt can always be useful and frequently enlighten-
ing, and is a good risk management strategy. In the end, we
believe that it is wise to remember that when professional
psychologists are called upon to explain a questionable behav-

ior, they are more likely to be held to existing standards rather
than to arbitrary justifications that may not have resulted in the
client’s best interests.

Endnotes

1. The terms patient and client are used interchangeably as different
psychologists designate whom they see using the term they prefer.

2. This information was provided by colleagues known to author Flor-
ence Kaslow who work as psychologists in three different Psychiatric
ERs or in in-patient units. None wanted their identities or their insti-
tutions divulged. The almost identical statements they made seemed to
add to the veracity of the points being considered.

3. Many states allow post-doctoral licensure applicants to obtain
supervised hours while registered as a psychological assistant to a
licensed psychologist, rather than in a formal post-doctoral fellow-
ship or other training program. If Rashaan’s registration was can-
celled due to a disciplinary reason, Dr. Chin should have been
informed by Rashaan earlier and/or by someone from the graduate
program which he was attending.

References

American Psychological Association. (2002). Ethical principles of psy-
chologists and code of conduct. American Psychologist, 57, 1060 –1073.
Washington DC: APA.

American Psychological Association. (2003). APA guidelines for providers
of psychological services to ethnic, linguistic, and racial minorities for
professional practice in telehealth: Implications for psychology. Wash-
ington, DC: APA.

American Psychological Association. (2006). Evidence-based practice in
psychology: APA Presidential task force on evidence-based practice.
American Psychologist, 61, 271–285.

American Psychological Association. (2010). The social media policy.
Washington, DC: APA’s General Counsel Office.

Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical
ethics (6th ed.). NY: Oxford.

Behnke, S. (2007a). Ethics and the Internet: Requesting clinical consulta-
tions over listservs. APA Monitor, 38(7), 62.

Behnke, S. (2007b). Posting on the Internet: An opportunity for self (and
other) reflection. APA Monitor, 38(1), 60 – 61.

Behnke, S. (2008). Ethics in the age of the Internet. APA Monitor, 39(7),
74 –75.

Chamberlin, J. (2007). Too much information. GradPsych, 5, 14 –16.
Egelko, B. (2009, July). Judge Alex Kozinski rebuked for explicit postings.

San Francisco Chronicle. Retrieved from http://articles.sfgate.com/2009-
07-03/bay-area/17219224_1_alex-kozinski-court-panel-federal-courts

Handlesman, M., Gottlieb, M. C., & Knapp, S. (2005). Acculturation as a
framework for training ethical psychologists. Professional Psychology:
Research and Practice, 36, 59 – 65.

Kaslow, F. W. (1995). Projective genogramming. Sarasota, FL: Profes-
sional Resource Press.

Kohlberg, L. (1973). Stages and aging in moral development: Some spec-
ulations. The Gerontologist, 13, 497–502.

Maheu, M. M. (2001), Exposing the risk, yet moving forward: A behav-
ioral E-health model. Journal of Computer-Mediated Communication, 6.
doi: 10.1111/j.1083-6101.2001.tb00130.x

Martin, S. (2010). The Internet’s ethical challenges. Monitor on Psychol-
ogy, 41, 32–34.

Ohio Psychological Association Communications & Technology Commit-
tee. (2010). Telepsychology guidelines, revised. Ohio: OPA. Retrieved
from www.ohpsych.org/professionalissues.aspx

Pope, K. S., & Vasquez, M. J. T. (1998). Ethics in psychotherapy and
counseling: A practical guide (2nd ed.). New York: Jossey Bass.

111ETHICAL DILEMMAS

Ragusea, A. S., & VandeCreek, L. (2003). Suggestions for ethical practice
of online psychotherapy. Psychotherapy: Theory, Research, Practice,
Training, 40, 94 –102.

Rosen, H. (1980). The development of sociomoral knowledge: A cognitive-
structural approach. NY: Columbia University Press.

Slovenko, R. (1980). Legal issues in psychotherapy supervision. In A. K.
Hess (Ed). Psychotheray supervision (pp. 453– 473). NY: Wiley.

Stromberg, C. D., Haggarty, D. J., Leibenluft, R. F., McMillan, M. H.,
Mishkin, B., Rubin, B. L., & Trilling, H. R. (1988). The Psychologist’s
Legal Handbook. Washington, DC: The Council of the National Register
of Health Care Providers in Psychology.

