Last month I was fortunate to present a poster titled “Polyamory as a Cultural Identity: Implications for Clinical Practice” at the National Multicultural Conference and Summit in Houston Texas.  The poster presented a literature review on polyamory geared towards clinicians, woven together with my ethnographic impressions, sample case vignettes and comments from clinicians both with and without experience serving this population.

The notion of positive and successful consensual non-monogamy continues to be a controversial topic in the psychological community.  This is especially true for polyamory, which so far seems to retain the fringe attribution that other forms of consensual non-monogamy, such as open relationships or swinging, have gradually sloughed off via growing public awareness (and tacit acceptance) of these practices.  However as I discussed in my poster, it is becoming increasingly evident that polyamory may be far more common than many realize.

Given my premise that polyamory can constitute a distinct and evolving culture, it seemed fitting to present at a conference dedicated to multiculturalism.  However I must admit to feeling anxious about how my poster would be received.  Waking nightmares of distinguished psychologists angrily and loudly contesting, or worse – cursorily dismissing my work haunted me in the days leading up to the presentation.

Fortunately, as with my symposium presentation on LGBT polyamory at last year’s APA convention, the response could not have been more positive and encouraging.  Every single person I spoke with was incredibly enthusiastic about the topic and my work.

My poster received an enormous amount of interest and traffic; I spent the entire 90 minute session talking to people individually or in groups.  It seemed like nearly everyone who saw the title stopped to stay a while.  The important take-away for me however was not just the positivity of psychologists’ reactions, but the particular flavor of them.

Beyond appreciating the poster, numerous people personally thanked me for sharing work on this topic.  Their reactions were as much emotional as intellectual, expressing relief and gratitude.  Psychologists and students alike spoke with me about the dire need for greater awareness of these issues among the clinical community.  Numerous times throughout the session clinicians told me stories of polyamorous clients at their practice, clinic or school that nobody knew how to work with.  I heard reports of biased supervisors, ignorant trainees, and clientele whose needs were going unmet due to the paucity of clinically-relevant knowledge on alternative sexualities.

My experiences presenting on polyamory at APA and the National Multicultural Conference and Summit have reinforced my belief that alternative sexualities are rapidly growing in participation and visibility.  I sincerely hope that expanding education and training among clinicians about these populations will ameliorate widespread biases and gaps in knowledge.

Diversity and multiculturalism are by definition expansive and inclusive concepts.  Therefore I believe that – as with LGBT populations decades ago – we must embrace the fact that these communities exist, they are more common than many realize, and psychologists must rise to the occasion by establishing standards of culturally competent care for them.

View the poster.

Until now, there hasn’t been much that we can do other than do good work, listen to our clients’ feedback, and hope that we don’t upset someone enough for them to want to publicly complain about our work on the Internet. My typical first response to someone who just got a bad online review is to recommend that they take a deep breath, try to shake it off, and seek support from their colleagues and people who know them and their work.

But for two years, I have been working on a solution. In my trainings, I’ve recommended that the best way for clinicians to manage this is to take steps to put client feedback back into their own hands by developing post-treatment feedback forms and getting client consent to post aggregate data on their sites.

Sample Referral Graph

Nine months ago, I developed a questionnaire asking psychotherapy clients what they would most like to find in online reviews of therapists. One hundred and thirty-six participants responded and I used that data to develop a follow-up survey. I’ve been using my own follow-up form in my practice for almost two months, as well as implementing an ongoing feedback form. I’ve also had a couple of other clinicians alpha test this in their own practice.

To view a preview of the data I’m getting, peek at my Client Feedback page.

Now you can get your hands on this survey because I’m releasing it in a public alpha launch.

Here’s how it works.

You pay a very reasonable set-up fee, I will host your form, then you send the link to your feedback survey to clients who have completed treatment with you and wait for your results to come in. Once you have 15 completed surveys, you will be sent an aggregate view of your data. If you’re itching to know how many responses you’ve gotten before you reach your 15, go ahead and check in with me and I’m happy to let you know.

