It’s been almost two years since the first post in my Psych Central series on the paradigm shift occurring for therapists in how we present ourselves on the web.  In October 2009, in Psychotherapists Unmasked on the Internet, I used an exchange between my psychiatrist father (of 45 years) and myself, a new Marriage and Family Therapist, to demonstrate the clash of eras and belief systems occurring.  He had given me a hard time about putting my picture up on my website several years back but in the end asked me to help him figure out how to get a website up for himself (sheepish grin).

About 6 months later, in Therapists, Social Networking and Blogging, Oh My! I observed that the “wave of the therapist new world order” was crashing down as demonstrated by a surge in website creation, article writing on topics related to therapy, emotional, mental and relationship health — as well as therapist involvement in social networking.  I offered some pros and cons for the above mentioned.

In Therapists Busting Out Online, Where Are We Now?, written 7 months later, I looked at the fact that  many therapists were fully embracing the change and putting out excellent and educational content for the public in a very ethical way.  But technology itself seemed to be a stumbling block for many clinicians wanting to get online but unsure of where to start.

Melanie Gorman, Senior VP of YourTango Experts, offered, “My experience as the architect behind ProConnect (the web/marketing service for experts on YourTango.com) is that there are still lots of folks who are slow to adopt technology. Further, there appears to be a divide between those who embrace technology and those who don’t…We owe it to ourselves to understand what that really means and learn how to use all the tools available to create a thriving business so we can get back to doing the thing we really love, which is helping clients.”

Others pondered the “how to” of putting it all together.

Tom commented, “I look forward to more discussion and insight into how professionals ‘compose’ our online personae, and how that interacts with our theoretical and therapeutic frameworks.”

Now here we are, 8 months later.  So many therapists, psychologists and psychiatrists are online that it is almost becoming a public expectation.  Unless you have a fully established, heavily word of mouth practice (as some long-time therapists do) you might find your business begin to suffer if you don’t take the leap.

The opportunity is also there to create a secondary income stream on top of a solid online platform.  For example, my Therapy-At-Home Workbooks® sell not only in the U.S. but all over the world.  I find it exciting that the paradigm shift also allows us the opportunity to educate others about the topics in which we have unique training while expanding our own businesses via whatever delivery method resonates with us (e-books, webinars…).

Others in our field have also emerged as leaders, having embraced the online world with knowledge, integrity, passion and business savvy – while maintaining flourishing private practices.  As I and others have experienced, the media tends to pursue interviews and comments from experts with a high level of visibility online, which only serves to further boost the therapist’s credibility.

Here are just a few of these standouts:

• EstesTherapy.com – by Jennine Estes, MFT
• StrengthenYourRelationship.com – by Richard Nicastro, PhD

As therapists have made the shift online a new business has also emerged, one to train therapists how to effectively implement all of this – including website creation, article writing, the ins and outs of social networking, marketing and creating secondary income streams.

Here are a few examples of folks in our field who do just that:

• The Therapist Leadership Institute – Casey Truffo, MFT
• Private Practice from the Inside Out – Tamara Suttle, LPC

As much as I believe this evolution has been positive, there are things we all should continue to be monitor with the “new norm” including issues related to:

• boundary diffusion (particularly in the area of social networking and clients)
• presenting ourselves in a way that doesn’t play on psychological frailties (over-use of heavy marketing techniques used in other fields)
• time spent engaging in online activities overshadowing time spent continuing to educate ourselves to be the best we can be with the clients we work with
• keeping our own egos in check

For those of us who have practices and an online presence, we must remain cautious that our primary focus (therapy) isn’t compromised in some way by any of the above.  If at any point you find this to be the case, you may want to re-assess.  It can get sticky and remaining mindful of this fact is imperative.

I had a number of comments on this piece from therapists trying to find their way in this foreign territory.  Marsha Lucas, PhD, said, “It’s a very different experience, walking into the waiting room to meet a new patient, and (a) they already know what I look like, but not the other way around; (b) they already know my educational history and approach to therapy; and (c) they’ve made a choice to see me, rather than (as in the old days) simply being referred by someone else.  It’s a different way to start the therapeutic relationship for sure.”

Esther Boykin, MFT, commented, “I am finding that the comfort zone of visibility varies not only by era but by field of study and prior work experience. As someone who has always worked (since graduation) in a private practice setting I see the value of visibility very differently than colleagues who have their professional roots in hospitals and/or agencies.”