Tarasoff v. Regents of University of California. (1976). 17 Cal. 3d 425, 551
P. 2d 334, 131 Cal. Rptr.

Zur, O., Williams, M. H., Levahot, K., & Knapp, S. (2009). Psychother-
apist self-disclosure and privilege in the Internet age. Professional
Psychology: Research and Practice, 40, 22–30.

Received April 8, 2010
Revision received October 13, 2010

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112 KASLOW, PATTERSON, AND GOTTLIEB

To Google or Not To Google: Graduate Students’ Use of the Internet To
Access Personal Information About Clients

David DiLillo and Emily B. Gale
University of Nebraska–Lincoln

The emergence of Internet search and social media sites now permits therapists to obtain a plethora of personal
information about their clients online. These behaviors raise a number of ethical issues related to client
privacy, self-determination, and informed consent. The purpose of this study is to examine student therapists’
opinions and behaviors in regard to the use these websites to search for information about their clients. A
national sample of 854 psychology doctoral students was surveyed in regard to their online activities, attitudes,
and frequency of searching for client information online. Results showed that Internet usage is pervasive in
this group, with the majority reporting daily use of search engine or social networking sites. Most participants
reported that searching for information about clients online using search engines (66.9%) or social networking
websites (76.8%) was “always” or “usually” unacceptable. Nevertheless, 97.8% of participants reported
searching for at least one client’s information using search engines in the past year; 94.4% reported searching
for client information on social networking websites. Overall, student therapists reported searching for 16.5%
of clients seen in the past year, using either search engine or social networking sites. The ethical and training
implications of these results are discussed.

Keywords: Internet, privacy, social media, training, ethics

The explosion of search engine and social networking websites
now permits anyone with an Internet connection to view a plethora
of personal information about others. Through these sites, infor-
mation that was previously private, or at least more difficult to
obtain, is now easily available to the public with the simple click
of a mouse. Personal information, including photographs, videos,
criminal records, credit reports, property values, political or reli-
gious affiliations, and other data are now potentially accessible
online. This unprecedented access raises a range of new questions
about how Internet search and social networking capabilities im-
pact the training of professional psychologists. For example, recent
writings have discussed the ethical implications of faculty mem-
bers using the Internet to search for graduate school applicants or
current students, as well as the possibility of clients accessing
detailed personal information about student therapists online (Le-
havot, 2009). In addition to these situations that may leave students
vulnerable to searches, there is also potential for trainees—many

of whom are likely to be well versed in search and social media
websites—to seek information about others online, including their
clients. Whether it is to verify facts provided by the client, to
obtain information perceived to be clinically relevant, or just out of
curiosity, the types of information that can be accessed by thera-
pists about clients are virtually limitless.

The vast amount of personal information online raises the im-
portant question of whether it is ethically appropriate for practi-
tioners, including student trainees, to search for information about
clients using the Internet. The current Ethical Principles of Psy-
chologists and Code of Conduct (American Psychological Asso-
ciation, 2002), which came into existence before widespread use of
the Internet as a source of personal information, provides little
explicit guidance in addressing Internet searches. Nevertheless,
General Principle E states that, “Psychologists respect the dignity
and worth of all people, and the rights of individuals to privacy,
confidentiality, and self-determination” (p. 1063). In commenting
on client privacy, Smith-Bell and Winslade (1999) noted that,
“when a person enters into a therapeutic relationship, the client
relinquishes his or her personal privacy of thoughts, feelings,
beliefs, and so forth, in exchange for the prospect of therapeutic
understanding and assistance” (p. 152). Implied in this arrange-
ment is an understanding that the client determines the type and
timing of personal information to be disclosed to the therapist.
Although various factors may influence these decisions (e.g.,
length of time in therapy; strength of the therapeutic alliance;
Farber, 2003), few would dispute that a client’s right to privacy
includes deciding if and when to share personal information with
a therapist. A corollary to this is that therapists do not actively seek
information about clients through outside channels without a cli-
ent’s knowledge. Indeed, doing so (e.g., through an online search)
may be viewed as an unauthorized intrusion of privacy that un-

DAVID DILILLO AND EMILY B. GALE, Department of Psychology, Uni-
versity of Nebraska–Lincoln.

DAVID DILILLO, PhD, is Professor and Director of Clinical Training at
the University of Nebraska–Lincoln. His primary research interests lie in
the areas of child maltreatment and interpersonal violence. He also main-
tains a scholarly interest in issues related to education and training in
professional psychology.