Sample therapy goals graph

Why the wait? We wait for 15 clients to complete the surveys to help protect the privacy of your clients. The goal is to see how you are doing generally, not person-by-person. And the potential end-user of this site is clients who are looking at your ratings online. If you like what you see and want to continue using the form, you can pay for a monthly (or yearly subscription, at a lower rate).

Also, some research indicates that it takes 6-10 local reviews for a business to gain trust from consumers. We want to make your results a bit more robust for you and your potential clients.

Every time you get 5 more responses, you’ll get an updated graph with a time and date stamp.

If you want to get a better idea of how your current clients feel about how their therapy is going, signing up also gets you a PDF of a Checking In form you can give to your current clients to see how they feel about how therapy is progressing.

How is this ethical? For one thing, it is sent only to clients you have completed therapy with, and with their consent. No testimonials or text-based responses are shared with anyone but you. Aggregate data is revealed which does not compromise the identity of participants to you, or to the public (or to their friend lists or Facebook. Bleh!).

How is this good for me? If you wait out the initial period as you build your feedback data, and send this to all clients you complete treatment with, you will have an alternative data point that you can post online to show people “Hey, I sent this to all of my clients, and here is what they are saying about my services.” This can take the sting out of the unfortunate experience of getting a negative online review from one disgruntled client.

You’ll also get a very good idea where your growth edge is and how you may be already excelling in your care and where you may need to pay a bit more attention. And if you choose to keep your feedback private, you can simply use it as a tool to improve your services.

How is this good for clients? It helps them to find out the information they want to know about you and your practice: the issues you treat, what you’re especially good at, and whether people who work with you would be comfortable referring others to you. It also protects their privacy without exposing their personal issues to their friend networks or the public. And it gives them a chance to honestly give you feedback, without any negative consequence. I believe that in our changing culture of Internet transparency, it also lets clients know that you are willing to stand behind your services and receive feedback about how you’re doing.

Do you want to take control of client feedback and make sure you know how your clients feel about your services? If the answer is yes, join me in my alpha launch.

Get started now by adding “Yelp-Proof Your Practice” to your cart in my online store.

I’ll follow up with an email with the FAQ, and giving you all you need to get started. If you have questions and concerns, we’ll chat on the phone and I can tell you more about my experiences with this product.

As an alpha launch partner, I’ll also be asking you for some feedback of your own, sharing what you like and don’t like about the product, and you can have a hand in fine-tuning it and shaping it.

I hope you’ll join me in this new venture and adventure!

If you’re looking for other resources about managing Yelp, I highly recommend the articles below:

Ofer Zur’s brand new post on Modern Day Digital Revenge offers many tips and resources for dealing with online reviews.

Matt Lundquist of TriBeCa Therapy in New York had a creative and human approach to dealing with his own negative review on Yelp.

Pysychotherapy Finances did a review of what you can do about Yelp, interviewing me and Dr. David Ballard, last year.

A recent blog post of mine had a number of experts weighing in on what you can and can’t do and whether those posting reviews of our services still have a right to confidentiality.

My New York Times Op-Ed, The Wrong Type of Talk Therapy, was when I first began wishing for an alternative to online review sites which might better protect consumers.

Lastly, some people have taken to adopting my language from my own Yelp page and using it on theirs. I allow any and all clinicians to use this on your page, if you wish.

The popularity of the 50 Shades of Grey books has been staggering. They have become the 9 1/2 Weeks of a new generation; glorifying the excitement of power, bondage, and…well, mind games. In fact, those who know what consensual BDSM participants actually do together have criticized the trilogy for portraying kinky sex as unhealthy and non-consensual. Others note that some of the activities in the book convey a lack of knowledge about keeping BDSM physically and psychologically safe.

