TUESDAY, MARCH 30, 2010

KLMNO

Internet can complicate client/therapist rapport

therapy continued from E1

and where lines should be drawn. Among the questions under

debate: Should a therapist review the

Web site of a patient or conduct an online search without that pa- tient’s consent? Is it appropriate for a therapist to put personal details about himself on a blog or Web site or to join Facebook or other social networks? What are the risks of having

patients and therapists interact online? Neither the American Psychi-

atric Association nor the Amer- ican Psychological Association has rules specifically governing therapists’ online behavior, but ethics advisers with the psychiat- ric association maintain that on- line searches are not wrong — as long as they’re done in the pa- tient’s interest and not out of therapist curiosity. Many therapists contend it’s more important to discuss such questions than it is to dictate be- havior. “It’s not whether a partic- ular application is right or not,” says Sheldon Benjamin, director of neuropsychiatry at the Univer- sity of Massachusetts Medical School in Worcester. “It’s wheth- er you do it mindfully — whether you understand how it changes the doctor-patient relationship.”

To Google or not

Benjamin, 53, swears by his iPhone and enthusiastically tells of sampling the Internet in its in- fancy. At the same time, Benja- min, who directs psychiatric training at UMass, advocates caution when it comes to mixing the Internet with therapy. He says he has never searched

a patient’s name online and wor- ries that doing so could dilute the therapeutic process by bringing in information from outside the patient-therapist discussion. When patients have asked Benja- min to read their blogs, he has agreed, with one caveat: that he do so during a regular counseling session. “Even if you brought me a disability form, I’d fill it out in the room with you,” says Benja- min. “I was taught to make the time with the patient the time when the work is done.” Suena Massey takes a different approach. Massey, 35, an assis- tant professor of psychiatry at George Washington University Medical Center, considers Goo- gling a patient a valuable profes- sional tool. “One of the duties of a psychiatrist is to corroborate what patients say,” Massey ex- plains. To that end, online searches can be helpful when tra- ditional approaches — obtaining the patient’s consent to contact his previous psychiatrist or fami- ly members — are not available. One such case involved a pa- tient who presented with symp- toms of mania, a component of bipolar disorder. The man claimed to be well connected in Washington. After their meeting, Massey typed the patient’s name into a search engine. Up popped postings suggesting that the man’s claims were accurate. In a subsequent session Massey told her patient she had Googled him, and he was okay with it. She end- ed up treating him for bipolar disorder; had his claims been false, she says, she would have considered his condition to be more severe. Massey says she will warn a pa-

But some therapists, especially

VIGG FOR THE WASHINGTON POST

tient about her possible use of Google searches if she thinks the patient might have a problem with it. “You could almost make the argument that it’s negligent not to search online when there is public information available” and it might help treat a patient, she says. “If you’re just looking things up out of personal inter- est, I think most doctors would feel uncomfortable with that.”

Public vs. private

But what happens when the

circumstances are reversed? What happens when a patient seeks information about his therapist online or pursues a re- lationship with his therapist on Facebook, MySpace or via an- other social network? Most therapists are not alarmed by the idea of a Google search. “I know my patients Goo- gle me,” Massey says. “I think it’s their right as consumers.” Some providers anticipate such search- es by maintaining Web sites de- tailing their professional qual- ifications. However, there can be prob- lems when personal details are available. Take the case of a man who, after developing romantic and erotic feelings toward his therapist, typed her name into a search engine and found a Web site featuring personal photo- graphs of the therapist, including a bathing-suit shot. The man quit treatment and

reported the discovery to Behnke’s office. “He knew the im- age of his therapist in her bathing suit was going to be so present to him that he wouldn’t be able to concentrate on his psychothera- py,” Behnke explained in a tele- phone interview. “There was ma- terial on the Internet that had an impact on this psychologist’s clinical work.” Behnke cautions therapists to assume that most clients will conduct online searches, and he urges them to make sure they re- main vigilant about what gets posted.

Although most therapists say

it’s inappropriate to have rela- tionships with patients via social networks, there is little agree- ment on whether it’s okay for therapists to join such sites, and, if they do, just how private their information should remain. For Huremovic, 39, social net- work abstinence is safest. “I have an understanding that if you choose to be a psychiatrist and a psychotherapist that you have to be very private in other parts of your social being,” he says.