EMILY B. GALE, MA, is a fifth-year student in the Clinical Psychology
Training Program at the University of Nebraska–Lincoln. Her primary
interests are ethical issues related to the Internet, training in psychology
and child maltreatment.

CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
David DiLillo, Department of Psychology, University of Nebraska–
Lincoln, 238 Burnett Hall, Lincoln, NE 68588. E-mail: ddilillo@unl.edu

Training and Education in Professional Psychology © 2011 American Psychological Association
2011, Vol. 5, No. 3, 160 –166 1931-3918/11/$12.00 DOI: 10.1037/a0024441

160

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dermines a client’s right to self-determination alluded to in Prin-
ciple E.

As suggested above, a key element in evaluating whether a
search violates a client’s privacy is the question of prior approval.
Standard 3.10a requires that therapists seek informed consent from
clients about the services to be provided. Although commonly
known to involve certain components (e.g., discussing confiden-
tiality and its limits, fees and payment options, the training status
of student therapists), informed consent also encompasses a
broader need to inform clients about the nature and process of
psychotherapy, including approaches and techniques that might be
used (Fisher & Oransky, 2008). Thus, just as therapists must
secure written authorization to obtain information about clients
from third parties (e.g., prior therapists, physicians; Fisher, 2002),
so too should they request permission before accessing sources
such as the Internet. Failure to do so places therapists in the
difficult position of deciding how to use newly acquired informa-
tion therapeutically without clients feeling their privacy has been
violated.

Although the need for privacy and informed consent suggest
that therapists’ use of the Internet to search for clients may be
inappropriate, graduate students’ views and actual behaviors in this
emerging area are currently unknown. Consistent with the above
discussion, many trainees may feel that clients should be the sole
gatekeepers of information about themselves—and that accessing
personal information online (i.e., by “Googling”) without a client’s
permission is a violation of privacy that could damage the thera-
peutic relationship. On the other hand, many student therapists, for
whom Internet search and social networking activities are com-
monplace in everyday life, may see little harm in conducting
searches. According to this view, information on the Internet is
publicly available and represents an appropriate and, at times,
therapeutically useful source of information about clients (e.g., to
check for prior sex offenses committed by a client). This viewpoint
would be consistent with the observation that social media and
other websites have contributed to an erosion of interpersonal
boundaries and decreased expectations of privacy between indi-
viduals (Behnke, 2008). These differing positions represent two of
the many opinions that trainees may hold about conducting
searches for clients on the Internet. Mirroring these opinions may
also be differences in actual searching behaviors, with some train-
ees having refrained from searches altogether while others perhaps
searching for many clients. Despite anecdotal reports that mental
health providers routinely turn to the Internet as a source of
information about clients (Clinton, Silverman, & Brendel, 2010), it
appears that no published research has examined therapists’ atti-
tudes or actual use of the Internet in this manner.

The overarching purpose of this study is to examine doctoral
trainees’ opinions and behaviors about online searches for infor-
mation about their clients. The recent emergence of these issues
called for an exploratory investigation of several important ques-
tions, which we conducted with a large sample of clinical, coun-
seling, and school psychology doctoral students. The specific aims
of the study were to do the following:

1. Assess graduate students’ attitudes regarding the accept-
ability of using search engine and social networking
websites to search for personal information about their
clients. Although the lack of prior work in this area

makes predictions about overall acceptability difficult,
findings that younger individuals are more frequent users
of Internet (Jones, 2002) suggest that, relative to older
respondents, younger participants will find such searches
more acceptable. Further, as time in program increases—
and students presumably receive more formal ethics
training and real-world clinical experience—we expected
that the acceptability of searching for clients would de-
cline.

2. Document the frequency with which trainees use search
engines and social networking sites to seek personal
information about clients. Corresponding to our predic-
tions about attitudes, we expected that younger partici-
pants and those earlier in training would more frequently
engage in these behaviors.

3. Finally, because of the ethical relevance of informed
consent in conducting Internet searches, we also assessed
whether student therapists inform clients of their attempts
to locate personal information about them online.

