Wednesday, March 25, 2015

Web Secret #355: Peaky Blinders

The other day I was at a dinner party.

They still exist.

I was seated at a round table (one of three) with 9 other guests. It was a cosmopolitan affair. The person to my left was a political activist from El Salvador. The person to my right was a twenty something artist form Berlin. There was a woman from Liechtenstein. An American specializing in the law pertaining to homeland security.

And what did this group talk about?

The TV shows they were streaming.

Most of them had or were in the process of streaming a Danish TV show called Borgen. Which has been described as the Danish "West Wing." Which I had never heard of.

A few days later, my 21 year old son told me he got a haircut. "It's a new style," he explained to me, "like the Peaky Blinders." Huh? I had him spell it for me. Turns out that the "Peaky Blinders," is a British historical crime drama television series about a gang operating in Birmingham, England, during the aftermath of World War I. I had never heard of it.

Of course with the Internet, I could quickly look up what I knew nothing about. Even though neither "Borgen" nor "Peaky Blinders" has every been broadcast on US TV, you can buy the DVD of "Borgen" on Amazon, and you can stream "Peaky Blinders" on Netflix.

My dinner guests and my son made me feel temporarily culturally illiterate.

In fairness to myself, achieving cultural literacy has become a highly complex affair.

When I was growing up, there was a finite number of TV shows, movies, books, music, and toys that you could access. And for the most part, you could only access your own country's cultural artifacts. In fact, if you lived abroad for two years - as I did between the ages of 10 and 12 - you came back with very little idea about what your friends were talking about. You had missed the TV shows, the movies, the jokes, the slang that had happened while you were out of the country.

Today, technology gives me access to more TV shows, movies, books and other knowledge than I can ever watch or learn in a lifetime. And should you wish to access the cultural heritage of another country, you can do so.

So what does it mean to be culturally literate in 2015?

Damned if I know.

Wednesday, March 18, 2015

Web Secret #354: clueless about confidentiality

The other day, I logged into Facebook, and I came across the following fully public post and comments (all names and identifying information have been changed):

First, the post - Abby writes: "Hi Bob, do you accept Aetna insurance?" (Note: Abby's full name and photo are posted.)

First comment, posted by Bob the psychotherapist: "Hi Abby. Can you send me a copy of your insurance card? What about using your EAP benefit? I'm affiliated with a number of Employee Assistance Programs. I would be happy to work with you.

2nd comment, a response from Abby: "The Acme Widget Company has an EAP. I have a counselor assigned to me. He wants me to see you due to our previous work together. He says I need more help with my issues than can be offered through the EAP. Do you know Dr. Phil in Oak Grove, IL? He is my new psychiatrist."

!!! ???

"Say it ain’t so, Joe." Or should I say Abby and Bob...

First of all, Abby, do not, EVER, I repeat EVER, write public posts in which you reveal:

1. that you have a mental illness (or appear to have one)
2. that you are seeing a psychiatrist
3. the name of your insurance plan
4. that you are seeing an EAP counselor
5. that you want to see Bob for counseling.

We do not live in a world of little ponies, unicorns and butterflies. And the information that you made public can be used against you. For example, someone at Acme sees this post and circulates it around the company. You don't get that sought after promotion, because your boss read your post and decided you are too unstable for the promotion. Or you apply for a job, and your prospective employers look for you on Facebook (and trust me, most will,) and they don't hire you, because, why take a chance that your attendance and job performance may be affected by your mental illness?

And Bob, you should never, EVER, respond to an inappropriate client post in a public Facebook setting. You violated this clueless client's confidentiality.

The irony is that I am absolutely positive that if Abby's employer called you at your office, and asked "Are you seeing Abby for counseling?" you would respond, as we have all been taught, "I can neither confirm nor deny that I am seeing Abby for counseling."

But on Facebook? You seem to have lost your bearings.

And you are not the only clinician who has. In a previous post, I wrote about studies showing that therapists do not understand the confidentiality issues raised by social media. I also presented some best practices to avoid breaking confidentiality on the web. I reiterate them here:

1. Overall, it is important for clinicians to recognize that their "private" online activity may intersect with their professional competence. Indeed, online self-disclosures may represent the intersection where dilemmas surrounding personal and professional roles meet - in some cases signaling the start of boundary violations.

2. Self-disclosure online is almost inevitable. Often it is initiated by clients who want to learn more about their therapists. Some clients may do more than a Google search: They may join social networking sites, join professional listservs/chat rooms, or pay for online background checks or online firms to conduct illegal, invasive searches.

3. Practitioners need to create and maintain a formal social networking site policy as part of the informed consent process. Informed consent processes should at the very least acknowledge the risks and benefits of using social media and other technology. In addition, such policies should lay out psychologists' expectations for using such sites, namely that practitioners do not "friend" or interact with clients on social networking sites.

4. Therapists should develop online technological competence - they must understand the nature and requisite technology of social networking sites. They should proactively set controls that limit who sees their personal information.

