These two posts were originally published on the American Counseling Association’s former member blog site, my.counseling.org in 2009, retrieved from the Wayback Machine, 2026.
Is it okay to “Google” your client?
So, let’s talk about this. I read an article recently: Internet Social Media Present New Quandaries for Psychiatrists published May 15th in the Psychiatric Times. Since then, I have had a couple of provocative discussions with workshop participants. This article is geared toward psychiatrists, but clearly this is an issue that can crop up in our profession as well.
So, what do you think? I am thinking, “No.” There are exceptions. For example, I might help a client understand his or her online presence and what others could know and see by “googling” the client’s name during a therapy session. We could process the information that comes up and it may lead to a deeper understanding for the client. But to just google my clients as a matter of course, well that seems invasive. And even if a client encourages me to google what do I do with all of that information? The lines get blurred, boundaries get fuzzy and to put it simply, I enter into the client’s private world, as public as that world may be.
Your client may have a blog. You may stumble upon it or your client may email the blog link to you. Do you read it? Do you follow the client’s blog posts? Again, what do you do with all of that information about your client’s life? The information is, after all, in the public domain. One might say it would be akin to reading a client’s published autobiography. Is that okay to do? If your client announces that his or her memoirs have just been published, do you log on to Amazon and order the book?
These are but a few of the many questions that are raised as we maneuver this Web 2.0 world. Even counselors with the strictest boundaries may find themselves faced with this or a similar dilemma because our clients are bringing technology, both literally and figuratively into the consultation room. I would love to hear thoughts and experiences from you.
DeeAnna Merz Nagel is a clinical counselor, teacher, workshop presenter, sits on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute.
4 Comments
Kate Anthony says:
June 26, 2009 at 10:33 am
At the training workshops I give, this again often comes up as a dilemma that hadn’t occurred to delegates. The general consensus from them is that Googling your client outside of the session (in other words, not within a contracted relationship which has agreed on this being acceptable practice) is tantamount to following your client home post-session and peering through their living room windows.
Hope that is of interest!
Kate
Dr. Keely Kolmes says:
June 26, 2009 at 2:30 pm
These questions have been coming up frequently with trainees and colleagues with whom I consult. I believe that if you are a therapist who is using Google to obtain additional information about your clients, then this needs to be formally integrated into informed consent and become an explicit part of your treatment agreement.
Googling clients or reading their blogs without their awareness is a subtle way of entering into a multiple role with them. The APA Ethics Code cautions us against entering into multiple relationships which can impair our objectivity, competence, and effectiveness in our primary role as psychologists. While it may not seem obvious on the surface, consider how doing these things invites us to be voyeurs, investigators, or audiences to our clients outside of their sessions with us.
In my work with clients, I obtain consent when I’m going to share (or collect) information from a third party. As I recently shared in a Twitter conversation on this topic, I think that the internet is now becoming a sort of third party, with additional client data becoming so easily accessible.
I like Kate Anthony’s comment above about Googling clients being like following them home. The example I often give is that of donning a disguise and following them to a bar where you can secretly observe their behavior. It is one matter if a client invites you to view their online content and it becomes integrated into the clinical conversation in some way. But it is an entirely different matter if we do this on our own, without the client’s awareness. I expect that these types of boundary issues on the internet will soon be addressed by ethics codes.
DaveMSW says:
June 26, 2009 at 8:31 pm
I can tell you of one situation recently where checking the accuracy of what a client was telling the treatment team became an issue of safety. The client had no collateral sources of information mainly because of a recent transient lifestyle.
The person was reporting she had been involved in a newsworthy event and there were many reasons to doubt her story. The treatment team was considering medication for delusional thinking and evaluating her ability to care for her children. Her story was verified and the idea of a neuroleptic was dropped.
There was other information, but I ignored anything that didn’t relate to my question and can’t tell you what was there.
I think it’s important to get the permission of the client in advance of what was intended, maybe even do the search in their presence. The information is public. I think ethics committees need to think hard about forbidding MH professionals from access information available to everyone else. However, guidelines would be helpful.
I can imagine other circumstances where a history of criminal convictions might be a critical part of an assessment or determining the nature and extent of a history of domestic or child abuse might directly affect decisions involving the safety of family members. We don’t hesitate to obtain a release to access medical information, why not civil and criminal information on the internet?