Method

Participants

Participants were 854 students enrolled in clinical, counseling,
and school psychology doctoral programs in the United States and
Canada. Participants resided in 43 different states as well as
several cities in Canada. The mean age of participants was 28.07
(SD � 4.92) years. Participants were mostly female (81.5%),
European American (89.9%), and non-Hispanic (93.8%; see Table
1 for full demographic characteristics of the sample). These sample
characteristics are comparable to national data reported to APA by
Accredited Doctoral Programs in the United States in 2008
(www.apa.org, retrieved March 16th, 2010). The majority of par-
ticipants were doctoral-level students (88.8%) and were enrolled in
clinical psychology programs (68.4%), followed by counseling
(15.9%) and school (15.8%) psychology doctoral programs.1

Measures

Internet usage questionnaire. This questionnaire was de-
signed by the investigators to collect data relevant to the primary
study aims (see Table 2 for item wording and response options).
To establish baseline usage rates, participants initially reported
their overall use of search engines and social networking sites for
any purpose, as well as whether they maintained a personal web-
page on a social networking site. Participants then responded to
Likert-type items, assessing (a) attitudes about the acceptability of
therapists who use search engines and social networking sites to

1 The survey was distributed only to doctoral programs. However, in
response to Item 5 (simply stated “Degree type”) some participants se-
lected the option “terminal masters” (see Table 1). All individuals who
selected “terminal masters” nevertheless reported that they were currently
in their third or fourth year of training, which is inconsistent with being in
a master’s program. We conclude that these respondents were doctoral
students who reported their highest degree earned to date (the masters).

161GOOGLE AND CLIENT INFORMATION

seek information about clients, as well as their actual searching
behaviors; and (b) clients’ awareness (or not) of such behaviors.
Following the item-assessing acceptability of searching, an open-
ended question asked participants to provide the rationale for their
response. Because the information available through search en-
gines and social networking sites can differ, participants were
queried separately for each type of site.

Procedures

Following approval from the Institutional Review Board, solic-
itation for participants proceeded in two ways. First, to contact
clinical and school psychology students, individual recruitment
e-mails were sent to the training directors (TDs) of APA-
accredited clinical and school psychology programs in the United
States and Canada. TDs’ e-mail addresses were obtained through
the websites of the Council of University Directors of Clinical
Psychology (CUDCP; 187 member programs) and the National
Association of School Psychology (NASP; 89 member programs).
A recruitment e-mail that contained a brief description of the study
was sent to TDs with a request for them to forward the survey link
to their students. To contact counseling psychology TDs, the same
study description and link was posted to the counseling psychol-
ogy TDs’ listserv, with a request that they forward the recruitment
e-mail to their students. Interested participants were directed to a
Survey Monkey website, where they gave consent to participate
before completing the questionnaire. As incentive for completing
the questionnaire, participants were offered the opportunity to

enter a drawing for one of three $50 cash awards. The completion
rate for this study (percentage of those viewing the survey who
finished it) was 91.3%.

Results

Overall Use of Search Engines and Social
Networking Sites

The distribution of responses to items on the Internet usage
questionnaire is contained in Table 2. Overall, 87.6% (n � 684) of
respondents reported using search engines on a daily basis,
whereas 30.9% (n � 242) reported daily usage of social network-
ing sites. In addition, 71.8% (n � 562) reported having a personal
webpage on social networking websites such as Facebook or
MySpace.

Acceptability of Searching for Client Information

Approximately 67% (n � 522) of participants felt it was either
never acceptable or usually not acceptable to search for informa-
tion about a client by using search engines. Because age and year
in program were positively correlated, r(820) � .36, p � .001,
partial correlations were used to examine associations between
these two variables and acceptability ratings with the effects of the
other variable removed. Contrary to expectations, there was no
significant correlation between age and acceptability of searching
for a client by using a search engine. Also unexpectedly, a positive
partial correlation was found between year in program and accept-
ability of searching for client information using a search engine,
r(773) � .12, p � .001.

For social networking websites, 76.8% (n � 598) of the sample
felt it was either never acceptable or usually not acceptable to
search for client information. Contrary to prediction, a partial
correlation controlling for year in program showed no relationship
between age and acceptability of searching for a client on a social
networking website. Also unexpectedly, a small but significant
positive correlation was found between year in program and ac-
ceptability of searching for client information on social networking
websites, r(773) � .09, p � .007.

