Communication With the General Public
If you were to meet me at a party, you might be forgiven for thinking that I am being purposefully rather vague about what I do for a living. When people ask me, I tend to answer with something like: “. . . I am a psychotherapist.” After the usual reply of, “Can you read my mind?” and some uncomfortable laughter, I might add, “I offer talking therapy to people who struggle with certain aspects of their lives,” and, if pushed, “I am a doctor specialized in emotional rather than physical problems.” However, while giving these brief replies, I’m aware that I’m underselling our profession, the extensive training and expertise, and the many hats that we wear daily (e.g., individual therapist, researcher, teacher, advocate, supervisor, or consultant). This makes me wonder: If I (with over 15 years of training and experience in clinical psychology) am struggling to explain in a few words what a psychotherapist does, how can I expect the general public to understand what psychotherapy is and how it could be of value?
The public’s image of psychotherapists remains incomplete and confused. Factors contributing to this impression include the frequently inferior quality of information about psychotherapy to which the public is exposed, the inherently complex nature of psychotherapy, psychotherapy’s still-emerging database and recent theoretical paradigm shifts, and the considerable overlap between psychology and other disciplines, such as psychiatry, sociology, social work, education, and physiology. Moreover, another source of public confusion is that psychotherapy does not present a consolidated front. Psychotherapists work in many different subspecialties, and in a variety of contexts, be it private practice, hospital, care home, prison, mental health clinic, academia, or even on a reality television show. To make matters worse, psychotherapists don’t usually actively engage in educating the public about who they are and what they do (Koocher & Keith-Spiegel, 1998; Llewelyn & Aafjes-van Doorn, 2017).
The idea that psychotherapists should convey the practical importance of their work to the public is by no means revolutionary. Lay people have expressed an interest in psychological information for many years. The term “psychobabble,” for example, was coined in 1975 by R. D. Rosen, and self-help books and popular psychology remain among the best-selling literature genres (McCartney, 2012). As early as 1969, American Psychological Association (APA) President George Miller encouraged psychologists to “give psychology away to the public” (Miller, 1969). This was echoed by Philip Zimbardo, in his own 2003 APA presidential address, encouraging psychologists to become proficient in interfacing with the public through the media (Zimbardo, 2004), as well as by their successor Ronald Levant’s call to turn psychology into “a household word” (Levant, 2007). This importance of communication with the public has been supported by large annual investments by the APA as part of its ongoing public education program (APA, 2017).
Engaging With the Public: Online Media
Many psychotherapists are involved in traditional forms of community engagement, such as advocacy, giving public lectures, facilitating trainings, taking part in science fairs or festivals, or other in-person opportunities. However, given the new technological developments in society, online community engagement, including news and social media (e.g., blogging, tweeting, active participation in social networks, online mentoring) has become increasingly important to consider (Besley, Dudo, & Storksdieck, 2015).
Historically, this potential to be “connected online” with experts in the field, colleagues, friends, family, peers, and clients is unparalleled, as illustrated by the popularity of online news and social media. For example, four in 10 Americans (50% of under 29-year-olds) often get their news online either from news websites/apps, on social media, or both (Mitchell, Gottfried, Barthel, & Shearer, 2016). Ten years ago, only 7% of the U.S. population used one or more social networking sites. Now that figure has increased almost tenfold, to 65% (GlobalWebIndex, 2017). Popular online platforms include Facebook, with over 1.871 billion active users; Twitter, with over 317 million monthly active users; and LinkedIn, with 106 million who “check-in” daily. As psychotherapists, we are also affected by these new online developments, as they bring opportunities and challenges to our field (Cotterill & Symes, 2014)
Why we should. Although we often take the media to task for its role in confusing the public about what psychotherapy is, the online media might play a major role in the future of our profession. Engagement on online media platforms may be important for several clinical, societal, and professional reasons. First, online media allows psychotherapists to connect with and support people who are isolated due to geographical, practical, or other considerations. Facebook, for example, encourages the development of interactions among connected members, and may therefore be particularly useful for those who live far away from mental health services or cannot leave their homes, such as those with chronic health conditions. For example, individuals with Cystic Fibrosis whose symptoms impact their ability to meet others may face mental health challenges, and reportedly find online support beneficial (Platten, Newman, & Quayle, 2013).
Moreover, the use of social media enables psychotherapists to reach potential clients from groups that may tend to engage less in traditional forms of psychotherapy, including younger individuals, men, and those who do not see themselves as “psychologically minded.” Social media may help us to chip away at the stigma of mental health and its treatments, and alert people to the potential benefits of seeking psychological help. One of our colleagues in the U.S. aimed to demystify psychotherapy on her blog with the catchy name: “analysisissexy,” and by posting on popular websites such as “psychedinsanfrancisco.” Another example of a popular psychology researcher who has been making maximum use of the internet is Brene Brown. She has been researching concepts like vulnerability, shame, courage, and authenticity, and has been able to communicate her findings in a genuine and accessible way via several Ted Talks, available on YouTube (https://www.ted.com/talks/brene_brown_on_vulnerability). Her TEDxHouston Talk on vulnerability, for example, has been viewed over 6 million times. Interestingly, the morning after Brene gave that particular talk, she apparently locked herself in her house for three days with a “vulnerability hangover,” which she then described in a later talk on shame.
