Thanks to a post by Dr. V of 33 Charts, I was led to Paul Levy’s blog Running a Hospital, where I read the full text of the notice the hospital sent about blocking Facebook, MySpace, and Twitter. I soon got sucked into the comments on whether health care organizations should institute blocks on employee access to social networking sites. My own comment is reposted below:

I think a more useful approach by the hospital would be to regularly review confidentiality and HIPAA practices and remind people that even locked, private accounts are not appropriate for posting confidential hospital information.

Blocking access during the work day will not guarantee responsible use after-hours.

I, myself, have occasionally been distressed to see therapists posting about cases without regard to the fact that the client him or herself may later see it (if a public account) or that someone on their follower list may see it and identify the person if it is a locked and private account.

So again, much better to educate internet savvy users about professional identity and how to understand and manage one’s professional role while still being an active user of social media.

As social media use develops and digital natives enter the field, healthcare organizations are going have to do much more to educate employees about the dangers of posting confidential health information. What if you have a locked account? You may feel that you are not providing enough identifying data to compromise a patient’s privacy in 140 characters, but what if one of your followers knows the family you just counseled on the loss of their child? Also, what does it convey to the public about how we embody our professional roles and responsibilities when we are frivolous about posting  the serious and personal issues our clients present to us? It’s worth thinking twice if you’re considering posting information about the session you just completed with your last client.

What about those who maintain public Twitterstreams and who post case details without identifying data? While nobody may know the identity of the male client who just sought your care for erectile dysfunction, what about the impact on the client himself if he should he happen to read your post? Is it fair to say that he may feel exposed? Ashamed? Objectified for the sake of your readership? And what if he’s shared with a close friend or his employer that he’s seeking care from you, but has not divulged the reason for coming to treatment? What if these people know when your client meets with you and later read your Tweets after a session? What if they then ask your client if your mention of the client with sexual problems was about him? We may think we have protected our client by not disclosing age or ethnicity, but in a public forum, we are providing much more information than we may realize.

Given how social networking encourages us to share the details of our days, it is becoming crucial for us to carefully consider our policies when it comes to updating our status updates in regard to our work lives. If you wouldn’t want your therapist Tweeting about your sessions, then think twice before you post about sessions you engage in with your own clients. And if you are a provider who intends to publish information to the web about the services you provide, then at the very least, your confidentiality statements and informed consent forms should reflect this fact and outline the steps you take to preserve privacy.

If you do make it your practice to blog or Tweet about sessions, make this a conversation that happens early in treatment and give patients the opportunity to “opt out,” of treatment with you, or the chance to “opt out,” of being used as a status update. And remember, it may be your day you’re posting about, but it’s your client’s personal life and it is protected health information.

More about my motivation for this can be read below.

Recently, I’ve had the opportunity to reflect on my experience as a graduate student doing research on kinky sex. Taking on therapist bias against BDSM as a dissertation topic was challenging. I frequently felt misunderstood or I worried that professors and other students might make assumptions about my sexual practices. When I wasn’t busy worrying about those things, I worried about the burden of responsibility that I suddenly felt to the BDSM community, by virtue of choosing this topic. I went back and forth several times and nearly changed my topic to something….less adventurous.

However, I’d had the experience in my early 20’s of discovering books and friends who taught me that BDSM wasn’t the terrible, dirty thing I had once assumed it was. I learned that it was actually something that could be about trust, love, safety, and consensuality.

I had my mind changed.

Thus, with the earnestness and conviction that can only come from having your own prejudices revealed to yourself, I took on the issue as a personal challenge to myself, and eventually completed my dissertation on BDSM. This also meant that I experienced anxiety and dread in anticipation of every class I took over the next five years, as it was standard protocol to introduce yourself and your dissertation topic on the first day of every first class each semester.

Of course I hoped that my doing research in this area might mean that it would help reduce bias for BDSM clients entering therapy one day. But I also dreamed that psychology graduate students who identified as kinky or poly might also feel safer as they navigated graduate school or at least feel that the profession had become more welcoming.

It’s now thirteen years since I started my graduate training, and I’ve recently heard from students in training programs who do not feel that their programs adequately provide support or mentoring for developing clinicians who identify as kinky and/or poly or who simply wish to work with those populations.

Most programs these days encourage students to explore their cultural identities and they have student organizations allowing students to connect around ethnicity, religion, LGBT-identity, disability, or other cultural affiliations. But students who are kink or poly-identified may have a more difficult time identifying one another and forming such groups. Students struggle with how–and whether–to come out in a professional capacity either as members of the kink or poly communities themselves or as simply having knowledge or interest in serving these populations. Many schools still don’t recognize these alternative identities as deserving of support or outreach.

My support/networking/consultation group for Bay Area kink/poly-aware clinicians would allow students from various training programs to meet and network with one another and also allow them to connect with those of us who are already established as kink & poly aware professionals.

