The Ethical Use of Social Media in Mental Health
KEY POINTS
Social media is a powerful force in our society, with pros and cons when it comes to mental health.
While basic ethical principles protect patient confidentiality, some professional influencers are not following them.
Misuse of social media by professionals undermines general confidence and breaks individual trust.
Broad awareness of ethical guidelines for mental health professional is a key step in restoring and ensuring confidence.
Given the explosion of social media, and especially platforms that support short, entertaining, and variably informative video clips—posted by an array of influencers ranging from conscientious licensed professionals, to researchers, to commercial interests, to casual untrained posters sharing impassioned personal experiences— the development of clear ethical guidelines to be followed by licensed clinicians and their various professional organizations is critically important. As highlighted in a trending Washington Post article entitled Your therapist is on TikTok. Will your therapy session end up there too? (2023), it's clear that there are serious under-addressed concerns1.
The situation is deeply problematic for individual patients who may recognize themselves or aspects of their private information online, as well as for other viewers, who may question the confidentiality and privacy of their own sessions2. At the same time, while we are all unique, we often share similar histories and identifying characteristics such as background and even specific life experiences. Likewise, many of the problems people bring up in therapy are shared—such as how to deal with familiar relationship conflicts—guaranteeingthat generalized examples may ring true. If they are timed with one's last therapy session, it may or may not mean the therapist drew on a specific example "hot off the press".
Whether treatment is with a therapist in solo or small group practice or at a large company, breach of trust may harm individuals; it also undermines professionals' ability to ensure safe and confidential treatment. Betrayal of trust not only undermines the specific clinician-patient relationship but also may interfere with future treatment or undermine other professional relationships.
Ethical Guidelines Are Part of Standard Practice
Until recently, guidelines about using case material have focused on professional publications, including books, journal articles and presentations. Standard practice is to obtain informed consent, that is permission from patients, in advance of using material. Informed consent involves a discussion of risks and benefits, how information may be used, and the nature of confidentiality. Clinical vignettes are highly anonymized, with major details altered to protect identitywhile preserving the generalized didactic and clinical points. In professional settings, the benefit is for learning, so that useful practices can be disseminated to help more people.
The same principles apply to public-facing clinical material, but there are additional considerations as professional education is only one potential benefit and the risks are greater due to wider exposure. Potential benefits include sharing high-quality information with viewers and readers (a self-helpargument), normalizing and destigmatizing mental health concerns, raising awareness of problems, and enabling a wider group of people to access information potentially important for making decisions about seeking evaluation and treatment.
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While short-form video clips are hot, the same questions apply for radio, podcasts, blogs, and other social media outlets, as well as conventional media like, such as shows about addictions, relationships, and therapy. When personal gain comes into play—for example, with mental health professionals developing a business or seeking influence outside of the consulting room—ongoing self-assessment by the licensed professional is required to ensure ethical practice.
Toward the Proper Use of Social Media by Therapists
Information shared should be credible and reliable, and not misleading. Unfortunately, however, social media is not well-regulated. A recent study found, for example, that only 21 percent of TikTok videos about ADHD (Attention-Deficit/Hyperactivity Disorder) presented quality information (Yeung et al, 2022).
While formal professional guidelines are still being developed in response to a rapidly shifting media landscape, there are long-held ethical principles (such as those for professional use of clinical information) to be guided by. Many organizations offer a clear framework for how to approach social media. The American Psychological Association's Guidelines for the Optimal Use of Social Media in Professional Psychological Practice (2021) are a good reference for clinicians3, viewers and readers, and media professionals:
Importance and Relevance of Social Media
Guideline 1.1: Psychologists are aware that social media can be highly useful for improving public access to information about behavioral health, psychological services, and the integration of behavioral health within primary, secondary, and tertiary health care.
Guideline 1.2: Psychologists are mindful of social media’s growing importance as a tool for communicating and engaging with interested groups of clients, students, peers, and other stakeholders around particular health issues, thereby adding value to health services, research, and education.
Ethical and Professional Issues
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Guideline 2.1: Psychologists are mindful of the public nature of social media and that their privacy and confidentiality often are not protected nor expected on social media.
Guideline 2.2: Psychologists are mindful of ethical and legal obligations to maintain client privacy and confidentiality at all times.
Guideline 2.3: Psychologists consider the risks and implications of using social media and online searches to obtain information about their clients, students, trainees, consultees, and others with whom they work on a professional basis.
Guideline 2.4: Psychologists consider the need to avoid contact with their current or past clients on social media, recognizing that it may blur boundaries of the professional relationship.
Guideline 2.5: Psychologists are aware of the benefits of establishing a policy regarding their participation in social media and discussing this policy and their use of social media as part of the informed consent process with clients.
Guideline 2.6: Psychologists are aware that social media provide many opportunities for investigating important research questions but are mindful of the need to guard against the misuse of research involving social media.
Guideline 2.7: Psychologists strive to maintain accurate and truthful statements on social media about their own practice, colleagues, the profession of psychology, and other issues and give special attention to the scientific support and empirical basis for statements made and the limitations of available evidence regarding particular topics.
Implications
Being aware of practice guidelines is key for people seeking mental health treatment in today's tech-enabled world. It's important at the start of treatment for expectations to be clearly discussed and established. In the process of seeking therapy, it's important for people to not only feel comfortable asking whatever questions are important (such as how the therapist practices, what they treat, what their policies and fees are, and more) but to know that that information is available and proactively offered by the professional.
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Clear understanding of how the therapist works and what to expect has always been a basic part of the "frame" of therapy, Nowadays, it is necessary to include information about whether a therapist is active on social media, whether they blog for the public, and whether and how they may use clinical experience in open forums. Therapists have a right to do work outside of direct patient care, including in media and publishing, with a moral imperative to provide trust and security to those for whom they render direct care.
References
1. Likewise, large tech-enabled mental health platforms have been called out for sharing data inappropriately, often for commercial gain and sometimes inadvertently. There is a balance between the benefits of using big data to help work out the best way to get help to those in need, versus the risk to privacy and the sole use for marketing of other goods and services.
2. As someone who is active on social media myself, and an active blogger, author and podcaster, I do not bring up specific clinical cases, preferring to review research, speak more "meta" about clinical issues, and rarely use fictionalized accounts which do not reference specific people. Inevitably, fictionalized accounts are relatable to many readers and viewers, because they are intended to highlight common problems many people face. This is problematic, because illustrative clinical examples are usually necessary for material to be most useful.
3. Clinicians are encouraged to reach out to their specific licensing and regulatory bodies for licensure and jurisdiction-specific guidelines, and to consult with and notify malpractice carriers of any potential areas of concern.
Yeung A, Ng E, Abi-Jaoude E. TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality. The Canadian Journal of Psychiatry. 2022;67(12):899-906. doi:10.1177/07067437221082854
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About the Author
Dr. Brenner is the co-author of three books Irrelationship: How We Use Dysfunctional Relationships to Hide from Intimacy, Relationship Sanity: Creating and Maintaining Healthy Relationships, and the most recent sequel [Feb 2023], Making Your Crazy Work For You: From Trauma and Isolation to Self-Acceptance and Love (Central Recovery Press). In addition, he is the author of the popular Psychology Today blog, ExperiMentations: Reflections on the Human Condition, with nearly 12 million views to date.