Figure 1 contains a summary of open-ended responses that
reflect the reasons why it might be acceptable to search for a
client’s information online. These responses were coded by the
second author for content, with a number of categories emerging.
Although the most common response overall was that it was not
acceptable under any circumstances to search for a client’s infor-
mation online, the most common reason searching was seen as
acceptable was to assess client risk. Chi-square analyses were used
to test differences between the frequencies of reasons provided for
conducting search engine and social networking searches. Propor-
tionally more respondents found it unacceptable to search for
client information on social networking websites compared to
search engines (40.0% for search engines; 47.2% for social net-
working websites), �2(10, N � 778) � 17.11, p � .01. Signifi-
cantly more respondents also indicated that client consent was
needed before conducting a search on a social networking website
(38.8%) than a search engines (26.4%), �2(10, N � 570) � 20.0,
p � .05. Similarly, a larger proportion of respondents said that
using search engines was acceptable to confirm client reports

Table 1
Sample Characteristics (N � 854)

Variable Univariate statistic

Age 28.07 (4.92)
Gender

Male 152 (18.5%)
Female 668 (81.5%)

Race–Ethnicity
White–European American 693 (89.9%)
Asian 44 (5.7%)
Black–African American 27 (3.5%)
American Indian–Native Alaskan 7 (.9%)

Hispanic
Yes 51 (6.2%)
No 769 (93.8%)

Degree type
PhD 690 (88.8%)
PsyD 40 (5.1%)
Terminal MA 46 (5.9%)

Program type
Clinical 560 (68.3%)
Counseling 130 (15.9%)
School 130 (15.9%)

Year in program
1st 160 (19.4%)
2nd 153 (18.6%)
3rd 166 (20.1%)
4th 140 (17.0%)
5th 117 (14.2%)
6th and beyond 88 (9.9%)

Note. PhD � doctorate; PsyD � doctor of psychology; MA � master of
arts.

162 DILILLO AND GALE

given in therapy (11.7% for search engines compared to 2.6% for
social networking sites; �2(10, N � 563) � 26.74, p � .01.
Differences were also found for searching for general information
about clients, with more participants indicating this is an accept-
able use of search engine (18.4%) than social networking website
use (3.2%), �2(10, N � 563) � 36.98, p � .01. Finally, seeking
personal websites that may be relevant to topics discussed in
session was more often offered as a reason for searching social

networking websites (26.6%) than search engines (11.8%), �2(10,
N � 571) � 50.26 p � .01.

Seeking Information About Clients

The total sample of 854 participants reported seeing 13,582
therapy or assessment clients in the past year (M � 15.9 per
student). These respondents reported having searched the Internet
for 16.5% of all clients (n � 2,241) using either search engine or
social networking sites. Of the 783 participants who reported
seeing clients, 97.8% (n � 766) had searched for at least one
client’s information using search engines such as Google, whereas
94.4% (n � 739 had searched for at least one client’s information
using social networking websites. It is interesting to note that
66.9% (n � 513) of those therapists who had conducted search
engine searches for client information also reported that it was
either always or usually unacceptable to do so. Likewise, 76.8%
(n � 568) of those therapists found it always or usually unaccept-
able to search for client information on social networking websites.

Partial correlations were again used to examine the relationships
between age and year in program in relation to percentage of
clients searched by using search engines and social networking
sites. Contrary to predictions, there was no relationship between
age and percentage of clients searched by using either search
engines or social networking websites, while controlling for year
in program. As predicted, however, a significant negative relation-
ship emerged for year in program and the percentage of clients
searched by using search engines, while controlling for age,
r(733) � �.28, p � .001. A significant negative association was
also found between year in program and the percentage of clients

Figure 1. Reasons for searching for clients who use search engine and
social networking websites.

Table 2
Summary of Internet Usage for All Participants

Variable Univariate statistics

Frequency of Google usage:
Never 2 (.3%)
Less than once every two months 2 (.3%)
Once per month 2 (.3%)
Once per week 91 (11.6%)
Daily 685 (87.6%)

Frequency of Facebook, MySpace, or other social networking website usage:
Never 173 (22.1%)
Less than once every two months 94 (12.0%)
Once per month 82 (10.5%)
Once per week 192 (24.5%)
Daily 243 (31.0%)

Do you have a profile on a social networking website?
Yes 563 (71.8%) No 221 (28.2%)

How do you rate the acceptability of searching for information about a client using Google?
Never acceptable 214 (27.4%)
Usually not acceptable 309 (39.6%)
Sometimes acceptable 164 (21.0%)
Often acceptable 59 (7.6%)
Always acceptable 35 (4.5%)

How do you rate the acceptability of searching for information about a client on social networking websites such as
Facebook or MySpace?