In my follow-up piece about 5 months later, Therapists, Social Networking and Blogging, Oh My! The therapist “new world order” was settling in as clinicians were gaining confidence in not only having websites advertising their practices but in writing articles on their blogs and social networking on sites such as Twitter, Facebook and LinkedIn. 

The debate about the ethics of social networking was starting to fade, leaving us with very personal choices about how we as therapists choose to navigate the social networking world as ethically and intelligently as possible given what we do — and how much information we feel comfortable adding to our digital footprint.    In the article, the “upsides” and “downsides” to having an “online life” as a therapist were also examined.

Dawn Pugh, MBACP shared, “I too have enjoyed my time blogging and informing others of cutting edge changes within our mental health arenas.”

I created my first website to market my practice almost 6 years ago and was one of a small handful of therapists in my area who were doing so.  I quickly learned that people actually do search for therapists online!  That site eventually became The Toolbox at LisaKiftTherapy.com, one of the original therapist-created resource websites out there (thank you very much to John Grohol / PsychCentral.com for your inspiration).  It’s now a comprehensive resource with topics related to emotional and relationship health with articles by not only me but other therapy professionals – as well as a platform in which to offer my Therapy-At-Home Workbooks® for individuals and couples.

Back then I was ahead of the curve.  The wave had not crashed down yet.  But now has it ever and I am amazed and impressed at what some have done to showcase their work in a useful, professional and authentic way such as Rewire Your Brain for Love by Dr. Marsha Lucas, PhD.  The more trained therapy professionals come out into the light to share their knowledge, the more the public can benefit.

The only dark cloud I see with all of this is therapists trying to do too much, getting too connected and too stretched out with their time.  This is something I have to work on constantly – to maintain balance between my business and personal life; from my therapy practice and my online writing endeavors.  I’ve heard from other online-savvy therapists that this is a struggle for them too. 

At the end of the day, as much as I enjoy my life online and writing, my real passion lies in the face-to-face work of individual or couples therapy.  I love the resonance, connectivity and potential for change in being in the room with my clients.  This is the meat and potatoes of why I got into this field.  For me, networking and blogging simply will never top that experience – but they do enhance the totality of my work.

What I’m curious to know is not the problems with social networking — there are loads of comments on Dr. Grohol’s article listed above if you’d like to sound off there — but why you are networking in this way in the first place?

Whether you’re active on Twitter, Facebook, Google Buzz or any other of the growing list of networking spots sprouting up all over the online landscape, what are your goals in doing so?

Here are a few reasons that come to mind around why therapists might be socially networking…

• Reconnect and stay connected to friends:  Perhaps you’re like millions of others who find social networking tools a wonderful way to stay in touch with people.  Facebook has helped me dig up my old cronies from as far back as elementary school and throughout the different phases of my life; high school, university, my days working in the movie and television business in L.A. – and I find it to be a very easy way for us all to keep tabs on each other.  The Facebook account I use for this purpose is locked and private so that clients cannot find me  (Side note:  If you have an account like this, be sure to check all of the privacy settings… As I was writing this I felt compelled to triple check my FB account and found that I missed checking a few boxes).
• Get connected to other therapists to share resources. This has been one of the most fun and useful aspects of Twitter for me.  Being that there are so many therapists “tweeting” that means as you develop relationships with others you can throw questions out, search for resources and learn as you read the many useful links to articles and information that are posted every day by knowledgeable therapy folks out there.
• Help develop a secondary business alongside your private practice. There has been a massive surge in the therapist community around this idea, how to create a passive income alongside your private practice.  Casey Truffo, MFT and founder of The Therapist Leadership Institute coaches therapists around the idea of “multiple streams of income” which includes developing products to sell online.  Social networking is very important to help do this.  I’m a therapist in private practice with a private practice website – and a therapist who writes workbooks for individuals and couples providing a cost effective alternative (not a replacement) to counseling — for some issues and some cases.  My journey into this started just before the recession slide a number of years ago – and my business model turned out to be a good one considering what ensued economically in this country.

  I have a separate website built for this purpose with all of my writing and articles by other professionals.  This is part of my platform to sell my workbooks – and social networking is an important aspect.  My intention had been to keep my private practice business and my online business separate but clearly there ends up being a bleed-over as people find my articles and such on the other.  In fact, this is how many of my therapy clients find me.  It’s become a bit blurry and has gotten me thinking a lot about the issues briefly touched upon at the beginning of this piece.