However, it is clear that the public is fascinated by kinky sex. In fact, 14% of American males and 11% of American females have engaged in some form of BDSM sexual behavior (Janus & Janus, 1993). But BDSM remains a taboo topic in the field of mental health where sexual diversity training focuses primarily on the experiences of gay, lesbian, and bisexual individuals. Despite removing homosexuality in 1986, the Diagnostic and Statistical Manual of Mental Disorders continues to list Sexual Sadism and Sexual Masochism as Paraphilias, or sexual disorders.

The tension between public interest in BDSM and outdated training of clinicians has created opportunities for psychotherapists who identify as “kink-aware” or “altsex friendly,” to identify themselves to savvy psychotherapy clients. These clients want to avoid wasting their time and money spending hours in therapy only to have their proclivities pathologized by clinicians who know nothing about their lifestyles. In fact, Kink-Aware Directories and Poly-friendly Directories exist to help consumers find a wide range of services from informed professionals. The Bay Area even has its own group: Bay Area Open Minds, to help clinicians network and to help clients find us.

Just as it’s not easy for all people to “come out” to their friends, family, or co-workers as kinky or polyamorous, it’s also not always easy to come out as an altsex-friendly mental health professional. Those of us who advertise these services – whether we identify as altsex clinicians or just allies — face the same challenges BDSM and poly clients face. Many health professionals believe that alternative sexuality is a sign of illness. If you truly want to see power dynamics in action, try coming out as an altsex friendly trainee in a psychology graduate program. It takes strength, courage, and support to do so surrounded by ill-informed colleagues. It is even more challenging to do this if you are a student, very much in need of affirmation from professors and supervisors.

Sexuality remains such a forbidden frontier that if one speaks up
 about the experiences of sexually marginalized people, it is assumed that they must be a member of the group. This circumstance keeps some altsex clinicians and their altsex positive allies silent. By contrast, few clinicians would worry that by specializing in treating substance abuse, eating disorders, anxiety, or depression, people might think they are in recovery, bulimic, depressed, or anxious. But most cannot imagine why a person would willingly speak up about kink in our field unless one were kinky herself.

I am a kink and poly-friendly professional who works with altsex clients. I discuss my altsex research, teaching, writing, advocacy, and clinical work in many professional settings. There are many reasons to be an altsex positive clinician. You may
 have known and loved someone who is kinky or poly, as a friend, partner, or family member. Maybe you have had your eyes opened to your own biases and judgment and want to make a difference. Maybe you believe in everyone’s right to fantasize or engage in consensual sexual acts, regardless of whether you experience the same desires. I believe that all clients deserve a safe, non-judgmental place to talk about their fantasies, behaviors and identities.

It is my hope that the public’s interest in exploring these fantasies and ideas in stories and media may begin to expand our notions of what is normal and will help change outdated ideas about sexual pathology. If every other person on BART and MUNI is reading 50 Shades of Gray, a book about sex and power, then shouldn’t it also be safe to go to your psychotherapist’s office and explore these issues there?

Janus, S., and Janus, C. (1993). The Janus Report on Sexual Behavior. New York: John Wiley & Sons.

Gay, Older, and Dating: I Have Survived! Now What?

I am lucky to be a veteran of 40+ years of living as an out gay man and a psychologist in the LGBT community.  Living in the San Francisco area in the Seventies, I enjoyed the Disco Revolution; I marched with Harvey Milk; I sat bedside during the Eighties and Nineties at the deaths of countless patients and friends; and I did my part to rebuild our community in the ‘00s, and have thankfully lived to tell the tale.  If you are reading this, you may be an older gay, lesbian, trans or bisexual person – which in our community could be anyone over 40 – and looking for love. Or you may be on your way to becoming an older gay person, so read on.

Let me first say that if you are looking for a one-nighter, fair enough: many older queer folk are not interested in a long-term relationship (LTR), or even dating, for a number of reasons.  Perhaps you have left or lost a partner, and are not up for the complexities of an LTR.  Or maybe you are simply too accustomed to the independence of single life.  Whatever the reason, by this stage in life, you know where to find what you need: online hookup sites (Scruff, Grindr, Manhunt, Adam4Adam, Craiglist) or the more traditional in-person, impersonal venues.

