How to use this Page

By Jan Willer

Social media and other technologies have changed how we communicate. Consider how we coordinate events and contact our friends and family members today, versus how we did it 20 or 30 years ago. Today, we often text, email, or communicate through social media more frequently than we phone or get together in person.

Now contrast that with psychotherapy, which is still about two people getting together in a room and talking. Certainly, technology has changed psychotherapy. There are now apps for mental health issues. There are virtual reality treatments. Psychotherapy can now be provided through videoconferencing (a.k.a. telehealth). But still, it’s usually simply two people talking in a room.

Our psychotherapy clients communicate with everyone else they know through multiple technological platforms. Should we let them “friend” us on social media? Should we link to them on professional networking sites? Is it ok to text with them? What about email? When are these ok and not ok?

Social Media Explained (with Donuts). Uploaded by Chris Lott. CC-BY-2.0 via Flickr.

Some consensus is emerging about these issues. Experts agree that psychotherapists should not connect with current or former clients on social media. This is to help preserve the clients’ confidentiality. Emailing and texting are fine for communicating brief messages about the parameters of the session, such as confirming the appointment time, or informing the psychotherapist that the client is running late. Research has shown that emotional tone is frequently miscommunicated in texting and email, so emotion-laden topics are best discussed during the session.

How do we learn about new people we’ve met? In the past, we’d talk directly to them, and maybe also talk to people we knew in common. Now everyone seems to search online for everyone else. This happens frequently with first dates, college applicants, and job applicants.

Again, contrast this with psychotherapy. Again, two people are sitting in a room, talking and learning about each other. When is it ok for a psychotherapist to search for information about a client online? What if the psychotherapist discovers important information that the client withheld? How do these discoveries impact the psychotherapy?

No clear consensus has emerged on these issues. Some experts assert that psychotherapists should almost never search online for clients. Other experts respond that it is unreasonable to expect that psychotherapists should not access publicly available information. Others suggest examining each situation on a case-by-case basis. One thing is clear: psychotherapists should communicate with their clients about their policies on internet searches. This should be done in the beginning of psychotherapy, as part of the informed consent process.

When we’ve voluntarily posted information online–and when information about us is readily available in news stories, court documents, or other public sources–we don’t expect this information to be private. For this reason, I find the assertion that psychotherapists can access publically available information to be more compelling. On my intake forms, I invite clients to send me a link to their LinkedIn profile instead of describing their work history, if they prefer. If a client mentions posting her artwork online, I’ll suggest that she send me a link to it or ask her how to find it. I find that clients are pleased that I take an interest.

What about the psychotherapist’s privacy? What if the client follows the psychotherapist’s Twitter account or blog? What if the client searches online for the psychotherapist? What if the client discovers personal information about the psychotherapist by searching? Here’s the short answer: psychotherapists need to avoid posting anything online that we don’t want everyone, including our clients, to see.

Ways to communicate online continue to proliferate. For example, an app that sends only the word “Yo” was recently capitalized to the tune of $2.5 million and was downloaded over 2 million times. Our professional ethics codes are revised infrequently (think years), while new apps and social media are emerging monthly, even daily. Expert consensus on how to manage these new communications technologies emerges slowly (again, think years). But psychotherapists have to respond to new communications technologies in the moment, every day. All we can do is keep the client’s well-being and confidentiality as our highest aspiration.

Jan Willer is a clinical psychologist in private practice. For many years, she trained psychology interns at the VA. She is the author of The Beginning Psychotherapist’s Companion, which offers practical suggestions and multicultural clinical examples to illustrate the foundations of ethical psychotherapy practice. She is interested in continuing to bridge the notorious research-practice gap in clinical psychology. Her seminars have been featured at Northwestern University, the University of Chicago, and DePaul University. 

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Last weekend I attended a writers retreat on deep editing.  I was in great company with many of Windy City RWA members.  The presenter was Margie Lawson, psychotherapist, editor, and international presenter, who whipped us through a grueling and head-exploding work session.  Toward the end of the day, the song "Amazing Grace" pounded through my brain ... 'I was blind, but now I see!' 

Words have power, we writers know that. Yet many times we become satisfied with mediocrity.  Then we wonder why our work doesn't have that spark we want.  The answers are varied, but I can give you a simple reason why we don't see our own less than stellar writing. 

Let's say I wrote:  "Bigger than a mountain." 

There is nothing wrong with this description.  It conveys something pretty darn huge.  That's what I want my readers to understand.  So I move on to the next sentence and the next.  Then my work for the day is done and the next day I re-read what I wrote.  Yes, this something is definitly bigger than a mountain and I pick up my writing where I left off.  By the third day, I skim over 'bigger than a mountain,' because now I'm focused on something else.  By the fourth day, 'bigger than a mountain,' is set in and part of the story.  By the fifth day I'm married to this phrase.  It's not going anywhere, it says what I want it to say.  I don't give it the time it needs to be a stronger part of the story.  I'm content with it because I've read it so many times it sounds perfect in my mind. 

Now the truth is 'bigger than a mountain,' is lazy writing; not intentional or careless.  It is the phrase that filled the void I needed and I moved on, not bothering to think if I could find better words.  Of course I could find stronger, more powerful words rather than 'bigger than a mountain.'  But it has become part of the story and I don't recognize it for the lack-luster phrase that it is.

This is where deep editing takes affect.  Again this is just one simple element of deep editing, but perhaps it will open your eyes to recognize these chunks of poor writing.  A simple test to find these unsightly phrases is to skim over your paper, highlighting words that could easily be replaced with stronger images.  Don't read, let your eyes search out weak wording, hightlight it, and then move on.  Once these phrases and words are spotted, take the time to restructure with power words that will thrill your reader to read them.

'Bigger than a mountain.'  What would you replace this phrase with?  I would probably replace the whole phrase and not refer to a mountain. 

"Astroid-sized bubble."  "The Grand Canyon hovering above me."  Get the idea?

Now the image has impact.  Your reader wants more.  And so you deliver!


Til next time ~

DL Larson