Therapists and counselors have been expressing concern for some time now that Facebook can “out” their clients to other clients, even when the therapist or counselor has not done anything to facilitate the connection. It can happen even when the therapist or counselor doesn’t use Facebook. Thanks to some good reporting by Gizmodo Media, we now have a better understanding of how that happens. We also now know just how little you can do to stop it.
The whole article “How Facebook figures out everyone you’ve ever met” is really worth your time. Here, I’ll just share some of the pieces most relevant to counselors, therapists, and other mental health professionals. For us, if even just a few of your clients use Facebook, the likelihood of keeping all your therapeutic relationships truly confidential is near zero.
We have all heard it before. The classic argument. “If you can go home and have a glass of wine or a beer after work, why can’t I smoke a joint? Why can’t I have an edible?” We tend to roll our eyes when we hear this from clients who may be minimizing their marijuana use or its effects. But what do you do when you hear that argument from your colleague, or from a supervisee? 
I was working in a residential treatment center for teens. It was a typical mid-week day, and I was supervising “school time,” a period where clients are able to work on their treatment assignments and homework from their schools back home. Often during this hour, the primary therapists would pull the clients for individual sessions. I happened to know that today was the day that Nicole* was going to be given her diagnosis of depression, and I was prepared to help her process her emotions should she need coaching after her return from session. Sure enough, Nicole returned from her therapist’s office with a solemn look on her face. When she sat down away from her peers, I walked over to her and asked, “How did it go?” 
App-based therapy platforms may well represent the next evolution of psychotherapy practice. 
Therapists and counselors in private practice find all kinds of creative ways to keep clients coming back. Some therapists offer clients package pricing, which they might also call a prepayment discount. For example, a therapist who charges $100 per session might offer five sessions for $450 if the client agrees to pay up front. Under either name, the therapist agrees to a price cut in exchange for a commitment to a certain number of sessions.