But if you are interested in dating, and the possibility of finding an LTR – either again, or for the first time – read on.  This article is dedicated to Boomers/Seniors looking for relationships, and many of the recommendations that apply to heterosexuals work for us too (see below).  But for LGBT Boomers/Seniors, there are some unique considerations in the mature quest for love.  As a psychologist who has worked with LGBT people from all generational cohorts for thirty years, I have some ideas that may help you in your search:

• Know what you want, and focus accordingly: These days, because of the Internet, it is much easier to connect with like-minded people in terms of dating.  Consider where you are in your life, and what you want: is it an LTR?  Casual dating?  Friendship?  What kind of people are you attracted to?  Those in your own generation, or others?  Be honest with yourself and others.  Engage with those whose relational goals are similar.

• Stay open: Be flexible in your “requirements”.  Also, be flexible in your choice of venues.  For instance, do you remember what it was like before computers “back in the day” when we actually met in person?  Go to bars; if you don’t like them, or don’t enjoy alcohol-saturated environments, join community groups; volunteer for LGBT causes.  If you live in a rural area where these options are not available, use your computer to connect – or take a deep breath and try and start a club/interest group where you live.

• Focus on what is under your control, and leave the rest: Are there demons in your head, telling you that you’re too old/too fat/too washed-up to find a loving relationship?  Don’t do that to yourself; these thoughts must be confronted and replaced with positive thoughts, because they will not help you feel confident in your presentation to others.  Are you comfortable in your own body?  If not, take steps to address that.  It helps.  Regardless of your age or ability status, everyone can find something active that they like to do.  Be content with who you are and what you have, and it will be much easier feel good about yourself when you meet others – of any age.

• Be honest: You know by now that ours is a youth-obsessed community, and it is easy for older people to feel invisible or marginalized.  Don’t buy into that; if you are patient, and sure of yourself, you will meet your Prince or Princess.  But you can’t lie, especially on the Internet, where lying seems to be the lingua franca of communicating.  Tell the truth about yourself (age, weight, SES, whatever) – you know that whomever you are interested in is going to find out the truth sooner or later.  Be up-front and you’ll feel better about your communications.

• Don’t despair: there is a market for everyone: So you think you are over the hill, and that no beautiful person will ever look at you again?  Think again.  It’s easy to worry about that (see above), but don’t allow yourself to go there.  It will not help you achieve anything, and will erode your self-esteem.  Be vigilant against toxic thinking!  Attend community groups where the participation of older LGBT people is valued; if you go out, visit bars/clubs/coffehouses that have mixed-age clientelte.  And online?  There are good resources available for meeting people form all over the world who admire us older folk: Silverdaddies and Caffmoscommunity are a couple of reputable sites.

• MOST OF ALL, EMBRACE YOUR AGE:You are likely used to feeling that being over 40 is a deficit in our community.  If you are indeed over 40, challenge that thought: you cannot change your age, but you can change your attitude about it.  You are mature; you have wisdom; life experience; and a lot to offer.  Make your self-talk more positive with activities that bolster your confidence.  Get to the gym.  Hang out with your friends.  Make time for the things that enhance your self-care, whatever they may be, and for God’s sake, stop working so hard.  And if you don’t want to be in a relationship after all?  Absolutely fine.  We are gay, after all; we have already broken the boundaries of heterocentric social expectations (in plain English: social norms of living like straight people), so if you are more comfortable as a single person, good for you.  Let it be.

• Follow the basic recommendations for straight Boomers/Seniors: Some of these apply to us, and let’s start with safe sex.  In the past few years, the CDC has reported an alarming increase in new HIV infections in gay men over 50 – an age cohort that has survived the initial wave of the health crisis.  What’s going on?  My theory is that so many of us older guys feel invisible, or just generally bad about ourselves, that we are willing to accept any kind of sexual attention, even if it is unsafe – especially if we have had too much to drink.  Don’t do it.  You know the rules of safe sex by now.  Follow the rules for online dating that straight people endorse: get to know someone, be slow to trust them, meet informally and publicly at the beginning, etc.

