Online Confidentiality

Do not discuss clinical cases online! In this post, I’ll discuss why.

With the proliferation of social media, clinical and other health professionals are starting to use online platforms to communicate with clients and discuss cases. Whereas some platforms are secure and HIPAA compliant, most are not. There are also other concerns related to informed consent. Did the client consent for you to discuss their case in an open forum?

Case consultation is not only accepted, but is considered part of best practices for our profession. When we consult, we know we need to protect client identity by removing any details that would make the client identifiable. However, it may not be enough to remove identifying details such as name, age, unusual diagnosis, etc. because even with the removal of these details there may be enough specifics about the case that make it identifiable. For example, if you live in a small town and one of the clients has an unusual occupation.

Protecting client identity during consultation online is particularly problematic because you have now shared private information in a forum potentially accessible to many people. Therefore, although clinicians on Psychology Today were split for/against, I don’t think online consultation is a safe practice.

In my view, it is not advisable to have any type of clinical conversation over an insecure and/or open platform. And if you don’t know if your platform is secure, you should assume it isn’t. Instead, you should work to develop an in-person peer support group to discuss cases. If that is not possible, try to find a colleague with whom you can partner for mutual support. And if you simply MUST post clinical information on social media or other platforms, post at the trend or topic level, i.e. “tools for men with depression.”

Lastly, you should have your consultation policy spelled out in your paperwork.

For more information, check out this article. As one of the forum participants puts it, “I am not here to scare you, but I assume you would rather hear from me what you ought to be doing rather than having to talk to an attorney about what you already did.”

Yours in the Joy of Knowledge,

Dr. Barb LoFrisco


Besides a new site design and other cool features like professional interviews, videos, and informative articles, Masters In also serves counseling students and new counselors by bringing on Dr. Barb LoFrisco, a licensed counselor to blog for the site! Dr. LoFrisco holds a doctorate in Counselor Education and Supervision, as well as a master’s degree in Rehabilitation and Mental Health Counseling from the University of South Florida. She is also a licensed mental health counselor, licensed marriage and family therapist, and certified sex therapist. Currently, she helps individuals and couples with anxiety, depression, relationship and sexual issues in her private practice in the Tampa, FL area. She is interested in social media, and one of her publications is an article in Career Development Quarterly on how university career centers are utilizing social media.

At Masters In, Barbara writes about counseling education as well as career and study advice. The blog aims to serve both counseling students and early-career counselors. If you have any topics you’d like to see Barbara blog about, please let us know! You can email us at [email protected] Or, leave a comment on Facebook or Twitter!