Health Care

Patient Therapist Relationships in the Digital Age

Should you or shouldn't you? When you meet someone new, curiosity may lead you to Google them and check to see if they have information available on a social networking web site, such as Facebook. This seems harmless, so long as the information is in the public domain. However, if you're a therapist or doctor, the issue isn't so clear.

A Question of Ethics

Currently, whether therapists should Google or Facebook their patients is an ethical and moral issue than a legal issue. At the core of this question is how can therapists, and other professionals where privacy is an issue, use the internet to help their patients without harming their expert relationship with them?

Neither the American Psychiatric Association nor the American Psychological Association has provided rules dealing with online behavior. Ethics experts have advised that online searches aren't necessarily wrong or unethical, as long as the therapist keeps the patient's best interests in mind.

The Issues

Patient-therapist relationships and the internet raise several issues:

  • Patient's consent. Some patients maintain web sites or blogs offering clues to their well-being or other information related to their treatment. However, unless the therapist gets permission from a patient, there's no consent. With the constant information available over the internet, a therapist can gather much information on a patient, without the patient even knowing, much less consenting
  • Diluted information. Traditionally, the patient-therapist relationship is a face-to-face meeting where all of the necessary information was obtained from these meetings. Seeing a patient online could dilute, complicate and confuse the therapy process by bringing in outside information
  • Online information could also be distorted. Posting information on the internet is often to impress or show a side of yourself that isn't true. Other issues include:

    1. Disclosure. If a therapist finds the patient, does this need to be disclosed to them? Is it ethical for the therapist to later raise issues that she learned over the internet during treatment?
    2. Negligence. This is a double-edged sword. Is it negligent to search the patient if there's public information available, or is it negligent not to search? For instance, if a patient makes a suicide threat online, should the therapist get involved?
    3. Payment. If therapists read patients' blogs or other information online, is this part of the patients' treatment? If so, can the therapist bill the patient for the time spent reading and searching?

    As there is little direction provided, there are no clear-cut answers and each interaction is different. Therapists are advised to be mindful and aware of the ethical issues raised by internet searches and how the patient-therapist relationship is affected by such actions.

    Should Therapists Join Social Networking Web Sites?

    These questions don't only affect therapists searching their patients online, but the reverse as well. While no one would criticize patients checking their treatment providers' credentials, where is the line?

    There's a danger of patient and therapists interacting online and getting access to personal information that can compromise your relationship. Finally, what happens if a patient develops romantic feelings for her therapist, especially after seeing private pictures?

    As a therapist, assume your patient will conduct an internet search of you, so you should be careful of what gets posted in your Facebook profile, blog or web page. Patients can have access not just to your pictures, but to your social contacts. Furthermore, what happens when a patient requests to be a friend on Facebook or other social networking site? Be cautious of what's available of them on the internet. For instance, bathing suit or other personal pictures shouldn't be posted or added as private, as well as any information that could impact the way your patients see you.

    These are important questions to keep in mind as a therapist and patient, and are more examples of how professions and relationships have changed with the digital age.

    Questions for Your Attorney

    • Are there any circumstances that I can get in trouble for Googling my patient?
    • Can I sue my therapist for information disclosed online?
    • Should I friend my therapist if I know they're on Facebook?
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