The LinkedIn Case Reflection
Dr. E, a licensed psychologist in a small city, posts a LinkedIn case reflection: "A 14-year-old boy with OCD, fire-setting, and school refusal was referred after a school threat assessment. His divorced parents disagreed about exposure therapy. After 20 sessions using a fire-safety protocol, he returned to school." She changes the name to "J" and omits the photo, but includes the parish, the boy's grade, the school's mascot, and the month of the threat assessment. A parent of a former client recognizes the details and complains to the Board that Dr. E disclosed her son's information. Dr. E says the post is de-identified and that she never used names. She has also accepted follow requests from two former clients on social media.
1. Does the LinkedIn post violate confidentiality? Analyze the re-identification risk.
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Removing a name is not enough to make a case presentation ethically de-identified. Confidentiality protects information that could reasonably identify the client, and Dr. E included a combination of details that makes identification likely in a small city: the parish, grade, school mascot, month, diagnosis, fire-setting history, and family structure. That combination is more identifying than a name alone would be to people in the community.
The post therefore risks a confidentiality violation. Case discussions may be used for teaching or consultation only when the client has consented or the information has been adequately de-identified. Dr. E did neither. The fact that she did not use the boy's name is relevant but not dispositive. The Board will likely examine whether a reasonable person in the community could identify the client from the post and whether Dr. E took adequate safeguards.
2. What issues do the follow requests raise, and how should Dr. E respond to the complaint?
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Accepting follow requests from former clients can create boundary confusion and a continuing personal relationship that is not part of treatment. Even if the contacts are brief, they can blur the professional relationship and create confidentiality and recordkeeping problems. Dr. E should have a written social media policy that addresses friend and follow requests, and she should not accept former clients as social media contacts without a clear clinical rationale and documentation.
In response to the complaint, Dr. E should remove the post promptly, preserve a copy for the Board, and cooperate with the investigation. She should not argue only that the post was "de-identified"; she should acknowledge the re-identification risk, consult a colleague or attorney, and document corrective action. She should review her informed consent and social media policy, and she may need to discuss the post with the affected family if advised. The Board may consider remediation, but the core issue is whether she disclosed identifiable information without authorization.