Perhaps not quite the same, but there are times where internet verification of information is important for other reasons. I have googled the housemate of a client who had heard a rumor he might be a sex offender. He was and my client arranged other housing. I have googled historical event referred to in a veteran’s story of traumatic military encounter and determined his story was not accurate and it started an assessment of malingering.
Next time we find a compelling need for collaborating information involving the safety of clients or others and can’t find other sources, I’m sure we will discuss the option of a Google search again.
DeeAnna Merz Nagel says:
June 26, 2009 at 9:49 pm
Hi Dave- You bring up two potentially valid uses for engaging in a google search of a client- One reason may be health, welfare and safety and the other may be in the case of forensic work. For instance, when I conducted domestic violence evaluations on mandated clients I would conduct a 911 check which does not require consent and is public record. I would, however, inform the client of all of the collateral sources of information. Thank you for sharing!
DeeAnna
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Listservs and Case Consultation- What About Confidentiality?
Are you a member of a listserv? The most popular Listserv service is Yahoo Groups. Various organizations and like-minded professionals often create listservs to communicate efficiently with one another. Once a member, you can usually either opt to receive the emails as they come in or a digest of all of the posts at the end of the day. Many counselor listservs focus on providing a place to network, share resources, find potential referrals and talk about cases. Yes. That is correct…talk about cases. Said differently, counselors talk about their clients on listservs.
The ACA speaks specifically about disclosure of confidential information when consulting with colleagues (Sec. B.8c) stating that “counselors should not disclose confidential information that reasonably could lead to the identification of a client or other person or organization with whom they have a confidential relationship…disclosing information only to the extent necessary to achieve the purposes of the consultation.”
Here are some points to consider when discussing client-specific information on a listserv.
When asking for a possible referral, keep in mind if you name the town and state the client’s issue (e.g. seeking a referral for a client who lives in Anywhere, TN. He is struggling with depression after being laid off from his factory job last month) then you potentially disclose enough information to identify the client.
Even when you “blind the record” removing all identifying information, if you talk about a client (e.g. 35 year old female client who has been diagnosed with post partum following the birth of twins 3 months ago) you may reveal the location of the client by way of your very own email signature line. (e.g. Respectfully, Dan Counselor, LPC, www.dancounselorlpc.net). Anyone looking up the website can see the counselor’s location and begin to connect the dots.
Not all colleagues follow the same code of ethics or interpret their codes similarly. Some colleagues do not understand confidentiality issues. And haven’t we all been confused with HIPAA compliance at one time or another? If you are on a listserv without a moderator who screens posts, a colleague may post a scenario that reveals much more than the examples given above.
Not all colleagues are ethical. Intentional or unintentional, our colleagues get involved in ethical blunders. So Jane Counselor may see an interesting case description then copy and paste the information to another colleague who is not even on the list.
Clients have a right to know that their case will be discussed, formally or informally. The most common statement I hear is, “We aren’t doing supervision.” Peer supervision, case consultation, case supervision, clinical supervision- in the end it boils down to telling another colleague your client’s personal business. Build consultation and supervision into your informed consent.
Consider not participating in listservs that engage in case consultation and consider an encrypted alternative. We are approaching a time when encryption will be standard for all online communication but for now, we must practice due diligence and protect our client’s case material to the extent possible. Encryption used to be cost prohibitive but that is not necessarily true anymore.
If you decide to remain on a listserv that discusses client information for the purposes of referral or consult, consider educating your listserv colleagues about some of the issues discussed here.
I spoke specifically about listservs in this blog post because many of us are members of listservs and have been for years. But these same points hold true for social networks, forums and other online methods of communication that are not encrypted. Consider providing the best standard of care that you can for your clients. It may not be as convenient but compare what I am saying to hearing a group of colleagues in a restaurant who are discussing cases over lunch. While they may not be revealing specifics or names, we discourage this behavior, don’t we?
DeeAnna Merz Nagel is a clinical counselor, teacher, workshop presenter, sits on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute.
One Comment
Paul Fornell says:
July 9, 2009 at 11:07 am
Excellent post DeeAnna, I hope every counselor on every listserv in the world reads it!
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