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A few subjective remarks about the online image of psychiatrists

Initial remarks about the Internet
The image of the Internet, or rather of the world reflected online, is obviously extremely rich, diversified and individually variable, but it also has some common features that need to be discussed at the beginning.

One of them is sensationalism or exaggeration similar to journalistic distortions characterised by little objectivity and a tabloid-like style. Unlike in the case of traditional newspapers in the past, the content on the Internet, however, does not disappear. There is a widespread opinion that it cannot be removed and the responsibility for posting and reproducing information online is negligible and dispersed. Indeed, even reputable institutions have difficulty with regulating contents published online, as evidenced by defamation cases, influence on election results or the recent references to the pandemic. The Internet is also used as a tool by whistle-blowers, NGOs or in spontaneous actions of groups of people (flashmob). The web is often criticised for the excessively sexualised, violent nature of much of its contents, including overly explicit distorted messages, often inaccurate. On many occasions, it is not easy to distinguish what is true from what is a lie or tell a well-intentioned description of the user’s own experience from malicious trolling. The web content sometimes resembles scribbles on fences or in toilets rather than reliable publications verified by responsible editors. What is worse, in both situations the medium is the same, the publication date is uncertain for the ordinary reader, and the country of jurisdiction or the current location of the material read is not clear. It is therefore easy to encounter fake news, i.e. hybrids of real and fabricated information. Because of all these disadvantages, the image of online therapy and therapists suffers, too.

Opinions of consumers, patients or maybe agents working for the competition

As usual in the case of any consumer opinion, negative evaluations of those who were offended, disappointed, in conflict, taking revenge or represent competition are more common. In many cases, it is not clear who wrote the post (it is not clear whether the e-mail address of the author of the post is real, whether the IP address is masked or authentic, whether the user has been verified by an administrator, how many times he or she has been warned or even banned, although the content posted by him or her remains online). Resolving such ambiguities requires more advanced skills than identifying a counterfeit banknote.

While there are reliable sites that publish opinions of verified experts only, there exist confusingly similar addresses and domains that pretend to be such or polemical sites of little or no value. There is also no shortage of unethical offers (which must be popular judging from the extent of supply) focusing on the promotion of the psychotherapy provider (or any other service). Admittedly, the author finds it difficult to imagine a clinician-surgeon or a cardiologist, and even more so a psychotherapist, ordering a set of positive opinions about his or her professional abilities from a company whose specialisation is even hard to define (advertising, public relations or IT?). Correcting defamatory opinions is, of course, legitimate but quite difficult due to the previously described reasons of few regulations and the Internet size. Moreover, unlike someone who bought an iron, rollerblades or a car, a psychotherapy patient may not want to identify himself or herself when posting opinions, let alone make it possible to verify his or her identity or make an authorised entry on the website of the ‘company’, i.e. the treatment facility. A public polemic between a therapist (or a physician) on a website and a patient or someone using the patient’s personal data is ethically questionable and, according to the author of this text, unacceptable because of the professional secrecy rule and the inability to verify the identity of  such an ‘interlocutor’.

Terminological difficulties

An additional confusion may be caused by terminological difficulties. Such terms as therapists or psychotherapists may be used (sometimes by the individuals in question) to refer to gurus, massage therapists, occupational therapists, life counsellors, radiesthesists, herbalists, quacks, bioenergy therapists, fair hypnotists (not hypnotherapists), psychologists with no special training, the so-called alternative medicine practitioners, folk medicine specialists, etc..

Therefore, the analysis of the online image of therapists and therapies offered by them should begin with establishing who the therapist is and what kind of therapists there are (as described in more detail in other texts). Then it is necessary to separate the layers of ‘competition vilification’ and ‘hidden advertising’. Also, you need to remember that as praise is less visible and less sensational, there is less motivation to post it online than complaints and warnings. Some asymmetry is also a result of ethical resistance and prohibitions related to proportional defence and attacks of parties. It is, after all, unacceptable to violate professional confidentiality rules online in the name of defence against the hate published by a dissatisfied patient’s family or the patient him- or herself. Such reactions, however, are frequent, for example, on the part of manufacturers of defective and non-defective goods or politicians, and therefore their perception is also particularly negative.