QUICK STUDY

BLOOD PRESSURE

Loneliness may lead to higher readings.

THE QUESTION Feeling lonely has been shown to affect sleep, mental health and thinking abili- ties. Might it also alter people’s blood pressure? THIS STUDY analyzed data on 229 adults 50 and older (average age 58 at the start of the study). Every year for five years, their physical and psychological health was evaluated through standardized testing and interviewing. This in- cluded blood pressure measure- ments and questions on social in- teractions and perceptions of loneliness. Blood pressure read- ings increased, on average, for all participants in the five-year span, but more so for those deemed lonely at the start. By the end of the study, systolic blood pressure (the top number) had increased 14.4 millimeters of mercury (mmHg) more for the loneliest people than for the least lonely.

WHO MAY BE AFFECTED? People

50 and older. Research has found

that, at any given time, a fourth to a third of adults consider them- selves lonely. CAVEATS The study found that the link between loneliness and higher blood pressure was inde- pendent of factors that could af- fect blood pressure, including smoking, alcohol use, weight, race and income; whether other things, such as access to health care, might have played a role, was not determined. The study did not show whether reducing loneliness might also lower blood pressure levels. FIND THIS STUDY March issue of Psychology and Aging.

LEARN MORE ABOUT high blood

pressure at www.nhlbi.nih.gov/

health and www.familydoctor. org.

—Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment’s effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.

Spending more meaningful time with fiends and family is a big priority for us. That’s why we decided to move to an Erickson community.

Now we have more time, more energy, and more opportunities to really enjoy being with the ones we love. Plus our expenses are much more predictable, so we have feedom to do the things we’ve always wanted to do. Our future has never been brighter.

Take the next step toward building a more secure future for yourself and the ones you love.

Call today for your free Guide to Ashby Ponds or Greenspring.

Ashburn, VA

1-800-915-9661 Erickson.com

The words and images used in this ad are reflective of sentiments expressed by people who are currently living at Erickson communities nationwide.

Springfield, VA

1-800-915-9692

”

“

younger ones for whom using the Internet is a way of life, don’t share this view. For instance, psychologist Stephanie Smith, 35, has a Web site, and she has a presence on Twitter. Smith tweets to market her Colorado practice and to al- low colleagues and other inter- ested parties to monitor happen- ings in psychology. Typical posts provide tips for managing stress, announce a recent study’s find- ings or refer followers to psychol- ogy blogs. Smith, who says Twit- ter has increased traffic to her professional Web site, admits to the rare tweet about her children or celebrity news. “It’s my style, but I know some people would not be comfort- able” with her disclosure of non- professional information, she says.

Smith also has a Facebook ac- count for her personal life. After teenage patients discovered that account and sent her “friend” re- quests, Smith enacted a policy forbidding past or current clients from engaging her online. She in- forms new clients of the policy and obligates them to comply. This is the type of problem that

UMass’s Benjamin wants to avoid. “To me, it’s a much bigger issue than bumping into a pa- tient in a restaurant,” he says. “You’re putting out there, ‘Hey, these are my contacts.’ And some- one then wants to enter your so- cial circle. It puts you in a posi- tion where you must take a stand.” Keely Kolmes, a California psy- chologist who writes and lectures on Internet ethics, recommends that therapists make clear dis- tinctions between their profes- sional and personal lives online. “Younger clinicians get the Net but don’t completely understand ethical and boundary issues that can come up,” she says. A former computer consultant,

Kolmes, who is in her early 40s, goes to great lengths to keep her lives separate. On her personal Facebook account, for instance, she does not use a photo of her- self on her profile page and she doesn’t make reference to her professional name. She also re- stricts her public tweets and blogs to news of a professional nature. Still, she recognizes that any online sighting of one’s therapist changes the dynamic for a patient. “A lot of patients really want to think about you as existing in just that one space [of the thera- py room,] and suddenly they’re seeing you on Twitter and blog- ging,” she says. “They can see that you’re online at night posting things. I realize my choice to do that suddenly shifts my relation- ship with them.”

health-science@washpost.com

Scarton is a Washington-based freelance writer specializing in health and medical matters.