• Use the resources dedicated to online dating for gay Boomers/Seniors: There are a number of reputable websites that offer advice, resources, social alternatives, and online communities for connecting with other LGBT Boomers/Seniors as those people who are interested in getting to know us better.  They include the AARP’s page for gay online dating, OutMaturity, and FromGaytoDecember.  Check them out.

Last but not least, enjoy yourself!  This can be an amazing time of life.  After all, we have survived (paraphrasing Gloria Gaynor), and as time goes by, we understand how precious life is.  Embrace your age and accept whatever health challenges you may have.  Put yourself out there.  Chances are, someone is waiting.

A highlight for me was watching the APA Ethics Committee, led by Stephen Behnke, JD, Ph.D., Director of the APA Ethics Office leading a session on hot topics in ethics in which the packed room all got to participate and share ideas. Another treat was having leaders I’ve admired for a long time attend my own presentations and come up afterwards to express appreciation. Moments like that can be incredibly meaningful to me as I move into becoming a mid-career psychologist. One such example was Dr. Philip Zimbardo coming up to to me after a talk I gave, and then watching him receive his Distinguished Lifetime Contribution to Media Psychology Award the next evening. Cool stuff.

I was also delighted to see one of my very favorite professors, Dr. Rhoda Olkin, receive her award from the Committee on Disability Issues in Psychology (CDIP). Dr. Olkin gave a very well-received talk on her great work on living with disabilities and working with clients with disabilities. If you haven’t read her book What Psychotherapists Should Know About Disability, you should go get it now.

Dr. Esnil, Dr. Mendoza-Newman, and Dr. Kolmes after the Roundtable

My presentations included the following, (and I’m grateful to my colleagues for teaching me so much in these presentations):

Transmedia Storytelling: Creating Engagement and Meaning in Business, Education, and Clinical Practice, with Pamela Rutledge, Ph.D. and Jerri Lynn Hogg, Ph.D.

Stigma Squared: Understanding Kink in LGBT Communities: The Revolution Within: Sexpositivity and Celebrating Sex Within LGBT Communities, with Theodore R. Burnes, Ph.D., MEd, Ryan Witherspoon, B.A., Anneliese A. Singh, Ph.D.

Connections, Intersections and Coalitions: Feminist Healers Group, Roundtable Discussion, with Edna Esnil, Psy.D. and Mary Mendoza-Newman, Ph.D.

Symposium on Social Media in Long-term Care Settings: Roles, Responsibility, and Unlimited Possibilities, with Mary M. Lewis, Ph.D., Geoffrey W Lane, Ph.D., Eleanor Feldman Barbera, Ph.D., and Patricia L. Bach, Psy.D., R.N.

Next year, APA will be held in Honolulu, and my goal is to engage in more relaxation and maybe just do one or two presentations.

The conversation started in response to this posting describing how clinicians are more free to respond to anonymous reviews and explaining how requiring people to post with real names is not great for health-related businesses (or the clients who wish to review them), as it would violate our pledge of confidentiality.

This is an area in which we need to exercise restraint and caution. Clients reviewing us on a website, no matter whether their real name is used, is not the same thing as their signing a release of information authorizing us to discuss their care. Even when we do get such releases of information, we can discuss only the minimum amount of necessary information, and only to people who are involved in their treatment.

While it can be tempting to defend our professional reputations on online review sites, I’d argue that this is not a necessary sharing of information relevant to an individual’s treatment. It is an unjustified breach of our primary obligation of confidentiality, disclosing a treatment relationship to a wide public audience, let alone one that is clearly not involved in their care. Yes, negative online reviews are problematic, but we need to consider other ways of managing this. And let us remember, that clients do not owe us confidentiality. This is a one way street.

