Lifeline or ethical nightmare?
Therapy Today, February 2024

My client has left the building and I go into the kitchen and flick the switch on the kettle for a quick coffee. My mind is whirring with thoughts about the client’s presenting issue, one I’ve never worked with before. I know I need to get some CPD on it as soon as possible. But first I ask for guidance from Jess as she specialises in this, and then draw Cath into the conversation as I know she’ll have something useful to add. I’m immediately feeling more settled about what I need to do as I return to my therapy room for the next client 10 minutes later.

However, Jess and Cath aren’t colleagues in a busy agency staffroom. I wouldn’t even necessarily recognise their voices or faces if they were in the same room as me. Like thousands of therapists I’m a member of various practitioner Facebook groups, and they feel like a lifeline to me working alone in private practice. But should they be? And how can we ensure we use these Facebook groups ethically and safely to enhance our practices? 

The number of therapist Facebook groups has grown exponentially in recent years. They come in many forms, some with close to 20,000 members, and others with just a handful. Some are generalised, reproducing the ethos of an agency staffroom, and others are more niche and specialised, for therapists working with specific presenting issues or who identify as part of a marginalised group.  

Counsellors’ Staffroom was founded by BACP registered therapist Zena Nicholas in 2020 and now has 6,800 members. Nicholas started the group during the first lockdown when, she says, ‘I could sense that we needed to be together.’ 

The drive to come together and connect during lockdowns – albeit virtually – was something I experienced personally. As a trainee at the time, at the onset of the pandemic I went from being surrounded by my cohort at college and being in and out of busy agency staffrooms on placement to suddenly spending most of every day alone, working and studying remotely. Like many others, this isolation continued post-pandemic and post-qualification as I moved into private practice and hybrid working. As one counsellor said, ‘I think many of us, especially in private practice, feel lonely and end up in a conflicting situation of loving the work but not loving the “lifestyle” that comes with it – no proper work colleagues, spending a lot of time on our own, and not being able to talk about much of what we do, outside of supervision.’ You don’t have to look hard to see the gap that therapist Facebook groups are filling.

Benefits

Josephine Hughes is a BACP accredited counsellor and coach who founded Good Enough Counsellors, a therapists’ Facebook group with 10,000 members. As well as reducing the sense of isolation that so many of us feel, Hughes feels groups provide support when the work is challenging, both on an emotional and a practical level. ‘There’s so much wisdom within the group. There are people with so much experience, and that’s very powerful,’ she says. Having instant access to a pool of several thousand therapists was simply not possible before these groups existed, and once you’ve got used to tapping into that ‘hive mind’, it can be hard to live without. Therapists can now get advice from therapists all over the country and from other modalities, bringing a broader insight to the dilemma they may be facing.

Conversely, online groups also provide direct access to a pool of therapists who may share your specialism or identity – invaluable for those who may not have such colleagues in their local area. There are groups for younger therapists, disabled therapists, therapists of colour, LGBTQIA+ therapists – all providing support for the specific challenges that can arise as a therapist in a marginalised group. 

Neurodiversity specialists Karin Brauner MBACP (Accred) and Sarah Williams NCPS (Accred) are co-founders of Counsellors Working with Neurodivergence. Both find therapist Facebook groups valuable for networking. Brauner has taken on several supervisees who have found her via the Facebook group. Groups can also be a rich source of client referrals. ‘There are group members I have got to know but never met in person who will refer clients to me – one therapist sends Spanish speakers to me, and I send French speakers to her,’ she says.  

As well as providing a forum for practitioners to share recommendations for training, CPD, books, videos and other resources, many groups also now offer spin-off CPD events. At the beginning of the pandemic, Hughes offered training in online therapy via Good Enough Counsellors. The Network for Younger Therapists provides monthly online gatherings with a topic to discuss, such as working with emergency service personnel or providing single-session therapy. Counsellors’ Staffroom has expanded to include a website to promote and host CPD opportunities for members. Post-pandemic, many online groups now offer opportunities to meet offline, in the form of local in-person networking and peer supervision groups. 

Disinhibition

But not everything about Facebook groups for therapists is positive. For people whose profession is based on empathy and non-judgment, the groups can be painfully judgmental spaces. Hughes sees this every day: ‘You get the online disinhibition effect and people say the most outrageous things to each other. You think, if you were sitting in the same room you wouldn’t speak to each other like this.’ Nicholas agrees – due to the size of the group, the complexities of moderation and the 24/7 nature of Facebook groups, she says ‘we cannot always offer the kind of safety in the group that we would like’. Hughes agrees that it’s very challenging as a moderator to keep large groups safe as ‘to an extent, you have little control’. 