Dear Therapists,

Our names are Keely Kolmes and Dan Taube and we are licensed psychologists who would like to request your participation in our research on the effects of encountering client information on the Internet on practicing therapists. This study has been approved by the Institutional Review Board of Alliant International University.

As a participant, you will be asked to complete a brief online survey covering your basic demographic information and your experiences regarding seeking or accidentally discovering client information on the Internet, on both search engines and social networking sites. We expect the survey to take between 15 and 25 minutes to complete.

Your input may help establish better guidelines for managing the effects of data obtained via Internet on the therapeutic relationship. It may help therapists gain more information about working in a world with increasing potential overlap with clients in an online environment.

As no names or personal information will be linked to the study, your participation will be completely anonymous. If you should wish to contact the researchers directly, your participation may become confidential rather than anonymous, although your name will not be linked to any of the data you submit.

To be eligible for the study, you must be: a) a practicing psychotherapist (Ed.D. LCSW, M.Ed. MD, MFT, MSW, Ph.D., Psy.D. or student intern) in any area of counseling, psychology, or psychotherapy who is b) also utilizing the Internet in either your professional or private life.

If you meet the above criteria and are interested in participating in the study, you can access the survey at:

Therapist Survey

If you do not qualify for the study but you know others who might be interested in participating, feel free to forward this url.

Thank you for your interest and participation.

Sincerely,

Keely Kolmes, Psy.D. drkkolmes [at] gmail [dot] com

Daniel Taube, Ph.D., J.D. dtaube [at] alliant [dot] edu

I will be joined by James Lyda, Ph.D., Staff Psychologist at the Tang Center at UC Berkeley, who will present a morning segment on research on Facebook and on college students’ usage of social networking sites. I’m very excited about this training and about hearing about the clinical issues that Training Directors and interns are encountering.

The outline and schedule are below:

Northern California Training Directors Conference

Clinical and Ethical Issues Related to Social Networking and College Mental Health

October 23, 2009

9:00am – 3:00pm

This training focuses on Web 2.0 social networking and its relevance to college mental health. Clinicians will learn how students are using the Internet and what related issues they may be bringing into treatment. We will also cover clinicians’ personal and professional online presence and how this may intersect with their clinical role. We will also discuss related clinical, legal, and ethical issues as they come up in social networking and  college mental health.

II. The Google Factor

II. Research on College Students’ Usage of Social Networking Sites

III. Facebook, Friending, and Privacy Settings

BREAK

IV.  Overview of Twitter, Flickr, MySpace, FriendFeed, Foursquare, LinkedIn and other sites

V. Blogging, RSS feeds, and personal ads

VI.  Clinical, Legal and Ethical Issues as they relate to the Internet and social networking

VII. Discussion

LUNCH

VIII. Small Group Breakouts with Clinical Vignettes

IX. Larger discussion of Vignettes

X. Completion of Paperwork and Surveys

My new office address is:

220 Montgomery Street, Suite 400
San Francisco, CA 94104

All other contact information will remain the same.

But, I’ve always been able to harness my productivity when I’ve organized work periods with friends. This was how I managed to get unstuck and get rolling on my own dissertation after many months of avoidance. I utilized it again when I was studying for my licensing exams. It is also how I most happily get satisfying chunks of work done now. It’s also a great way to get to see some of my other busy (and productive) friends who I might not otherwise see if we waited until our respective projects were complete. Co-working can give you an opportunity to be accountable to another person which can sometimes be more compelling than keeping commitments to yourself. You also have the built-in reward of socializing.

Some people like co-working so much that they will happily do it with strangers. This may be a good solution for you, if you’re looking to break out of solo-work isolation. If so, you may want to check out this great co-working wiki designed to help folks find others with whom they can work. If you’re in San Francisco, like me, you may find the direct link to the SF resources helpful.

But the way I most prefer to utilize co-working is to do it one-on-one with a friend or a couple of people. If you haven’t done this before, try sending an email out to your pals to see if anyone is up for a work date. Or if you know someone doing any of the following things: taking classes, studying for a big test, working on a book, wrestling with a large project, consider emailing them directly to ask if they want to try a work date. Agree on a set time period. I suggest two hours to start. If you’re both having trouble focusing on your work, set up before you meet just how much time you will spend catching up. It may work to spend the first 20 minutes catching up and then settling in to spend 40 minutes working. Then plan to take a 15-20 minute break to talk a bit more, followed by another 40 minute work period. See how this goes for you, and then fine-tune as necessary.

Be prepared for the reality that not every co-working couple is a match made in heaven. Some people have a much harder time buckling down and getting focused on work, or you may just have different styles and needs when it comes to taking breaks or chatting as you work. Like all relationships, you may need to communicate a bit more about this in order to find a good working arrangement. Sometimes, you may need to accept that a good friend is better as a movie and dinner date than a co-working date. On the other hand, if you’re easily distracted, you may get lucky and find someone who is a good influence on you. Also, one of the dangers of working in public spaces is that other things like unexpected noises may distract you. Consider trying earplugs or using earbuds to play low-level ambient sound as you work.