This is also a good time to look back at what our agreements are with clients at the outset of treatment. If we outline the limits of confidentiality and we do not state that online reviews constitute an exception to this on our part, it is a huge breach to disclose this information whether or not we like the review a client has left of our practice.

There have been cases in which physicians have attempted to limit the freedom of speech of clients by requiring treatment agreements that care can be terminated if the client posts an online review. Others have tried to assert copyright ownership over online reviews left by their clients. Perhaps physicians and clinicians would be better off outlining how they intend to respond to reviews instead and making this part of treatment agreements.

It is my belief that clients have a right to disclose their relationship to us with anyone they choose, without a threat of our disclosing their health data.

Similarly, if an individual tells a friend or their spouse that they see us in psychotherapy, this does not mean we have a free pass to discuss them with these people. If a client tells a room of people that they met with us and loved us (or hated us) we are not permitted to talk to those people about their care.

Should a public forum on the Internet be any different? Why or why not?

Do you think a client leaving a review should mean their clinician can comment about their treatment?

Note: comments are now enabled on this blog. I’d love to know people’s thoughts and responses to this.

Be sure to read the other great articles on Dr. Alban’s website, and if you’re in San Francisco, you won’t want to miss him presenting on Saturday, May 19th on Law, Ethics, and Charts: Every Therapist’s ‘Dirty Little Secret’. 9:30am – 12:30pm.

Dr. Alban’s post is below:

I’d like to preface this comment by saying that I do not have an opinion about whether promotions such as Living Social, Groupon, etc., are appropriate or constitute impermissible fee splitting when used by psychologists.  I do, however, think that it’s useful to think about these things as the marketplace changes and as psychologists such as ourselves feel the need to be more enterprising.

Here’s the text of 6.07- “Referrals and Fees: When psychologists pay, receive payment from, or divide fees with another professional, other than in an employer- employee relationship, the payment to each is based on the services provided (clinical, consultative, administrative, or other) and is not based on the referral itself.”

It seems to me that it’s important to remember the main purpose of 6.07, which is to make sure that referrals are made based upon clinical indications and not upon a fee.  This provision of the Ethics Code is in place to maintain the integrity of the treatment.  It’s also helpful, I think, to keep in mind that 6.07 does not prohibit fee sharing; its function is to ensure that any fee distribution is based upon services rendered.

Here’s how I would approach an arrangement like Living Social or Groupon:

1.) Determine who is making the referral:  Are patients self-referred based upon a mass email?  Or, is the website targeting individuals based upon other data?  Who decides whether the patients purchase the offer and/or visit the psychologist?  IMPORTANT: If patients decide to purchase a “deal,” is he/she aware that the psychologist’s participation in the deal is a promotion?

2.) Determine, to a reasonable extent, whether/how the partnering business maintains patient data.  Under many circumstances, the mere fact that a patient is seeing a psychologist is confidential.  However, patients who willingly choose to disclose that fact to a third party may do so of their own free will.  It’s not the psychologist’s dilemma if a patient breaches some elements of confidentiality.  But if the partnering business requires that the *psychologist* continues to provide patient data after the initial contact, the patients may need to be made aware of this in order to provide consent for this data transaction.  Patients can disclose private information on their own, or they can consent to the release of their private information.  (It’s certainly possible that many psychologists would reasonably believe that the potential intrusions disrupt the frame to such an extent that the treatment becomes irrevocably warped, but IMHO that is a theoretical judgment and not an ethical decision, per se.)  HIPAA Covered Entities may, under some circumstances, need to enter into Business Associate agreements with partner businesses if the information sharing is required (by contract) to continue.

3.) Something else to consider is whether partner businesses such as Groupon or Living Social are more like advertisers or more like business partners? Or, are they some altogether different form of business?   Recall that 6.07 provides examples of “clinical, consultative, administrative, or other” as services that are permissible bases for fee division. Is advertising an “other?” Are these types of promotions an “other?”

