Boundaries, apps, and dispensaries: Seeing clients in public

Brodie Vissers / Burst / Used under licenseAs mental health clinicians, we all know the importance of setting and maintaining boundaries with clients. We have several posts on this blog about setting boundaries online, specifically in regards to social media use (1 2 3). One boundary that we have not discussed is how to manage situations when you see a client outside of the regular therapy setting.

Therapists generally agree that we do not to approach clients outside of therapy, out of respect for the client’s confidentiality. If someone else knows that you are a therapist, they may make the connection that the person you are interacting with is a client. If a client approaches the therapist first, however, engaging is often considered appropriate. Even so, many therapists agree that it is difficult to maintain professional boundaries while also engaging clients socially.

Legal and technological changes are further complicating the potentially uncomfortable situations where we might encounter clients outside of the office. More specifically, we may see clients in settings that were not previously socially acceptable or accessible. Therapists today are at risk of seeing clients on dating apps, at meet-up groups, and at marijuana dispensaries. The potential for seeing clients in social situations has always been present, but there is added risk that those interactions will reveal private details about your personal life.

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Facebook connects your clients, even if you don’t use Facebook

Woman using mobile app / Burst via Creative Commons Zero licenseIn testimony to Congress the week before last, Facebook CEO Mark Zuckerberg made a point of emphasizing that if you’re a Facebook user, you own your information. This is meant to reassure users, but it is more than a little misleading. “Your information” is what you personally have uploaded to Facebook. You do not own what other people have uploaded about you. That’s what has privacy advocates so concerned. It’s also why even therapists who don’t use Facebook should be worried about the client confidentiality risks that the company poses.

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Talkspace forces therapists to break rules. The rules may be the problem.

Matthew Henry / Burst / Licensed under Creative Commons ZeroApp-based therapy platforms may well represent the next evolution of psychotherapy practice. I praised Talkspace a few years ago for offering access to mental health care for many who otherwise would never find their way to a therapist’s office. But the platforms — Talkspace, Betterhelp, and the like — have run into controversy over their confidentiality policies. Therapists using these apps may have little to no ready access to the client’s full name, address, or other information necessary in an emergency.

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