Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Saturday, May 14, 2011

To Friend or Not to Friend: That is the Question

Florida Psychological Association
Guest Blog 


Recently on the Florida Psychological Association (FPA) listserv there was a spirited debate about whether or not it is professionally appropriate to accept a “Friend” request on Facebook by a client.  The fact that the debate was happening at all speaks to the enormous change that the Internet and a private social media company, Facebook, is having on the practice of psychology.  For the uninitiated, Facebook provides a space, much like any personal web page, where one can post pictures, text, links to other sites, and share all that personal information with a select group of “Friends.” Friends are other users of Facebook who are invited by you to see everything you’ve posted on your page, engage in conversations with you, and otherwise interact with you.  One can also create professional pages, but most users prefer personal profiles.

Facebook has over 500 million users worldwide, so the chances are good that some of your clients have Facebook pages.  In fact, as the debate on the FPA listserv suggests, many psychologists who use Facebook have encountered situations where clients have asked to become Friends of their psychologist.  Whether or not to accept such a request is a complicated decision, depending on one’s level of comfort with dual relationships, whether the dual relationship is unethical, the theoretical orientation of the psychologist, the risk management practices of the psychologist, the unique circumstances of the request, and perhaps other factors as well. 

In other words, there are legal, ethical, professional, and personal factors to consider.  Each of these general factors is separate from the others.  For example, a psychologist may be personally comfortable with having a client as a Friend, but from a psychoanalytic orientation may have concerns about what that relationship may have on the development of transference in therapy.  Or, a humanistic psychologist may feel that to draw a relationship boundary with a client over Facebook would be a sign of disrespect, a way of creating a hierarchical relationship with the client that suggests “you must be self-disclosing with me, but I will not disclose myself with you,” yet may still choose not to accept a client as a Friend because of concerns that the relationship may increase the chances of the client filing a complaint against the psychologist or terminating therapy.  Several articles have been written recently about managing such concerns on Facebook, Google, and the Internet in general.  A very good one about Facebook was written by psychologist Ofer Zur (2011), and the full text is available on his website.  I will briefly address the ethical dilemma with current clients here. 

As always, when deciding whether a professional behavior is ethical or not, we look first to the APA’s Ethical Principles of Psychologists and Code of Conduct.  The most relevant standard relates to Multiple Relationships (3.05).  This standard reads in part:

“A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
 Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.”

This standard informs us that to “friend” a client is not inherently unethical, because a Facebook relationship is not intrinsically harmful and may not impair the psychologist’s effectiveness in the professional relationship.  It is up to the psychologist to predict whether harm may come to the client or to the professional relationship.  Some conceivable harms could include: the client learns personal information about the psychologist which causes the client to dislike the psychologist; the client develops an unhealthy fantasy about the psychologist as a result of this window into the psychologist’s life; the psychologist comes to view the relationship as more casual than professional, resulting in impaired objectivity or failure to maintain professional standards of behavior; or, finally, the online relationship results in an accidental breach of confidentiality that offends or harms the client in some way. 

The risk of harm by “friending” must also be weighed against the harm, albeit unlikely, that could come to the client by not accepting the request.  For example, the client may be inappropriately offended by the refusal, resulting in damage to the professional relationship.  This harm could likely be avoided through a frank discussion with the client about why the client wants to be Friends, and why the psychologist does or does not wish to accept.  If the psychologist does accept the request, there is still an obligation to be vigilant so that if harm occurs it can be minimized as quickly as possible.
 
If the FPA listserv may be considered a crude survey of the prevailing attitudes of psychologists, most maintain a policy to not accept Friend requests, and maintain strict controls over privacy on Facebook to prevent possible clients from viewing their personal profiles.  To “friend” a client is not automatically unethical, but clearly there are many risks with few apparent benefits, so the answer to the question posed in the title according to emerging consensus appears to be, “Not.”

Reference

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