4.) A very real and practical concern (less an ethical concern) is that the response to these daily deal sites can be overwhelming. Be prepared for an avalanche of calls.

You can read more of Dr. Alban’s thoughts on this on his own blog. If you’re interested in hearing more from him, also know that he facilitates a monthly Law & Ethics discussion night for San Francisco Psychological Association.

I’d love to see you there!

Register here.

SFPA Members get member rates!

Digital and Social Media Ethics for Psychologists
May 20, 2012
1:00pm to 4:00pm. Registration at 12:30
3 CE hours

Sponsored by
Santa Clara County Psychological Association
Location-Palo Alto University
5150 El Camino, Suite 22, Bldg C
Los Altos, CA

Course Description:
The Internet and social media are offering a number of new clinical and ethical challenges for those who provide face-to-face mental health services. These challenges include extra-therapeutic contacts between therapists and their clients, questions about what distinguishes personal from professional activities online, and a lack of clearly developed policies related to our online behaviors and interactions.

This course offers an introduction to digital ethics and to various social networking sites and activities. It provides guidelines for anticipating and managing the problems that may arise for practitioners who are using these sites. Applicable ethical standards will be addressed. The instructor will incorporate vignettes and encourage discussion to address the different ways clinicians are addressing these issues.

Learning objectives:
• Describe social media and summarize several popular social media sites and services.
• Distinguish between one’s personal and professional activities on the Internet.
• Identify the ethical challenges that may arise from engaging in activities on the Internet.
• Construct a social media policy for one’s office to address potential boundary issues with clients.

Presenter’s Bio:

Keely Kolmes, Psy.D. is a licensed psychologist in private practice in San Francisco, CA. She serves as Director of Digital Communication for APA Division 42, Psychologists in Independent practice. Dr. Kolmes writes, does research, and provides consultation and training on clinical and ethical issues related to social networking and technology. Her Private Practice Social Media Policy has been frequently cited and is a recommended sample document for clinicians by the APA Insurance Trust. She has published a New York Times Op-Ed on the challenge of consumer reviews of mental health services. Her professional website is www.drkkolmes.com where she keeps her blog, Mindful Musings: www.drkkolmes.com/blog. She can also be found on Twitter as @drkkolmes

CPA is approved by the American Psychological Association to sponsor continuing education for psychologists. SCCPA maintains responsibility for this program and its content.

And then, in an instant, it can also take so much away: feelings of pain, jealousy, feeling left out, or trying to interpret messages from pixels on the screen.

The Internet makes it easy to communicate without having to talk to people like some of us digital immigrants did in “the old days.” Don’t forget that the human relationships you most value do require some direct, face-to-face communication sometimes as part of their regular care and feeding.

Since so many of us are living our lives online these days, here are my six pointers for avoiding injury to yourself and others on email and social media.

1. Be careful of “heat of the moment” posting.

It’s so easy to impulsively respond to an email or a tweet or a wall posting when you’re feeling hurt or angry. But if you find yourself composing something when you’re feeling angry or shaken, try making it into a draft and giving yourself at least a 24 hour cooling period before clicking send.

If you have a trusted friend who you know to be a careful and balanced thinker or communicator, perhaps run your posting by him or her.

If you goof, and post something that maybe you shouldn’t have, you can still self-correct and delete it later. An apology may sometimes be a step towards a better interaction, as well.

2. Don’t use status updates as a passive-aggressive way to communicate something to just one person.

If you know you are really posting that tweet or status update for an audience of one, and it’s an indirect way to get something off your chest, try a direct message to the person you’re trying to to reach instead. Or better yet, send an email (or – gasp! – pick up the phone and call) and see if they are available to talk in the near future.

Don’t use vaguebooking or passive-aggressive posts to try to get attention. You may irritate people, and you may find that it doesn’t really wind up getting you what you want. Of course, private jokes or sweet messages can sometimes become a status update. But beware if you are using your twitterstream or Facebook Wall or G+ account as a way to beat around the bush.

