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Psychology : Applied

Should Shrinks Tweet? Public personas in the context of private work

Twitter app opened on an iphone

Quite simply, the world is not what it was ten or fifteen years ago let alone in 1895 when Freud and Breuer’s book Studies in Hysteria, the precursor to psychoanalysis proper, was published. Though born in the age of what some have called the second industrial revolution, psychoanalysis pretty much eschewed technology. In fact, Freud made a point of it, giving up the popular trend of hypnosis (a technology of sorts) as well as the hydro, magnetic, vibrational, and electric treatments that were in vogue at the time for the treatment of mental illness. Freud opted for a couch and a technology as old as human communication itself, the voice. The famous Anna O. (Bertha Pappenheim) of Studies simply referred to it as “the talking cure” or, more prosaically, chimney sweeping.

Freud began a tradition that many psychoanalysts followed, which involved sitting behind the patient, a positioning which allowed the patient to free associate without hindrance. While it is said that the real reason Freud chose this method was because he couldn’t bear be stared at eight hours a day, the technique has persisted. Part of the reason for its persistence is the nature of “projection” and “transference” two very important psychoanalytic insights that acknowledge that individuals don’t always see others as objectively who they are but rather, they are seen through the lens of previous relationships. The most comment transferences are those in which the imagos of parents are transferred onto the analyst. Classically, the father or mother is tranferred onto the analyst, and the patient responds to the analyst as if they were their mother or father.

Rather than dissuading such transferences, the analyst in fact encourages them through his or her neutrality. By bringing the transference to the surface, the analyst can better understand the unconscious process of the patient, and then help them to understand how their unconscious transferences are activated. In this context you can see how important it is for an analyst to maintain neutrality in order to avoid contaminating the transference with his or her own personality.

While many still do practice psychoanalysis in this classical fashion, most psychotherapists have moved on from it for several reasons. First of all, it is foolhardy to think that the analyst’s personality won’t contribute to the psychotherapeutic experience. In fact, most therapists today agree that it is the relationship with the therapist that is probably most central to healing. Secondly, we understand that by being neutral we are not inviting a neutral experience, rather we are encouraging a transferential response to an individual who is behaving neutrally, that can be very frustrating! Third, transferences are quite strong, and can be detected even within a frank interpersonal context, and fourth, all relationships are co-created, meaning that we contribute to what happens in relationships between subjects not just from one subject to another. Much of the theory in this area comes from the tradition of Object Relations as developed by Relational Psychoanalysis.

So What Does This All Have To Do With Twitter?

Good question, and it should be coming together now. What social networking platforms like Twitter do is they allow an individual to extend aspects of themselves into the digital world, making themselves available to others 24 hours a day. To quote Marshall McLuhan (1964) from years ago:

Today we have extended our central nervous system itself in a global embrace, abolishing both space and time as far as our planet is concerned. Rapidly, we approach the final phase of the extensions of man – the technological simulation of consciousness, when the creative process of knowing will be collectively and corporately extended to the whole of human society, much as we have already extended our senses and our nerves by the various media (pp. 3-4).

While this “extension of self” is relevant to us all, it is particularly relevant to psychotherapists for the reasons above. If we become publicly available through our Facebook profiles and Twitter feeds, how is that going to affect the patients that we see every day? How does our presence outside the consultation room affect what is going on inside the consultation room? What does it mean that our patients/clients have 24 hour access to our 140 word tweets?

In the early days of social networking these problems were easy to ignore. Therapists could simply remain outside the world of Twitter and Facebook, standing outside connect-up society in a similar way that shamans reside in the margins of the villagers they are meant to heal. However, psychotherapists are people too, and many don’t wish to remain outside the digital society that is becoming more integrated with daily life with every passing year. Additionally, expectations are changing. A new generation of therapists are coming into the field with long digital dossiers that went online long before they started to train. Many others seeking therapists may find it odd that prospective therapists have no online life. All of these cultural issues are at play before we even begin to think that social networking is also fundamentally a marketing tool. If we acknowledge the hard truth that the intimate and important service of being a psychotherapist is also a business (particularly to those working privately), then social networking for psychotherapists is not something to be ignored.