• Help build your private practice. Perhaps you believe that getting your name out there in the social networking world will help your phone ring a bit more as potential clients seek you out.  I think a lot of therapists are hoping for this outcome for their own private practices.  I don’t happen to use social networking in this way as my reasons really rest in the above three.  I’ve typically not targeted my local community in my social networking but over time it’s organically happened that my list of local contacts is growing.  Though very occasionally I’ll mention my practice, I don’t really consider this a personal “goal.”

Therapists who use social networking, why do you do so?  Do any of the above reasons I cited fit for you?  Are there others?  Considering social networking is likely here to stay and will continue to be alive with more and more people “tweeting” and “facebooking” –  I think it’s important for you to examine why you’re engaged in the activity and then contemplate how to manage the concerns around it as they relate to your practice – which are certainly valid and complex.

I’m still scratching my head a bit at how to navigate through it all in the best way.  I think many of us are.

The wave of the “therapist new world order” has crashed down, and many of us are now swirling around in it. The question, “Should I have a website with a picture of myself?” is passé. The question, “Is it ethical for a therapist to publicly engage in social networking?” has been hashed over (albeit, with some debate still gurgling).

I’m a therapist with a private practice — and a writer. I have enjoyed cultivating my online presence for almost five years now, writing about topics that resonate with people and more recently, connecting with other therapists via social networking. As this rapid change in the online landscape for therapists has unfolded, I’ve been curiously observing and have taken mental note of a few things perhaps helpful to others who are considering jumping into the “swirl” with the rest of us.

Here are some of my observations around the “upsides” and “downsides” to therapists having the sort of online life I’ve described above:

Upside:

• Perfect venue for writer-therapists. All you need is to attach a blog to your site and you can clickity-clack away. For more proactive types, there are plenty of places you can submit your articles — and local sites that would probably welcome your columns! I dreamed of being a writer as a little girl so for me, writing has been an enjoyable supplement to my private practice.
• Makes sense for therapists with helping products. This can be things like online seminars, books, workshops, retreats, etc.
• Social networking can be fun and educational. I have met some of the most interesting people from all over the world this way, including many therapists like me who are doing “their thing” online. It’s like a collective knowledge base of helpful links, interesting ideas and thought provoking quotes that make you go, “Hmmm…”

Downside:

• Huge amount of work. Unless you can afford to pay someone else to set you up online, make sure your articles are seen and tweeted for you (kind of defeats the purpose of creating relationships but some people have someone else do this) — be ready to put in a lot of hours.
• Watch out for the rabbit holes. Most of us know just by having internet access that there are endless potential “rabbit holes” while surfing. They can serve to distract and take you away from more important tasks — such as work or family obligations. Social networking in and of itself can be the worst of them all — with so many interesting people to check out, exchange information and chit-chat with! Take it from me, a “rabbit-hole-slipper” in recovery.
• Remember what’s really important. Recently, seeing a number of therapy clients struggling with being consumed with social networking, blogging, and being “out there,” it’s clear that there is great potential for any of us to let it consume our lives in an unhelpful manner. My first love is my face-to-face private practice and I stay mindful not to let the online activities detract any time thinking about how to help my clients, doing research, and other practice-specific activities.

Though there are many more options for therapists than there ever have been — it’s not for everyone. There are likely many traditional therapists who want nothing to do with all of this “nonsense.” Like in life, different things resonate with different people. I’ve enjoyed the synchronicity of the two parts of my therapy-related world, distinct yet connected. It works for me.

Here are some of the life lessons I’ve learned from my therapy clients:

People can be incredibly brave. It is hard for some to even get through the door of a therapist’s office let alone open up their most wounded parts to another soul.  I am touched by the strength of people to be able to present themselves in the ways that they do.

People can be incredibly insightful. It amazes me how wise and intuitive some are.  It’s a joy to observe and participate in this with people committed to figuring it all out and making the changes they want in their lives and relationships.

People can be incredibly resilient.The fact that people figure out strategies to survive in the ways that they do to overcome the most horrendous situations is humbling.  When everything “should” point to a life of chaos after a traumatic childhood but doesn’t – one explanation is they just “came out of the gate” that way and had tools from the onset that others don’t necessarily have.  This has been one of the most awe-inspiring lessons of all.