This dark side can have a big impact – several counsellors report having had to stop using the groups because of the impact on their own wellbeing. Nicholas has frequently received messages from members who have been affected by harsh or judgmental responses to questions posed in groups. It can result in group members opting to ‘lurk’ but not participate – many say they are too fearful of judgment to post or comment, generating a feeling of exclusion rather than belonging. 

Client confidentiality

Another area of concern is the maintenance of client confidentiality by posters in groups. Hughes says they decline posts every day where people aren’t careful enough to protect client confidentiality. Nicholas notes that even if an initial post doesn’t disclose client details, she and other moderators have to be vigilant because additional information provided by the poster in response to comments may then compromise confidentiality. Hughes feels the disinhibition effect is in part to blame for this too. ‘It can feel like you’re in a peer group of therapists so it’s OK to talk openly but it’s not – it’s a public space,’ she says.  

The disinhibition effect may mean we are more trusting of what we see online than we might otherwise be. As Nicholas notes, ‘on Facebook we might not know who they other users of the groups] really are – their name might not be their actual name. There’s no accountability.’ People may not be who they say they are, and without real names we may not know if they’re qualified and are a member of a professional membership body.  

Kate Dunn, author of the BACP Good Practice in Action resource Social media, digital technology and the counselling professions (GPiA 040), points out that ‘those who work in the counselling professions are required to preserve the anonymity and privacy of clients in all contexts. Even in closed groups we cannot be sure that clients are unable to access posted material.’ 

Most of us are aware that it is never ethical to post about a specific client or clients we have experience with, even if details are disguised. We are learning to post ‘does anyone have any CPD recommendations for working with agoraphobia?’ rather than ‘I have a client who has agoraphobia and I feel I need more CPD on this’. Where we might slip up, however, is in revealing details when we respond to questions from people who comment on the post.  

Being a communal space, therapists often work together to help by drawing moderators’ attention to posts and comments that may be compromising a client’s confidentiality. Well-moderated groups tend to have moderators who are very attuned to this issue and welcome the assistance of group members. 

For some therapists, the downsides of Facebook groups are too great and they’ve opted out. If, however, you recognise the downsides but still want to engage and reap the benefits that membership of these groups can bring, we need to guard against getting complacent and remain vigilant about engaging with them ethically and safely, especially if we use them regularly.

Facebook groups are an easy go-to, instantly available on our phones or just a couple of clicks away on our laptop after a Zoom session. But the most available option isn’t always the best one. It’s always worth asking if the question you’re about to post is actually better taken to supervision. If you find yourself resisting that, it’s perhaps time to explore whether the regularity and quality of your supervision are adequate for your needs.  

It’s also worth choosing wisely which groups you join as the awareness of ethical issues varies between them, as does the quality of the moderation. We are all vulnerable to the online disinhibition effect, and if we feel strongly about issues raised or are under stress in our personal lives, emotions may overtake us. You may have a rule about always checking what you’ve written before pressing ‘post’, but what happens to that rule when you feel triggered by what another poster has said? Scrolling through posts can become mindless so we need to make a conscious effort to check and reflect on what feelings posts may be bringing up, especially if we’re scrolling in between clients.  

The proliferation of counsellors’ Facebook groups highlights the valuable part they play in many professional lives now. But it’s worth taking time, perhaps in supervision, to reflect on the role they play in yours. Nicholas says that while Facebook groups clearly meet a need, at times they may meet that need quite crudely: ‘We must always consider whether other ways of seeking support may be more appropriate.’ Hughes feels the groups themselves must take responsibility, ensuring there is a ‘firm steer on moderation’ to keep a group safe and ethical.  

A decade ago we could not have imagined the role that Facebook groups have come to play in our working lives, and given the ever-changing nature of the digital landscape we don’t know what is to come. But we should all know what ethical practice looks like, and we owe it to our clients and our profession to hold that in mind every time we post online.  

• As an alternative to Facebook groups, join Communities of Practice, the member-only platform for peer-to-peer support. See www.bacp.co.uk/ events-and-resources/bacp-events/communities-of-pract