To Google or Not To Google Patients

To Google

By Steven R. Cohen, Ph.D.

When seeking a psycholo­gist, physician, plumber, or any other service provider, the first place many people look is the Internet. It has been years since a new patient found my name using a phone book. Most patients today inform me that, even with a direct referral, they have checked me out on the Internet. This is basic to being a good consumer. In addition to finding my website, patients often find information about me that is not psychology-related. There may be postings about charitable activities or service on nonprofit boards. I am on LinkedIn, but I am not on Facebook, MySpace, or other social networking sites. Even if we limit our presence on the Internet, clients can find out a lot about us. All of this is public information, available to anyone with Internet access.

Just as our clients may learn about us on the Internet, we may gather valuable information about our clients. My work, doing forensic evaluations and treating court-ordered clients, influences this view. When doing a forensic evaluation, I want to be as thorough as possible: The crucible of cross-exami­nation is a great teacher about thoroughness. If the Internet offers information about a client, an oppos­ing attorney is likely to have obtained it. I believe it is incumbent upon us to at least Google the client.

At times, the information obtained can signifi­cantly influence the report. Not long ago, I evaluated a mother with a history of drug and alcohol prob­lems, who assured me she had been clean and sober. Hair follicle testing yielded negative results, which supported her claim. At her second interview some time later, I asked again if she had been using sub­stances. She assured me she had remained clean and sober. However, unbeknownst to her, the previ­ous day I had Googled her name and found she had just been arrested for drunk and disorderly conduct. When I confronted her, she said she had hoped I wouldn’t find out until the evaluation was com­plete. In another case, a teen’s mother accused her “ex” of not adequately supervising their daughter. He disputed it — until the daughter posted photos on Facebook of herself and friends playing drink­ing games at her father’s house. Had I prepared the reports without Internet searches, my recommenda­tions might have been completely different. I believe that in some situations, searching for Internet infor­mation about our clients is an emerging standard of care.

I realize most psychologists are not engaged in forensic evaluations. In individual therapy, we often lack collateral information to validate clients’ reports, and too naïvely trust what they say. However, it is not unusual for clients to post contradictory informa­tion about mood, substance use, and even suicidal ideation on their social network sites or blogs. If we treat adolescents who tell us they are drug- and alcohol-free but post pictures of themselves drinking, the photos are relevant to treatment. If information is available in a public posting, I believe under many circumstances we should take a peek. I am not advo­cating “friending” a patient or finding a way into their private postings, but I believe the public behaviors of our clients are fair game.

In the July/August 2010 APA Monitor on Psychology, APA Ethics Director Steven Behnke dis­cusses ethical challenges posed by the Internet and says curiosity about a client is not a clinically appro­priate reason to do an Internet search. Yet so much of our emphasis is on data-gathering, gathering evi­dence, and looking for validation that I believe there are times when “clinical curiosity” may warrant an Internet search. Some say we need special consent. I do not believe consent is needed to look at public information, whether posted by others or by our clients. But, you must use your clinical judgment to decide when Googling will help or hinder therapy.