Health&Science

E5

PHOTOS BY KEN BOHN/SAN DIEGO ZOO

Above, Jeffrey Lemm of the San Diego Zoo’s Institute for Conservation Research, takes a sample of the chilled water that mountain yellow-legged frogs prefer. Below, a specimen of the endangered frog.

Scientists hope big chill will get frogs off thin ice

By Louis Sahagun

Some like it hot. Apparently, the endangered mountain yel- low-legged frog is not among them. The three-inch-long amphib- ians much prefer it cold as melt- ing snow. So conservationists at the San Diego Zoo have placed two dozen of the nearly extinct frogs in refrigerators they jok- ingly refer to as “Valentine’s Day retreats” in hopes the animals will emerge with the urge to mate. The big chill at the zoo’s In- stitute for Conservation Re- search represents one of the most ambitious wildlife reintro- duction experiments in the na- tion. If it is successful, the frogs could produce upward of 6,000 tadpoles next month, all of them scheduled for a spring home- coming in a remote San Jacinto Mountains stream from which they have been absent for a dec- ade.

Scientists hope many of those tadpoles will mature and pro- duce new generations in the wild, paving the way for the Ra- na muscosa population to rees- tablish residency in Southern California and grow exponen- tially. “A month from now, there could be tubs of tadpoles all over the place,” said Jeffrey Lemm, a zoo research coordina- tor. “Eventually, we may have thousands of adult frogs in self- sustaining populations for the first time in half a century.” Mountain yellow-legged frogs thrived for thousands of years in the streams cascading down the San Gabriel, San Bernardino and San Jacinto mountains. Since the 1960s, the species has

been decimated by an array of threats: fires, mudslides, pesti- cides, fungal infections, loss of habitat as a result of devel- opment, and the appetites of nonnative trout, bullfrogs and crayfish. Today, fewer than 200 of their descendants are believed to ex- ist in nine isolated wild popula- tions, giving mountain yellow- legged frogs the distinction of being one of the most endan- gered amphibians on the planet. The most intimate details of their mating behavior are the fo- cus of a master’s thesis project being conducted at the institute by research technician Frank Santana. In their native habitat, the frogs flock to streams gushing with spring snowmelt. Males announce their presence with a low-pitched underwater bark. Parental discretion is advised for what follows: “A male gets a good grip of a female with his forearms, and the female, if she’s in the mood, lets him,” San- tana said. “Then the male thrusts his whole body to stim- ulate the release of her eggs. The female goes into contractions as both arch their backs to line up their cloacae.” Sperm and eggs are released simultaneously. Tadpoles emerge from the eggs about three weeks later. In the wild, only 3 to 5 percent mature into adult frogs.

“In the laboratory, the hard work comes when we’ve got a bazillion two-millimeter-long tadpoles on our hands in need of daily water changes, and meals of frozen lettuce and fish food,” Santana said. The zoo’s recovery program was launched in the summer of 2006, with 82 tadpoles rescued from a drying creek in the San Bernardino National Forest. Two years later, institute re- searchers discovered a clutch of 200 eggs in one of their tanks. However, the frogs were young- er than is typical for breeding, and only a handful of the eggs were fertile. The institute be- came the first to breed a yellow- legged frog in captivity when one of those eggs produced a tadpole that matured into an adult. Now the institute has 61 frogs, including the 16 females in the refrigerator — each one of them, Lemm said, “looking nice and healthy and bulging with 200 to 300 eggs.” All the tad- poles produced in the labora- tory will be reintroduced into a mountain stream that U.S. Geo- logical Survey biologists have determined is free of predators. In the meantime, federal wildlife authorities are devel- oping measures to reduce the ef- fect of human activities in areas where the yellow-legged frog is still found and may be reintro- duced. “A few years ago, there wasn’t

even a captive breeding pro- gram for these frogs,” Santana said. “Now, we are hoping to re- establish populations by mim- icking their natural cycles. For these frogs, that means winter hibernation, spring thaw and lots of tadpoles. Hopefully.”

—Los Angeles Times

Our priority this year is making sure we have our priorities straight.

6537744 Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58