Furthermore, given our position in society as highly educated scientists and medical health clinicians with clinical, research, and communication skills, we are qualified to take a stance on societal matters, and should consider doing so whenever possible. This could involve talking to the media after mass shootings, natural disasters, or other highly traumatic events, and developing online support groups, for example, concerning domestic violence or national immigration issues (Kaliebe, Chokrovery, Cuffe, Berkowitz, & Scott, 2016). In other words, we have a social responsibility in our role as advocates for the mentally distressed in society (Cohen, Lee, & Mcllwraith, 2012). Although they are by no means perfect, what better platforms for advocacy than the online news and social media forums that reach such large groups of people?
Besides these clinical and societal reasons, communicating on online media platforms might also be important for professional reasons. First, by sharing the latest insights and developments in the field, new information is more likely to be considered, implemented, and immediately applied—there and then. Second, involving the public in discussions about new findings/methods and ideas is particularly crucial for addressing health disparities and may guide future professional practices, reduce mental health stigma, and help bridge the practice-research gap (Goldfried, 2012). Moreover, platforms like Twitter, LinkedIn, and Mendeley are available to professionals to connect with each other, encouraging information sharing and partnerships. Twitter, for example, provides a public “micro-blog” format that can offer an efficient means of gaining an overview of news and current research. This can be a useful tool for broadcasting up-to-date information to an open audience, which is useful for topics such as research news, events, jobs, funding opportunities, and policy developments. Furthermore, these online media could facilitate a sense of professional identity for psychotherapists through online communication with peers based in multidisciplinary teams, distant research departments, or geographically remote areas. The “#PhDchat” hashtag2 used on Twitter, for example, offers a community for PhD students from all disciplines and locations to share thoughts, ideas, and other information. #PhDchat has a group moderator who collates conversations and resources shared by the PhD community onto a wiki (a webpage that allows users and site administrators to delete, add, or modify content).
Why we don’t. Given all these potential benefits of engaging in the online media, why are psychotherapists so reluctant? There might be several reasons why we decide not to actively engage with the online public, either by deliberate choice or for more implicit reasons.
A common concern about online news media is the lack of accuracy and completeness. When predetermined editorial angles must “stack up” and journalists must maintain advertising revenue, actual research findings, if presented at all, are often selected based on controversy rather than scientific quality. Our critical and complex reflections are often sidelined for something which fits the brief format, regardless of being stereotypical, ahistorical, atheoretical or harmful (Boynton, 2012). The average sound bite in a radio news report is fewer than 10 words in length (basically: Say a couple of sentences, avoiding technical language, and be quiet), and an online tweet only allows for 140 characters (although Twitter is testing doubling that character allotment). But psychological research and subjective experiences of people are complex, and there are limitations as to how psychotherapy data should be interpreted and applied. Also, the ability for online news content to be generated by online users, rather than experts in the field, can pose several problems around information control, accuracy, and validity of posts. It is exceptionally easy to share information or publish claims that may not be verified. Wikis, for example, often allow anyone to contribute to the information stored without any quality control (an exception is ClinPsy.org.uk online wiki and forum, where content is overseen and moderated by a team of qualified clinical psychologists).
Another common concern with online media platforms is the potential for information to leak to unintended recipients (Coiffait, Bartlett, Houghton, & Condie, 2013). The ease of information sharing in social media can make it difficult to manage potentially revealing personal information and misinformation posted by others (Solove, 2007). This becomes a problem when these platforms are used for both professional and personal purposes. Online social media sites such as Twitter and Facebook do not have an obligation to check posts for quality or content. This means that, at present, it is up to individuals to maintain their online presence, and if necessary act to manage any misinformation posted about themselves. For this reason, some express concern about the popularity of social media use among psychology graduate students and describe the online media as a “training and policy issue” (Campbell et al., 2016; Cotterill & Symes, 2014). Some even go as far as to suggest that psychotherapists in training should avoid posting information on social network platforms altogether due to the potential risk to their perceived professionalism (McKenzie & Fawns, 2011).
Besides these ethical concerns around information control, accuracy, and validity of posts, another reason for psychotherapists not to engage with online media is the sheer lack of time. Developing an online presence can be time consuming, with often little or no discernible reward. For those employed in public services, the requirements of doing clinical work soon swamp psychotherapists’ ability to carve out time for anything else. For those who are self-employed, engaging in online media may lead to reduced income (at least in the short-term), as writing online posts may restrict time available for appointments. For academic psychotherapists, contributions to online media platforms are usually not seen as valid publications (i.e., not peer-reviewed) and are not considered in tenure track evaluations.
