1. Part of this question is driven by the moral panic surrounding new technologies and the rapidity of change. Throughout history, new technology has caused a negative reaction from those used to doing things ‘the way things have always been done.’ Our schema, or core beliefs, about how we interact with the world are very powerful. Changes can cause cognitive dissonance and identity threat. When threatened, evolutionarily speaking, people go into fight (antagonism toward new media) or flight (denial.) This goes back to Socrates and writing, Gutenberg and the printing press, the dangers of novels, radio, TV, and now social media. As Yogi Berra said, “It’s déjà vu al over again.”
2. It’s pretty clear that bad publicity is bad publicity when it comes to professional services. Especially in a healthcare profession, bound by professional ethics and a moral mandate to ‘do no harm,’ bad publicity is bad. Bad publicity works for celebrities because it increases their notoriety and, perhaps more importantly, part of the appeal is to see icons as fallen heroes (think mythology), but for caretakers who build relationships based on trust, it obviously undermines not just the primary therapeutic dyad but the profession at large. That’s why there is so much emotional investment in debates over reality shows that are essentially ‘therapy on TV.’ Some argue that it promotes public awareness of mental health issues and provides a normalizing effect, but others say the important psychological issues are subservient to the sensationalism of public humiliation and exposure. The truth is it’s probably some of both.
3. Conversely, however, is no publicity bad? Or perhaps better stated, is no media presence bad? Technology isn’t going away and it is how we, increasingly, communicate. There is an entire generation of people growing up who expect to be connected to people and information 24/7. It is how their world works, the basis of their schema. This ubiquitous connectivity changes people’s expectations about a lot of things, such as who are experts, how you can get information, response times, validation of information (i.e. the ability to triangulate information), trust, and interactivity. To ignore this phenomenon in how psychologists communicate with the public and with patients means that you, as a psychologist, are unwilling to ‘live’ in the world everyone else does, so how can you show empathy for your clients if you are close that avenue to connect?
4. There is a difference between distributing general psychological information and giving therapeutic advice. Both require a moral stance, but the second raises issues of trust, privacy, and the responsibility of the provider to make sure the interaction (of any kind, even face to face) is appropriate and supportive of the client goals.
5. It is, however, important to have a web presence because, after word of mouth or personal referrals, the web is the second most powerful source of information and validating someone’s legitimacy. The world has changed enough that if you don’t have some kind of web presence, you look like you have something to hide. There are, obviously, ethical issues here and each person has to make some judgment about their professional profile, but you have to deal with this in any public venue. I believe a web presence, from LinkedIn to a personal website or blog, should be professional, informational, and not overtly commercial, and should offer the things that someone would want to know: focus of practice, theoretical orientation, background, location, hours, how to find out about fees, insurance reimbursement, a photograph of the therapist, perhaps some articles of general interest or links to scholarly publications and contact information. Some people also like to include ways to buy their books or clips from media appearances — that is individual judgment of the services they offer and the market they want to serve.
6. Most importantly, there are many ways to use new technologies that make psychological more leveragable. For example, research suggests that homeless teens use the Internet in libraries and social services to get health information as well as contact family and friends. It can also be used for less than desirable arrangements, but the larger part of the use is positive. Mobile devices have been used to support behavioral change, such as dieting and health maintenance (like diabetes). Because so many young people communicate by texting, it has been an effective way to provide emotional support (touch points perhaps) to check in with teens in treatment to provide a safety net.
Skype with video chat can be used to do therapy when geography makes it untenable in person. Is it as good as the real thing? Yes, it can be, but it can also take a bit longer to establish the therapeutic bond. Starting with face to face and then using Skype, however, overcomes that problem.
There are ways that technology can facilitate the ease of access to psychological care: ability to make email inquiries, make appointments on line, see examples of types of therapy, as well as emphasizing the value of seeking professional help for psychological problems, such as depression or addiction.
Online support groups have been extraordinarily effective means of creating social support with people who are working through similar issues. There are, of course, groups that gather to promote their pathologies, such as the ‘pro-ana’ (pro-anorexia) groups or even more dangerous things like child pornography. But these things will exist with or without the Internet and the benefits of the support to so many far outweigh the downside. It’s easy to forget, given the spotlight of media coverage, that pathological behaviors are not the majority. If they were, we wouldn’t call them pathologies.
7. The important thing about using media is to be very clear with your audience or client and yourself about the limitations and benefits of technology. A reporter asked me to give him a diagnosis of an American actor who was having a public meltdown. I told the reporter that it was unethical to give a diagnosis for someone I hadn’t met, but that if I had, in fact, worked with the actor in a therapeutic situation sufficient to give a diagnosis, it would be unethical for me to comment on that too. One solution that some psychologists feel is appropriate to say “I haven’t met this person, but the following behaviors are often indicative of this disorder…” That’s an individual choice but it’s important to be mindful of the slippery slope and the potential for distortion in the media. You don’t get the final edit.
With clients, it is important to explain things that might not be understood: for example, email is presumed private and usually is, but can’t be guaranteed to be totally secure, particularly on shared computers, as you do in your disclaimer.
8. One thing marketers know is that familiarity breeds ‘liking.’ Therefore media of all kinds provides an opportunity to spread information and knowledge and helps to re-norm social perceptions of mental health so people feel more comfortable and less stigmatized by seeking help and ways to get help. That’s another reason why it’s important for good, conscientious practitioners to join the conversation.
This is a new world of communications and many are reticent, but I believe that psychologists must engage early and feel our way conservatively but persistently so that we establish best practices and spread accurate information. There are an increasing number of sites that strive to do this, for example, John Grohol’s PsychCentral, WebMD, the Media Psychology Blog, and of course, at the top of the list, Psychology Today contributors and bloggers, as well as sites dedicated to specific issues and disorders, from media use to depression.
The danger is that we allow trepidations about ethics and media technologies to bog us down to a snail’s crawl, thus allowing the path to be defined by those less ethically concerned with patient well-being than other more personal or lucrative agendas. Media is a tool. Like a hammer, it can be used well and badly. How well we use it is in part determined by how well we understand its affordances and limitations so we can decide how to use it to support our goal of bettering society, relieving distress and improving people’s sense of well-being.
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