Shrink Rap News

Friend Me? Psychiatrists and Social Networking


Your friends are on Facebook, your patients are on Facebook, and they talk about their interactions during sessions. Even your mother is on Facebook. If you’re like most psychiatrists, you’re not on Facebook. A survey conducted by the Maryland Psychiatric Society revealed that only 22% of MPS members had Facebook or MySpace pages. Thirty-six percent said they limit their use of technology because they are psychiatrists.

Why do psychiatrists shy away from social media? I’m not aware that anyone has done research on this, but I have a few theories. Psychodynamic psychotherapy has placed an ideologic burden on psychiatrists to keep their private lives private; the work of therapy includes the interpretation of transference, and transference develops best when the patient knows little about the psychiatrist’s personal life. If transference can be tainted by having photographs of one’s children in the office, think how counterproductive it is to see the psychiatrist’s beach vacation pictures or to know he “likes” a certain political figure!

Psychiatrists often value their privacy, especially since they may see patients who are dangerous, and may worry that it makes them vulnerable to have personal information easily available. It may be difficult to see a positive side to social media, and there are certainly stories of people, including physicians, who have lost their jobs because they have posted information on their Facebook pages without using discretion, and this year the mandatory risk management session at Johns Hopkins Hospital included an entire presentation on the dangers of social media. These warnings boiled down to common sense: Don’t write about your patients on Facebook, don’t post photographs of your patients on Facebook (yes, doctors have done this), and don’t “friend” your patients.

Finally, some psychiatrists worry that their patients will try to “friend” them and will feel hurt if their request is denied, and have decided it is easier to simply not belong.

Why would anyone – much less a psychiatrist – even consider having a Facebook page? For starters, it’s fun. It’s an easy way to connect with people from the past, to communicate with people, and to keep up on information. It’s now part of many aspects of mainstream daily life, and many things transpire on Facebook: The American Psychiatric Association has a page it updates regularly, as does Johns Hopkins Medicine. If you “like” an organization, its updates come to your news feed, and it’s no longer just about gossip. It’s a great way to promote a service or a product, especially when there is news associated with it. Definitely “friend” or “fan” your favorite restaurants and news sources.

If you’ve been considering joining Facebook, here are some guidelines:

  • If it will make you too anxious, don’t do it.
  • If you don’t join, don’t assume you’re not there. If you’ve ever been to a wedding or a party or in a 4th grade class photo, someone else may have posted your picture.
  • You can join with a pseudonym or some variant of your name. If you join under a fake name, you can reach out to others and tell them it’s you, but the public won’t know how to find you.
  • You can join and quietly lurk: You don’t need to post photos, information, or post to anyone’s wall.
  • If you include personal information or photographs, you may want to learn about privacy settings and set them so that only “friends” can see.
  • Unless your page is set up as a professional practice page, it’s probably a good idea not to “friend” patients or to accept their friend requests. I have never had a patient ask to be my Facebook friend. If patients ask: “Why won’t you be my friend?” a reasonable answer is to say that it may be considered a boundary violation, it’s frowned upon in the field, and some hospitals forbid patient-doctor Facebook friending.
  • No matter how anonymous you believe you are, or how high your privacy controls are set, with anything you post on the Internet, assume it’s possible that your patients, your mother, your boss, your residency director, and every malpractice attorney may see it. If that would present a problem, it doesn’t belong anywhere on the Internet.

Steve Daviss will tell you that Google+ is the social networking site of the future, that it allows for higher privacy, better control of where information disseminates to, and videoconferencing. I’ll leave that discussion to him.


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