Because of the nature of psychotherapeutic work as briefly described above, therapists need to be particularly thoughtful about how they engage in their online lives. Fortunately, professional organisations, albeit rather late, are getting on board to help. The British Medical Association, for example, recommends that medical doctors not “friend” patients or former patients on Facebook. Furthermore, the potential for doctors’ online profiles like Facebook to become public raises the recurring question about whether the way any given doctor behaves in her private life can be held accountable in the professional sphere; this has similar ramifications for psychotherapists. McCartney’s (2012) conclusion is a sensible but cautious one, recognising that any given doctor cannot be fooled into thinking their online private life is entirely different from their professional life, while at the same time stating that they “must not be overly cautious and miss the richness of communication and interaction that social media can offer. Doctors, like other citizens, are entitled to express opinions online, and one effect of the undoing of the medical god-complex has been to humanise medicine and populate it with doctors who are fallible but professional” (e440). This balance between professional and private life is equally important for psychotherapists to bear in mind.

In the world of psychotherapy itself, there is more thinking being done. Doctor Keely Kolmes has given much thought to this issue asking Why Clinicians should give a Tweet; the Online Therapy Institute has created a series of ethical guidelines for psychotherapy and technology. The Tavistock and Portman Clinic has also produced some material, and The United Kingdom Council for Psychotherapy (UKCP) has created a special interest group on technology and new media (of which I am a member) and will shortly be publishing a book on this issue (in which I consulted and wrote a chapter).

So, Should Shrinks Tweet? The Most Important Thing To Do Is To Think Properly About It:

The title of my chapter in the forthcoming UKCP book on New Media and Psychotherapy is How to Think About Psychotherapy in a Digital Context. The idea here is that we cannot give up our way of psychotherapeutic thinking in deciding not only how we (psychotherapists) interact in the digital world ourselves, but also the effects of the digital world on individuals at large. In my forthcoming book The Psychodynamics of Social NetworkingI discuss how we might apply psychological thinking to the very nature of social networking and individual relationships. As psychotherapists who tweet we need to be particularly careful about how and what we tweet, and our motivations behind our tweeting.

Outside of ethical guidelines there there is no prescriptive advice, since therapists come from a variety of backgrounds and will have to make their own decisions about if and how they use social media. That being said, and this being a blog, some brief “top ten” points are probably called for, so here they are:

1. Before setting up a Twitter account, decide why you are doing so and how you intend to use it.

– e.g. Tweeting links to helpful articles, interesting psychological aphorisms, links to your blog, etc.

2. Tweet as if every client/patient you ever had will be reading all your tweets, so be conscientious.

3. Tweet as a professional. While you may share personal perspectives, do so in a professional capacity.

4. It should go without saying, but never tweet confidential material or anything to do with your clinical work.

5. Be aware that tweets are received by the public without a wider context, and there is much more room for phantasy, transference and projection than in face-to-face relating.

6. Do not be frightened of new media, but think through your decision about it with the same critical tools you do for clinical work.

7. Twitter is a form of self expression, so have fun in your own professional style.

8. Check your Twitter stream regularly and make sure you are comfortable with it.

9. Consider having a social media policy and amend it as necessary. See a sample from Keely Kolmes or myself.

10. Accept the ubiquity of social media, and engage with it in a way that suits your personally and professionally.

Getting Started:

If your answer to "Should Shrinks Tweet" is "Yes" then the best way to get started with Twitter is to set up an account and get going. If you’re a bit nervous, do so under a pseudonym and start following other therapists who tweet to get an idea of how it works. When you feel ready, set up your official account, and take the step.

I don’t claim to be a role model, but I do claim to have given my own engagement with Twitter a lot of thought. While I may not do it how you’d like me to, or how you do it yourself, you are welcome to follow me. I’ll try to lead by example, but I also welcome your feedback.


McCartney, M. (2012). How much of a social media profile can doctors have? BMJ Jan. 23, 2012. 344:e440 McLuhan, M. (1964). Understanding Media. London and New York: Routledge.



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