Never acceptable 328 (42.1%)
Usually not acceptable 271 (34.7%)
Sometimes acceptable 121(15.5%)
Often acceptable 37 (4.7%)
Always acceptable 23 (2.9%)

163GOOGLE AND CLIENT INFORMATION

searched by using social networking websites, after controlling for
age, r(733) � �.26, p � .001.

Client Knowledge of Searches

As mentioned previously, 97.8% of therapists had searched for
at least one client using search engines such as Google, and 94.4%
had searched for at least one client using social networking web-
sites. The nearly universal reports of having searched for client
information raise the question of whether clients are aware of these
activities on the part of their therapists. Among those who had
searched for at least one client, therapists reported that 82.1% (n �
643) of those clients were aware of the Google search, whereas
82.5% (n � 646) of clients were said to have been aware of their
therapists social networking search.

Discussion

This study may be the first to assess therapists’ attitudes and
actual attempts to use the Internet to obtain personal information
about clients. Most participants (67%) found it completely unac-
ceptable or usually not acceptable to search for client information
online. Although these findings indicate that therapists primarily
disapprove of using the Internet as a source of information about
clients, nearly all participants had searched for at least one client
by using search engine or social networking sites (97.8% and
94.4%, respectively). Moreover, two thirds of these participants
who disapproved of searches had nonetheless conducted at least
one search for information about a client. This discrepancy be-
tween attitudes and actual behaviors should be considered in the
context of graduate students’ overall frequent use of Internet
search and social media sites. Here, the majority of respondents
reported using one or both of these sites on a daily basis, and over
75% maintained their own social networking pages. These findings
demonstrate that search and social networking activities are com-
monplace in trainees’ everyday lives. Thus, just as doctoral stu-
dents may think nothing of taking a few moments to learn some-
thing about a new social acquaintance online, so too may they
quickly turn to the Internet as a source of information about their
clients. Responding to survey questions about these activities,
however, may have given participants reason to pause and more
carefully consider the appropriateness of these activities, leading
most to express hesitation about conducting such searches. Nev-
ertheless, the reported discrepancy between attitudes and actual
search behaviors suggests that although trainees recognize that
searches are ethically questionable, the ubiquity of these activities
in their everyday lives may lead them to feel that client searches
are of little consequence or are easily justified because of their
anonymity (e.g., “What my client doesn’t know won’t hurt him/
her”). If so, this suggests a need for education efforts that heighten
trainees’ awareness of the ethical implications of online searches
in order to bring behaviors more in line with their cautious atti-
tudes about such practices.

Contrary to expectations, no unique associations were found
between age and either attitudes about client searches or actual
search behaviors. Perhaps exposure to the culture of the Internet,
including the pervasive use of search and social networking sites,
has resulted in a similarity of attitudes and behaviors within the
relatively narrow age range of participants in this study. As ex-

pected, we found a relationship between year in program and
search behaviors, such that more advanced training was associated
with fewer clients searched. These results are encouraging and
suggest that with increasing experience and professional develop-
ment, students are less likely to engage in client searches, presum-
ably due to greater cognizance of the ethical and therapeutic issues
involved. At the same time, however, we found positive associa-
tions between year in program and the acceptability of conducting
client searches. Although significant, these associations were
rather weak (.09 and .12 for search engines and social networking
sites, respectively).

Nearly all graduate student therapists had used search engine or
social networking sites to search for at least one client’s informa-
tion. Student therapists, therefore, are actively seeking information
about certain clients through means other than face-to-face con-
versations or traditional requests for records from third parties. At
the same time, therapists are not searching indiscriminately for
every client online (16.5% of all clients had been searched), which
suggests that trainees are using criteria in making decisions about
which client’s information to search for online. The responses to
the open-ended questions shed light on this reasoning. The most
common reasons for searching included (a) gaining a better un-
derstanding of the client’s outside life, (b) clarifying personal
information such as phone numbers or addresses, and (c) investi-
gating issues that arose in therapy (i.e., risk issues or confirming
questionable client reports). These findings suggest that a wide
range of justifications are being used for conducting searches.
Further, differential criteria were offered for using search engine
versus social networking sites. Search engines were more likely to
be used in cases of fact checking client reports. Notably, issues that
concern clinical relevance were more likely to trigger searches on
social networking websites than search engines. This finding sug-
gests that therapists may view these websites as useful sources of
clinically relevant information such as self-harm or substance
abuse behaviors. These findings indicate that therapists are deter-
mining which website will best provide the type of information
they are seeking about their client.

