Imagine a GPS navigational system that said something like this: “In approximately 30 minutes, you will run into your old boss, who will want to make you feel like a worthless pile of feces. Erect personal boundaries immediately…. I said, Get in your bubble, Woman … Are you listening? She’s approaching you on your left. Lock up all childhood tapes now (the ones that convinced you that were weak, ugly, and pathetic) and DO NOT, I said DO NOT play them for her. Remember, their messages are no longer valid. Proceed carefully. You will speak to her in approximately 3, no 2, no 1 second.”

Me? I would like one of those.

So I made one. In book form.

With more and more therapists embracing social networking sites like Facebook and Twitter, the question arises — where do you draw the line in terms of boundaries with your patients? Where does a patient’s and therapist’s privacy end or begin on such sites? How do patients and therapists navigate this brave new world of connectedness and “friending”?

Dana Scarton over at The Washington Post has the insightful article addressing this issue by talking to a number of therapists across the country. These therapists have had to deal with their own challenges with social networking sites and “researching” people online once it was brought into psychotherapy by a client or a client’s actions.

Professional associations haven’t addressed this kind of technology in their ethical guidelines, but common sense rules the day. As I just gave a presentation to therapists on this very topic, here’s the upshot of what I had to say about this from a professional’s point of view …

Beware psychiatrists bearing gifts.

If psychology wants to remain a science based upon the understanding of human behavior — both normal and abnormal — and helping those with the “abnormal” components, it would do well to avoid going down the road of prescription privileges. But perhaps it’s already too late.

We first noted this disturbing trend in 2006, how they were shot down 9 out of 9 times trying to gain prescription privileges in 2007, and why prescription privileges for psychologists will eventually drive psychiatrists out of a job. We also noted that one of the programs setup to help psychologists get prescription training wasn’t a “college” at all.

The fundamental problem with psychologists gaining prescription privileges is the inevitable decline over time in the use of psychotherapy by those same psychologists. This is precisely what happened to psychiatry — they went from the psychotherapy providers of choice, to the medication prescribers of choice. Now it’s hard to find a psychiatrist that even offers psychotherapy.

Most clients know what it feels like when they meet with a therapist and it isn’t a good fit. Maybe you leave the initial session feeling misunderstood or knowing that the therapist’s personality or style isn’t a good match for you. Maybe the therapist reminds you of someone in your life for whom you have negative feelings. Or maybe you can’t stand her office or the location, or you recognize that the fee she charges is more than you can reasonably afford.

But what about when you think it’s a good fit and the therapist doesn’t? This can be uncomfortable — particularly if it doesn’t match your perception of the connection you made. When a therapist tells you that she or he doesn’t think it’s a good fit or she doesn’t believe she is the best person to help you, this can understandably be a little confusing. Maybe it even feels like a rejection.

There are multiple reasons why a therapist may not believe it is a good match, and unfortunately, we often don’t offer detailed explanations to clients. Sometimes there are good reasons for being less specific about it.

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