5. Clinicians should contact both their professional and personal liability insurance representatives to find out whether their professional and personal liability insurance covers social networking sites. Psychotherapists should avoid using certain types of speech online, even if they use high privacy restrictions and other protections, such as pseudonyms. These communications might include breaches of client or supervisee confidentiality, speech that is potentially libelous and speech that denigrates the reputation of the field in which they practice.

And the greatest of these is "Therapists should develop online technological competence."

If you are not sure you understand Facebook privacy settings...

... Don't use Facebook. 

Wednesday, March 11, 2015

Web Secret #353: Learning all the time

I learned two important skills, a long time ago, in high school and college.
1. How to research the crap out of any topic.
2. How to write - really well - about anything.

I use them all the time for work.

But everything else I do on a daily basis for my current job, I learned during the past 10 years.

Some of it, I just learned yesterday. I wish I was kidding.

I have to keep up, just to tread water.

Now the good thing is that I am at heart an information junkie and a lifelong fan of learning stuff.

The bad thing is I never would have imagined how much new stuff I have to learn all the time, because everything is changing so damn fast.

And it's right around the corner.

Just this morning, I came across two articles:

"Professional Millennials and Super-Powered Smartphones are Changing the Working World". The Economist’s Cover story — January 3rd 2015.

"How tiny robots will rewire our world". Fast Company, February 2015.

I need to read these articles. 82 million Millenials are entering the workforce. There are 16 billion active wireless-connected devices in the world, and that number may exceed 40 billion by 2020. 2020! That's only 5 years from now. What does that mean? What are the implications for my work? I need to know this.

Every year, I give several talks on the impact of technology on mental health and employee assistance practice. You would think that the presentation I gave in September of 2014 would be perfect for May 2015.

But it isn't. I have to rewrite about 50% of my PowerPoint slides every 6 months.

Sometimes I feel the intellectual equivalent of gasping for air.

Sometimes I wish I had chosen a tech proof career like violin maker, park ranger, pool shark.

Will there come a point when I say "enough, no more"?

Wednesday, March 4, 2015

Web Secret #352: Millenials - attention must be paid

If you pay even vague attention to the news, you probably noticed a recent proliferation of studies and articles informing us that "people born between 1980 and 2000 now outnumber baby boomers."

More importantly, a study by the University of North Carolina Business School, "Maximizing Millennials in the Workplace," indicated that while Millenials consisted of 34% of the workforce in 2014, there will be 46% of them in the workforce in 2020, 5 short years from now.

Are you ready? They will be game changers. They invented social media. They came of age in a terrible economy which forced them to think outside the box when it came to employment. They will be using your EAP or your private mental health practice. They are less concerned with confidentiality (they divulge just about everything to their peers on Facebook,) and much more about convenience.

Let me give you an example that is not EAP/clinically based but is very prototypical. In a recent article in the New York Times, "Power Lunches Are Out. Crumbs in the Keyboard Are In," John Koblin reported that Millenials are eschewing lunching at Manhattan restaurants in favor of "conference rooms; over coffee, cocktails or breakfast; on Skype, Gchat or email. The status conferred upon those who get the best seat in the house is not necessary or even valuable to this crew, which measures its clout in retweets and followers, not table position." Fancy restaurants are not conducive to sharing a PowerPoint presentation on a laptop screen. Many larger companies offer inexpensive or even free cafeteria food.

My take? The winners: online eat in websites like GrubHub, food trucks, and informal eateries like Chipotle or Pain Quotidien. The losers: the Manhattan restaurant industry.

You do not want to be the Manhattan restaurant industry. I expect that the larger EAP companies are focusing on this young demographic. But I am not sure about the smaller players or the individual practitioners.

So here are my recommendations:

1. If you don't already have a website, it's time. It can be very simple, and very inexpensive. If you are not sure how to do it, hire someone.

2. If you are not offering your services via online video platforms, get going. I am the parent of three very social Millenials. Two are college aged, and the other is 25. I am exposed to a multitude of their friends. Obamacare means that counseling is covered by insurance and Millenials are covered under their parent's insurance until they are 26. For this age group counseling is increasingly stigma free. And I can tell you that many access mental health services only online.

If you are not tech savvy, and even if you are, note that online therapy is NOT therapy just delivered online. There are unique logistical, paperwork, licensing and encryption issues (and that's for starters.) I strongly recommend becoming distance counseling certified through the Online Therapy Institute or other similar expert provider.

3. Consider making appointments and confirming them using e-mail or even better, text.

4. Consider creating an app that showcases your expertise, your credentials and your publication. You don't even need to know how to code. Check out .

5. Do not, I repeat, do not create a Facebook for your practice, and if you have a Facebook, lock it down with the most stringent privacy settings.

Attention must be paid to these young people entering the workforce and using our services.

Bonus tip: Want to understand the Millenial mindset and lifestyle?
1. Read the annual Beloit College Mindset List. Find out what the college class of 2018 is really like.
2. Read the Refinery 29 lifestyle blog for young women.
3. Read Thrillist to find out about the lifestyle of young men.