People all primarily want to feel accepted, connected and okay. At the end of the day, if you filter through all of the presenting issues, relationship cycles and the “process vs. content,” people really all yearn for a sense of emotional safety.

I wonder if people realize that some of us therapists are as moved by them as I know many of us are.  I love this profession in that I am given the opportunity to sit with people in such a profound way.  I’ve heard clients make statements about therapists “not really caring” and it’s “just a job.”  Perhaps there are those for whom those descriptions would fit but I dare to say most do care and are influenced by their experiences with their clients as I am.

I look forward to many new life lessons learned between my office walls.

In the “Clinician’s Digest” section of the November/December 2009 issue of Psychotherapy Networker, Garry Cooper discusses a study led by psychiatrist Jakob Koch of Christian-Albrechts University in Kiel, Germany suggesting that “effective psychotherapy with depressed clients is associated with changes at the brain’s cellular level,” increasing the production of a key brain protein that assists in creating neural pathways. In this study they used Interpersonal Psychotherapy (IPT) which looks through the lens of both cognitive and interpersonal issues. It would be interesting to know how other theoretical orientations would fare.

There is a lot known about the power of oxytocin (the hormone of love) to bond people together but oxytocin can also be an ally to encourage therapeutic change. According to Linda Graham, MFT and trainer on the integration of relational psychology, mindfulness and neuroscience, it is “the neurochemical basis of the sense of safety and trust that allows clients to become open to therapeutic change.” It was a class I recently took with Linda, “The Neuroscience of Attachment,” that left me feeling so inspired about the implications of this in my practice. As a therapist, it’s nice to have something solid and research-based to hang my hat on.

Daniel Siegel, MD, one of the pioneers in this field has been saying for years that there is potential for the growth of new brain cells via relationships. I remember seeing him speak at a conference about five years ago but got derailed somehow and didn’t follow up on any further research on the matter. I’m glad to have made my way back to these concepts so I can further learn how to provide the most fertile soil possible for therapeutic change within the four walls of my own psychotherapy office.

The power of the “relationship” is not to be underestimated. Important relationships can do monumental damage – or they can facilitate profound healing. Many psychotherapists have known that the therapeutic relationship is one that can provide a “safe container” for emotional and psychological healing. Many of us believe that by providing a stable, nurturing model of something “different,” there is the potential for a corrective experience that the client can integrate into his life.

Now we know there is the potential for changes within the brain as well — which is only more encouragement for the lasting, deep shifts that we hope for our clients — and they hope for themselves. Perhaps the commonly held belief that “people can’t change” will finally, truly be a thing of the past.

“Do you put your picture on your website?” he asked.

When I told him that I did, he about fell out of his chair and went on a rant about how inappropriate this is, likening it to taking an ad out in the yellow pages of a phone book. Initially I felt deeply criticized and offended by what my father had said. But upon further reflection, I “got it.”

My dad comes from a very different time in the practice of psychotherapy — when therapists didn’t advertise at all, let alone display a personal photo.

My, how the landscape has changed for therapists since then! Some of us have websites (with pictures, Dad), some of us list ourselves in directories (again, with pictures), some of us use social networking platforms and some of us are writing and blogging. A few of us have figured out ways to create a passive income to supplement our therapy practices.

What does all of this mean? It means that therapists are more visible than we’ve ever been in the history of this field of work. However, the change in landscape has not occurred without controversy around issues of personal disclosure, therapist-client boundaries and the “digital footprint” left online, which cannot easily be removed.

Being that this is the age of information (albeit “information overload” at times), people want to know a little about who might become their therapist. I’m not suggesting therapists lay out their life stories on their personal websites but strike a balance between demystifying themselves and remaining in their ethical comfort zone.

The other night when my dad was over for dinner, he sidled up to me and said, “Hey Lis, I’d like to ask you a few questions about how to do a website.” This time it was me who cocked my head slightly and looked at him suspiciously. He enthusiastically explained that he wants his own website to put all of his articles in one place.

For a moment I flashed back five years to that day we sat on the patio and he berated my online endeavors. This memory was quickly followed by a surge of validation knowing he must have decided what I’ve been doing all this time has some merit. (Isn’t it true how much we want validation from our parents?)

“But,” he clarified. “No picture of me.”

In that moment, two psychotherapy eras came together — well, sort of.