If you find a good co-working pal, consider making a regular thing out of it. Or you may want to find several good co-working partners and rotate days and times with them so you get to see all of them more often.

Good luck and welcome to the co-working revolution!

Time: Wednesdays, 4:00 – 5:30pm (October 7, 14, 21, & 28)
Location: San Francisco (2148 Market St. between Church & Sanchez)
Cost: $30 per session per person, $120 for month of October
Contact: Please contact Dr. Keely Kolmes at 415-501-9098 or
drkkolmes at gmail dot com if interested.

The dissertation process can be challenging. Students struggle with
isolation, procrastination, time-management issues, feeling stuck, and
moments of low self-esteem. Some lack adequate support from advisors,
school, friends, or family.  I offer a weekly support group for
graduate students who are in the dissertation phase of their academic
career. Learn to structure your time while getting support from
others.

This group utilizes co-working and an email list to help extend
support beyond our weekly meetings.  Group is open to graduate
students of all sexes, genders, and sexual orientations and is open to
up to 8 participants at a time.

All members have a free initial interview. I will also maintain a
waiting list in the event that the group is temporarily full.

Psychology and the Internet: From Freud to Facebook

With the popularity of online social networks and services, what’s the psychology behind how people use them? How is the Internet changing people’s lives for better (or worse)? What does the research show about how people use Facebook and Twitter? Can you get effective mental health treatment online?
Our panel will address the following questions:

1. What is research telling us about technology and mental health?
2. How are Facebook and Twitter changing our relationships with others?
3. How is technology being used to help people with mental health concerns?
4. Is e-therapy a viable alternative to face-to-face treatment?
5. Are people’s online identities merging with their real life ones, and if so, what are the ramifications of this?
6. Is technology creating new types of psychological or personality challenges?
7. How do online support groups work and are they effective?
8. What computer software programs are most helpful for which issues?
9. Is Internet addiction something to be concerned about and if so, what do you do about it?
10. What clinical and ethical issues arise when combining mental health with technology?

Days:

September 2, 9, 16, 23, and 30

Time:

Wednesdays, 4:00 – 5:30pm

Location:

San Francisco (2148 Market St. between Church and Sanchez)

Cost:

$30 per session per person, $150 for month of September

The dissertation process can be challenging. Students struggle with isolation, procrastination, time-management issues, feeling stuck, and moments of low self-esteem. Some lack adequate support from advisors, school, friends, or family.  I offer a weekly support group for graduate students who are in the dissertation phase of their academic career. Learn to structure your time while getting support from others.

This group utilizes co-working and an email list to help extend support beyond our weekly meetings.  Group is open to graduate students of all sexes, genders, and sexual orientations and is open to up to 8 participants at a time.

All members have a free initial interview. I will also maintain a waiting list in the event that the group is temporarily full.

Please call or email me for more information.

You can vote for our panel (and others you’re excited about seeing at SXSW 2010, including music and film panels) by heading over to the PanelPicker.

Dr. Grohol and I met at SXSW 2009 where we attended one another’s Core Conversations, both of which focused on mental health and technology. Mine was Therapy 2.0: Mental Health for Geeks, which also included a resource wiki for attendees and those who couldn’t make it to the presentation. His was Social Networking in Health: e-patients, Data, and Privacy. Both Core Conversations generated significant interest which delighted me, as I don’t typically see many health related panels at SXSW.  I was also happy to connect with another psychologist who is passionate about the relationship between psychology and social media. As you can imagine, I’m thrilled that we will be collaborating for next year’s conference, should our panel be selected.

Last year’s Core Conversation was designed as an interactive discussion with all those in the room. But this year, I’m interested in doing a more formal presentation compiling research on technology, social media, and mental health and presenting it to SXSW attendees. Here is our submission:

Psychology and the Internet: From Freud to Facebook

With the popularity of online social networks and services, what’s the psychology behind how people use them? How is the Internet changing people’s lives for better (or worse)? What does the research show about how people use Facebook and Twitter? Can you get effective mental health treatment online?

2. How are Facebook and Twitter changing our relationships with others?

4. Is e-therapy a viable alternative to face-to-face treatment?

5. Are people’s online identities merging with their real life ones, and if so, what are the ramifications of this?

6. Is technology creating new types of psychological or personality challenges?

7. How do online support groups work and are they effective?

9. Is Internet addiction something to be concerned about and if so, what do you do about it?

10. What clinical and ethical issues arise when combining mental health with technology?

We are hoping to be able to include a couple of other panelists who are involved in psychology and social media.

The PanelPicker will remain open through the end of the day on Friday, September 4th, so don’t forget to vote for the presentations that you want to see. And I hope to see you again in Austin next year.