Surprisingly, trainees reported that the vast majority of clients
(82.1%) were aware of the searches they had conducted. This
finding is encouraging and consistent with the open-ended reports
that obtaining client consent is an important consideration in
determining whether to conduct a search, particularly on social
networking sites. These results also suggest broad support for the
notion that searches should not be conducted without client knowl-
edge and informed consent. However, many questions remain
about the means by which clients are informed about these
searches. For example, do therapists obtain consent from clients
prior to conducting a search or do clients find out only after
searches have taken place? Are clients inviting therapists to
“friend” them on social networking sites, thus granting them
permission to search? Given the importance of obtaining informed
consent, further investigation is needed to explore how and when
these conversations are taking place. Finally, we cannot rule out
the possibility that the high rates of informing clients about
searches found here partially reflect over reporting by therapists
who are hesitant to disclose searches were conducted without
clients’ knowledge.

Clearly, some trainees are turning to the Internet as a source of
information about clients, and believe that doing so is acceptable

164 DILILLO AND GALE

for a variety of reasons. This suggests a need for clear principles
to guide clinicians in deciding the circumstances in which searches
can be conducted ethically and in the best interest of clients (e.g.,
without unnecessary breaches of privacy). For example, most
would agree that searching online for a client’s contact information
is not ethically problematic; however, searching for other infor-
mation should be guided by more explicit ethical guidelines. As
noted, although certain aspects of the current APA Ethics Code are
relevant, the current version was developed before the emergence
of the Internet as a major source of personal information. We invite
APA to consider offering more explicit guidance, or to provide
further advice for extrapolating current principles to online
searches (see Behnke, 2010). For example, Clinton et al. (2010)
offered a heuristic framework for making ethical decisions about
the appropriateness of client searches. This framework stresses a
case-by-case consideration of (a) the reason for conducting a
search, (b) the positive or adverse effects of a search on treatment,
(c) the question of obtaining client consent, (d) whether to share
results of the search with the client, and (e) whether to document
the search. Efforts such as this may help therapists to avoid
inadvertently placing themselves in ethically compromising situ-
ations.

It is important to consider the present findings in light of the
study’s limitations. First, although we were successful in obtaining
a large, geographically diverse sample, individuals self-selected to
participate in the study. Thus, it is possible that those who decided
to respond to the survey differ systematically from those who did
not. Similarly, because our survey was distributed primarily to
PhD programs, resulting in proportionality fewer PsyD respon-
dents, it is unclear whether the current findings generalize to the
broader population of students in PsyD programs. Second, al-
though participants responded to open-ended questions in regard to
the reasons in general for conducting client searches online, we did
not ask about motivations for any particular searches. Thus, we do
not know how often searches were conducted for relatively harm-
less reasons (e.g., to obtain basic contact information) or for more
ethically questionable purposes (e.g., curiosity about a client’s
personal life). Future studies should examine this important ques-
tion. Finally, the present findings represent a “snap shot” of
opinions and Internet behaviors at the point of data collection.
However, the Internet is rapidly evolving, which includes the
continual advent of new applications and features (e.g., Twitter,
Foursquare) with potential relevance to training and clinical prac-
tice. It is safe to assume that therapists’ attitudes and behaviors in
regard to the role of the Internet in these domains will continue to
evolve as well.

The acceptability of conducting searches for client information
online is but one of the many complicated issues confronting
therapists in a rapidly changing Internet environment. Findings
from this study, particularly the incongruence between attitudes
about searching and frequency of actual search behaviors, suggest
a pressing need for this issue to be addressed within doctoral
training programs. To facilitate this process, we offer the following
recommendations:

1. Programs should establish policies governing student thera-
pists’ use of the Internet to seek information about clients, includ-
ing the circumstances, if any, in which it may be appropriate to
conduct such searches. In general, we recommend proscriptions
against these behaviors except where it is likely to benefit the

client and prior consent (preferably written) is obtained. There may
be exceptions to this general rule, however, such as in certain
forensic cases or situations when the therapist, client, or another
individual is in imminent danger.

2. Policies governing therapists searching for clients (as well as
other online contact) should be discussed with clients and spelled
out in understandable terms as a part of the informed consent
process at the outset of therapy. Therapists who desire to search for
information about a client online should seek permission from the
client to do so. Just as clients sign releases of information granting
therapists permission to seek information from third parties, so too
should written permission be obtained for therapists to seek infor-
mation about clients online. This process should include a discus-
sion of the risks (e.g., breaches of privacy) and inform clients of
any exceptions to the need for informed consent.

