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|Clinician's Digest - Page 3|
Googling Your Clients
Everyone is googling everyone these days, so it seems safe to assume that many therapists have googled their clients. But is it ethical? And even if it is, what are the therapeutic ramifications?
Suppose, for example, you google a client who's come in for something relatively innocuous, like loneliness or a relationship problem, and you find out he's on a sex offender registry list. Should you tell him what you did and what you know? Should you use this information, and if so, how? Can you do therapy effectively without revealing it?
Writing in Psychiatric News in May 2009, Linda Hughes, director of the American Psychiatric Association's Office of Ethics, advised that googling should be done "only in the interests of promoting the patient's care and well-being and never to satisfy the curiosity or other needs of the psychiatrist." Hughes points out that the "standard of practice" for obtaining information is face-to-face interviewing, with collateral information obtained from medical records and family members. "Standard of practice" is a specific legal term, and therapists who violate it are vulnerable to sanctions and lawsuits. Significantly, Hughes doesn't say psychiatrists shouldn't google clients; instead, she says, they should consider how the information will influence treatment and how the clinician will use the information.
Psychologist Ofer Zur, whose 2007 book, Boundaries in Psychotherapy, examines ethics issues in the context of today's technology and changing perspectives about therapy, points out that Gen-X and younger clients are less likely to consider it an invasion of privacy if their therapist googles them. From their standpoint, it's an accepted way of getting to know someone, and some might even be mildly surprised if their therapist doesn't think to google them, or at least check their Facebook profile. Many even may be more comfortable having information about themselves revealed in that way.
Nevertheless, says Zur, it's a good idea to obtain informed consent before you google. Doing that not only helps protect against sanctions, but it can prevent sticky situations in which the therapist finds out something so important that keeping it a secret can create unwelcome complications and twists in treatment.
The Worst Media Therapist Yet!
The depiction of therapy has made great leaps on television. Early sitcoms featuring Bob Newhart's Robert Hartley and Kelsey Grammer's Frasier were more about comedy than therapy, and gave little insight into what happened in sessions. Then came The Sopranos. Whatever Dr. Jennifer Melfi's flaws, she was a thoughtful clinician, and the therapy-wise scripts have inspired some provocative discussions of her methods. Psychiatrist Glen Gabbard wrote a book on the psychology of The Sopranos, and family therapist William Doherty has run ethics workshops using Melfi's sessions.
With the series In Treatment, HBO went even deeper into an examination of therapy. Gabriel Byrne's Dr. Paul Weston and Dianne Wiest's Gina are intelligent, committed, compassionate, and highly skilled, and the interplay of their personal and professional lives brings the complexity of therapy and therapists into sharp focus.
Now a comedy series, available only on webcasts and in its second season, gives us one of the worst therapists imaginable. Lisa Kudrow, known for her role in the network hit Friends and winner of a Webby Award for her portrayal of therapist Fiona Wallice, is a narcissist who's clearly in the wrong profession. The premise: Wallice conducts three-minute therapy sessions each week via webcam. Longer sessions are useless, she explains, because only three minutes of every therapy session contains anything important—the rest is about things like dreams, feelings and memories "which add up to a whole lot of nothing."
She begins each session by telling the viewer, "I'm Fiona Wallice, and this is Web Therapy," her smile coming just a beat too late to look sincere. The dialogue, mostly ad lib, serves as a primer for what therapists should avoid saying and doing. "You look bored," one client says, clearly identifying Wallice's lack of interest in him. "I'm not bored," she says. "I have enough of an inner life to keep me interested even in what you're saying." When a dissatisfied client announces that she's going to see another therapist, Wallice replies, "It's unethical for you to go see another therapist without discussing it with me," telling the client that's like "stealing intellectual property." When a client, sensing things aren't going so well, asks, "Your analytic training was where?" Wallice replies that for therapy to work, the client will have to give up his need for control.
In today's impatient world, when the wisdom of therapy sometimes seems in danger of being reduced to one-liners and quick solutions, Web Therapy is a comedic nightmare vision of short-term therapy taken to an extreme.