Google and Facebook raise new issues for therapists and their clients

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By Dana Scarton
Special to The Washington Post
Tuesday, March 30, 2010

As his patient lay unconscious in an emergency room from an overdose of sedatives, psychiatrist Damir Huremovic was faced with a moral dilemma: A friend of the patient had forwarded to Huremovic a suicidal e-mail from the patient that included a link to a Web site and blog he wrote. Should Huremovic go online and check it out, even without his patient's consent?

Huremovic decided yes; after all, the Web site was in the public domain and it might contain some potentially important information for treatment. When Huremovic clicked on the blog, he found quotations such as this: "Death makes angels of us all and gives us wings." A final blog post read: "I wish I didn't wake up." Yet as Huremovic continued scanning the patient's personal photographs and writings, he began to feel uncomfortable, that perhaps he'd crossed some line he shouldn't have.

Across the country, therapists are facing similar situations and conflicted feelings. When Huremovic, director of psychosomatic medicine services at Nassau University Medical Center in New York, recounted his vignette last year at an American Psychiatric Association meeting and asked whether others would have read the suicidal man's blog, his audience responded with resounding calls -- of both "yes!" and "no!" One thing was clear: How and when a therapist should use the Internet -- and even whether he or she should -- are questions subject to vigorous debate.

"We are just beginning to understand what ethical issues the Internet is raising," says Stephen Behnke, ethics director for the American Psychological Association. "To write rules that allow our field to grow and develop and yet prevent [patient] harm at the same time: That's the challenge."

In fact, the tremendous availability online of personal information threatens to alter what has been an almost sacred relationship between therapist and patient. Traditionally, therapists obtained information about a patient through face-to-face dialogue. If outside information was needed, the therapist would obtain the patient's consent to speak with family members or a previous mental-health practitioner. At the same time, patients traditionally knew little about their therapists outside the consulting room. Now, with the click of a mouse, tech-savvy therapists and patients are challenging the old rules and raising serious questions about how much each should know about the other and where lines should be drawn.

Among the questions under debate:

Should a therapist review the Web site of a patient or conduct an online search without that patient's consent?

Is it appropriate for a therapist to put personal details about himself on a blog or Web site or to join Facebook or other social networks?

What are the risks of having patients and therapists interact online?

Neither the American Psychiatric Association nor the American Psychological Association has rules specifically governing therapists' online behavior, but ethics advisers with the psychiatric association maintain that online searches are not wrong -- as long as they're done in the patient's interest and not out of therapist curiosity.

Many therapists contend it's more important to discuss such questions than it is to dictate behavior. "It's not whether a particular application is right or not," says Sheldon Benjamin, director of neuropsychiatry at the University of Massachusetts Medical School in Worcester. "It's whether you do it mindfully -- whether you understand how it changes the doctor-patient relationship."

To Google or not

Benjamin, 53, swears by his iPhone and enthusiastically tells of sampling the Internet in its infancy. At the same time, Benjamin, who directs psychiatric training at UMass, advocates caution when it comes to mixing the Internet with therapy.


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