3. To promote understanding of program policies, faculty and
supervisors should discuss with students the ethical and therapeu-
tic implications of conducting online searches. Until such time as
more formal guidance is offered from APA, particular emphasis
should be placed on the relevant principles in the existing Ethics
Code along with heuristic models such as Clinton et al. (2010).
Clinical supervision is an ideal context in which to have these
discussions. While guiding students through a decision making
process, supervisors can help them consider important therapeutic
issues (“What is your motivation for searching?” “Will this infor-
mation benefit your client?” “What will you do with the informa-
tion?”).

Additional research is needed to shed further light on trainees’
searching activities. For example, it will be important to examine
clients’ perceptions of therapists’ searching behaviors. Although
many clients may experience uninformed searches as an invasion
of privacy, others may be comfortable with certain online interac-
tions with therapists. Anecdotally, we have heard of clients reach-
ing out to therapists through Facebook and other sites. In contrast
to the unilateral searches investigated here, these activities involve
mutual interaction between therapist and client that raise a range of
concerns about multiple relationships and boundary violations.
Nevertheless, additional work is needed to explore whether there
are any circumstances under which these types of interactions are
permissible (e.g., a therapist “friending” an adolescent client to
observe and help monitor online activities). Relatedly, an impor-
tant focus of future research should be the converse of this study—
that is, how often are clients searching for therapists online, and
how does the information they obtain impact clinical practice?
Considering the frequency of online activities, we assume that
graduate student therapists are actively posting personal informa-
tion on the Web, but it is currently unknown whether they consider
the information they are posting in light of their roles as develop-
ing clinicians and professionals (Lehavot, 2009). The relevance
of this issue is highlighted by recent findings that the majority of
medical students and residents are active Facebook users and of
those posting photographs, 70% of the photos included use (and in
some cases excessive use) of alcohol, which could be considered
unprofessional (Thompson et al., 2008). These results again un-
derscore the need for students to receive guidance on the ethical,
professional, and privacy implications associated with Internet
usage.

165GOOGLE AND CLIENT INFORMATION

References

American Psychological Association. (2002). Ethical principles of psy-
chologists and code of conduct. American Psychologist, 57, 1060 –1073.
doi:10.1037/0003-066X.57.12.1060PMid:12613157

Behnke, S. (2008). Ethics in the age of the Internet. Monitor on Psychol-
ogy, 39(7), 74.

Behnke, S. (2010). The Internet’s ethical challenges. Monitor on Psychol-
ogy, 41(7), 32.

Clinton, B. K., Silverman, B. C., & Brendel, D. H. (2010). Patient-targeted
Googling: The ethics of searching online for patient information. Harvard
Review of Psychiatry, 18, 103–112. doi:10.3109/10673221003683861.PMid:
20235775

Farber, B. A. (2003). Patient self-disclosure: A review of the research.
Journal of Clinical Psychology: In Session, 55, 589 – 600.

Fisher, C. B. (2002). A goodness-of-fit ethic of informed consent. Urban
Law Journal, 30, 159 –171.

Fisher, C. B., & Oransky, M. (2008). Informed consent to psychotherapy:
Protecting the dignity and respecting the autonomy of patients. Journal
of Clinical Psychology: In Session, 64, 576 –588.

Jones, S. (2002). The Internet goes to college: How students are living in
the future with today’s technology. Washington, DC: Pew Internet and
American Life Project.

Lehavot, K. (2009). “MySpace” or yours? The ethical dilemma of graduate
students’ personal lives on the Internet. Ethics & Behavior, 19, 129 –141.
doi:10.1080/10508420902772728

Smith-Bell, M., & Winslade, W. J. (1999). Privacy, confidentiality, and
privilege in psychotherapeutic relationships. In D. N. Bersoff (Ed.),
Ethical conflicts in psychology (2nd ed., pp. 151–155). Washington, DC:
American Psychological Association.

Thompson, L. A., Dawson, K., Ferdig, R., Black, E. W., Boyer, J., Couffs,
J., & Black, N. (2008). The intersection of online social networking with
medical professionalism. Journal of General Internal Medicine, 23,
954 –957. doi:10.1007/s11606-008-0538-8

Received September 1, 2009
Revision received March 7, 2011

Accepted March 29, 2011 �

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