3. Never unfollow or unfriend someone out of retaliation just because they unfollowed you.

Yes, it stings to find out that someone has stopped following your tweets or is suddenly showing up as a recommended Facebook friend when you know you were connected just a week ago.

If it’s a close relationship, you can always send a note and say you’ve noticed they stopped following you and ask why they did so. Don’t do this unless you are prepared to hear their answer.

But if you are still following them on Twitter and you like their tweets, don’t unfollow them to “get even.” Try giving it 30 days or so to see if they are still providing valuable content to you. If it’s still bugging you, and the relationship is close enough, you can ask why they took you off their Follow list.

If what follows is a “difficult conversation,” see my blog post on how to have difficult conversations.

And try those off of the Internet! Oh wait, that’s item #5!

4. Don’t obsessively Facebook, Google, or Twitter-stalk your ex (or the person your ex is now dating).

Of course, it’s tempting to find out what has happened in someone’s life when you’re no longer in it, and the Internet has made it ridiculously easy to browse photos, news, and updates on the lives of people who are no longer in our lives. In the old days (yes, this is a phrase I am now old enough to use), people might drive by an ex’s house in a moment of longing or self-loathing. But now we can just sit home in our pajamas and look at their social media profiles to find out what’s new with them.

But this has become a new form of self-injury for many people. Sometimes, it can feel like a compulsion and it can be hard to stop. If you find you are doing this, consider employing some harm-reduction strategies such as using the “block” function or imposing time periods during which you’ll stay away from the offending profiles.

Try 14 days of not looking. Then try 30 days. You may find that not looking helps you move forward and helps stabilize your mood.

If it helps, enlist a friend whom you can call when you have a weak moment. Ask your friend to help support you in choosing something healthier to do rather than checking these profiles.

Chances are good that the profile will still be there to peek at once you’ve had 30 days of sobriety from checking your ex’s profile.

5. Try to keep important and difficult conversations offline.

The online disinhibition effect can lead people to sometimes get closer online and share more than they would offline with positive effects. But it can also lead some folks to say things that are more cruel and toxic than what they would say if they were chatting face-to-face, looking into someone’s eyes and seeing how their words land. This can be problematic, if you want to process hard things in a friendship.

One of the worst things you can do is tell someone that something should happen in an offline chat, but then dump your side of the conversation into an email. That’s unfair and it only makes sense that a person would want to respond to that email.

So do both of yourselves a favor: if you think something warrants a face-to-face conversation, don’t start it over email. Send an email and say, “Let’s get together and chat, I’ve got some stuff I wanna talk to you about.” Or pick up the phone and do the same.

Unless you’ve got a proven track record with someone who also likes to process things over email, don’t assume this is the best way “to talk.”

6. Avoid inflicting FOMO on your friends (and yourself).

While it’s great to post photos and updates of all the cool and groovy things you do in your life, remember that people are going to see these updates who may feel very hurt and left out when they find out you had a big birthday bash and neglected to invite them.

Be mindful of what it means to have wide audiences who are now privy to your every social engagement and think about whether you really want to share these things with everyone or whether you want to create filters and friend groups so that you are not in inadvertently pissing off half of the folks you call your friends.

And if you’re prone to FOMO yourself, start booking up your own social calendar rather than cruising for online information of what you’re missing out on. If you’re feeling like you’re missing out on too much, it may be a sign that it’s time to work a bit harder on creating more offline activities for yourself than online ones.

But I’m going to begin experimenting with allowing moderated comments on some of my blog posts now and see how that goes. I plan to screen all comments before posting, not to be a heavy-handed control freak, but just to be sure that they contribute to the value of dialogue, community, and my site. Hateful, and abusive speech will not be approved.

I look forward to hearing from my readers and having conversations with you about my writing.

Thanks, as always, for checking out my site!