What can you learn from the online image of a therapist? 

In the subjective opinion of the author of this text, an online image shows more errors and abuse than are actually the case. It may be caused by dissatisfaction with therapy effects on the part of patients (perhaps justifiable) as such people are more motivated to express it than people who are relatively satisfied and content with therapy. It may be related to a high level of misinformation resulting from ideological disputes, especially about the effectiveness of the treatment offered by adherents of very different psychotherapy schools. Hence, the patient or his relatives may conclude that treatment X is much better than treatment Y, disorder Z is basically incurable and there is no hope left, centre T is full of arrogant charlatans, while the clinic of W Ltd. employs only angels. 

Reliable sources of information about therapists

Considering the above, should one consult the Internet in order to increase the patient’s safety and to optimise the choice of a therapist? Maybe you should ignore the pushy and primitive advertisements of ‘world-class specialists’ or even the very neatly and elegantly described ‘experts in everything’, especially if the only basis for such an evaluation is just one, probably their own, website. In the process of choosing a therapist you may want to consult lists of  certified professionals with the supervisor-grade diplomas verified by relevant institutions (state and university bodies, larger and older professional and scientific associations). Despite GDPR restrictions, the Internet may still allow you to find out who practiced where before opening the current practice, when they graduated (although, unfortunately, creative self-advertising such as ‘I gained my experience in Department X’ can also be found there without any information that, e.g., the person’s training lasted only 4 weeks and the reader is left with the impression that the person was employed there or received solid education, while in fact they did not obtain any qualifications). Thanks to the web, it is possible to find out about the therapist’s experience, publications or presentations at conferences, as well as the kind of conferences attended. It is also possible to find out about the manner in which he or she expressed his or her opinions about colleagues or patients, etc. 

Should a therapist disclose personal information?

The issue of the therapist’s transparency (or, alternatively, non-transparency) is often taken up by psychodynamic theorists and clinicians and the reader may find out more about it in their publications. It needs to be emphasised that patients do not need to know what kind of dog the therapist has, whether he or she has children, is religious or ecologically-minded, as it distracts them from the therapy and sometimes wastes both the patient and the therapist’s energy. Secondly, without such knowledge it is easier to use the therapist as a blank projection screen allowing the patient to see more of their own content projected onto this screen. Thirdly, it will be more difficult to conduct therapy disrupted by frequent references to the therapist’s social media content (e.g. holiday photos). Even the subpage ‘About me’ on the therapist’s website requires some reflection before publication.

In conclusion, therapists will not avoid the Internet but they should use it prudently to present a balanced image of themselves online and recommend the same to their patients.

Recommended reading

Jerzy Aleksandrowicz. Psychoterapia. Poradnik dla pacjentów. Wydawnictwo Uniwersytetu Jagiellońskiego. Kraków, 2004. ISBN 978-83-233-1890-3

Patricia Wallace. The Psychology of the Internet. Cambridge University Press 1999.

John Suler The Psychology of Cyberspace. The Classic Text. Department of Psychology, Science and Technology Center, Rider University. The Psychology of Cyberspace Online Access on 22.01.2022

About the author

Jerzy A. Sobański, MD-PhD – psychiatrist and psychotherapist, assistant professor at the Faculty of Psychotherapy of the Jagiellonian University Medical College. For two decades he has been teaching psychotherapy to students of medical and postgraduate programmes. He has authored publications on the psychopathology of anxiety disorders and the effectiveness of psychotherapy. He is deputy chief-of staff of the bimonthly ‘Psychiatria Polska’ and secretary of the Edititorial and Publishing Committee of the Polish Psychiatric Association. He earned his doctoral degree in medical sciences from the Medical Faculty of the Jagiellonian University Medical College.