In addition, we may be reluctant to engage with online media for reasons of which we are less consciously aware. We know, for example, that communicating expertise with a larger audience is not everyone’s cup of tea. First, as a profession, we are used to not talking about the content of our daily work. The therapeutic encounter is uniquely confidential and personal, and we tend to feel ethically bound to protect our patients from outsiders peeking in. Also, we are not comfortable being the expert. We tend to see ourselves as a valued collaborator rather than the one who “knows all.” We worry about the patient-therapist power difference, and, for example, don’t use the title doctor, because we do not want to make other people feel uncomfortable. Compared to judges, academics, or medical professionals, psychotherapists don’t often express clear opinions. Most of us have a tendency for fence-sitting; we seem to prefer avoiding conflict, and don’t want to choose sides or confront people. It is not surprising that psychotherapists are often criticized for not disagreeing or stating their views firmly enough.
And, even when we do express our expert opinions, we tend to be elaborate and nuanced, rather than concise and to the point. As a group, psychotherapists appear more comfortable listening and responding to feelings while developing a complex picture of the an individual’s subjective experience, rather than communicating expertise in brief terms to large audiences. Although we might be particularly good at communicating with our patients, whom we get to know intimately over a longer period of time, communicating our expertise with a large, anonymous audience is a whole other ball game. The thought of sharing information with the public might make us feel relatively unsure ourselves about what it is exactly that we do. With the jargon, techniques, manuals, and acronyms of more than 400 different psychotherapy approaches, one could be forgiven for feeling totally overwhelmed. We might doubt ourselves (Blades, 2003), be afraid to open ourselves up to criticism, or simply not know how to link it all in with current affairs or how to write in the most entertaining way.
A related other explanation for our reluctance to communicate about the work that we do is a lack of media training. Despite years of rigorous training as scientists and clinicians, most psychotherapists receive their first and only training with the media by the seat of their pants.
Considerations Moving Forward
Given the many opportunities and challenges that come with building an online media presence as a profession, further research and training is needed. To date, there is a lack of empirical research and scarce guidance offered by professional bodies on the use of online media. Although psychotherapists are likely to be aware of, and to explicitly discuss, issues of boundaries and roles, it is crucial to remain aware of professional and ethical commitments in the personal and professional sphere, as well as how they may influence one another. To further encourage the integration of online media use into our professional careers, additional resources for seasoned psychotherapists as well for psychology graduate training programs are needed.
To address some of these ethical and professional complexities, our field needs explicit news and social media policies. These guidelines should clarify what constitutes a “good enough” press release, or informative yet engaging news feed, as well as appropriate and inappropriate social media use; they should also specify procedures for addressing misuse, and elucidate our professional responsibilities of developing and monitoring our online presence (Campbell et al., 2016).
Ultimately, psychotherapists can and should be critical friends of the online media. We can pick and choose the media with which we engage. We can share resources and experiences. We can highlight when the online media get it wrong, and we can also celebrate when we see good practice. The range of opportunities in working with or alongside the online media can reassure us that we can all play a role. Psychotherapists can readily contribute to the online psychology world in terms of producing materials (e.g., via blogs), sharing consulting insights (e.g., via Twitter) or signposting toward their recent research (e.g., via LinkedIn). Although many of us might not be tech-savvy, with online media emerging as one of the best ways to share information and promote clinical services to the public, psychotherapists should not be reticent. The main requirement for those who want to be effective online is to learn to communicate well: Write clearly in a jargon-free, concise way—whether it’s a tweet, a status update, YouTube video, or whatever hologram technology is coming next (DeJong, 2014).
Luckily, some colleagues serve as good role models and may inspire us. For example, a clinical psychologist in private practice in the U.S., Dr. Kolmes, has made significant use of her own professional Twitter account. First, she posted her own blogs and online articles on social media ethics, and began sharing her posts and other mental health news via Twitter. Then she developed and released a social media policy to guide her private practice, which was disseminated on Twitter. This quickly gained the attention of mental health professionals worldwide who were seeking guidance on the topic. Within a few years, Kolmes became a sought-after expert and speaker on social media ethics and her Twitter following grew to 86,500 at @drkkolmes. She publishes in The New York Times about the challenges of consumer review sites for psychotherapists, and is a frequent news source for the media (Kolmes, 2009).
Working with the news media is an important means by which psychotherapists can educate the public about the value of their work. Rather than simply blaming the media for the clichés and psychobabble that permeate much of what the public thinks psychotherapy is, we must begin to use the media as a critical ally in challenging public prejudices, initiating public debate, and projecting positive stories about mental health as a means of improving public education and awareness (Stuart, 2006). An increasing number of psychologists, academics, health organizations, think tanks, charities, and government departments currently already engage with online media, as an innovative, far-reaching, and inexpensive tool for information dissemination, aftercare, and engagement with hard-to-reach populations. Thus, it is not if but how psychotherapists involve themselves with the online news and social media that raises ethical questions about social responsibility, competence, conflict of interest, and the public image of psychotherapy (Koocher & Keith-Spiegel, 1998). Psychotherapists should avail themselves of online media training workshops and seminars (for tips on online media use, see Blades, 2003; Farberman, 2013). We should continue to expand our online media presence and translate our expertise into palatable and digestible chunks of meaningful information that showcase our profession in a positive light, promote our services, and help us engage with future generations.
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