(no subject)

[rivka]

The awkward thing about being a psychologist is that sooo many people feel like qualified experts based on their common sense, personal experience, or reading of pop psychology books. Double that when you're a child psychologist, because practically everyone feels qualified to give parenting advice. And homeschoolers, of course, have essentially constructed their lives around a belief that they can do as good a job as trained professionals.

So someone will post a dilemma online, and potentially dozens of people will chime in with recommendations, advice, and - yes - diagnoses, based on what they feel is sound lay experience. And I'm sitting there saying, "I don't have enough information to comment. Yes, I know that everyone else posting here has enough information to comment, but not me." Or even more explosively: "I know everyone else here is dispensing advice freely, but my advice is worth money."

Somebody messaged me on Facebook - a complete stranger, contacting my professional page - asking for advice. She included, no kidding, a .jpg of her kid's test scores. It isn't the first time that someone has done that.

I sent back a message:

Thanks for contacting me. Your situation certainly sounds frustrating, and I can see how you'd be at a loss for what to do next. But for ethical reasons, I really can't give advice outside of an established therapist-client relationship with proper boundaries. It's also hard for me to give advice that's truly helpful unless I have more background context than I can get through a Facebook message.

As you may or may not know, I'm located in Maryland, which is probably a little further than you'd like to travel for an appointment. However, your state is one of the places where an out-of-state psychologist is allowed to consult on a limited basis. I'd be happy to set up a consultation relationship, where you can send me all of the testing data you have and we can have a full conversation about your concerns over the phone. Then I could put the test data and our conversation together and give you constructive advice based on my professional expertise. That kind of service usually runs about $300 to $450, depending on how much background material there is for me to review. Let me know if you'd like to schedule something like that.

If she posted what she sent me on a message board, dozens of people would give her authoritative advice for free. It's part of the culture of parenting/homeschooling message boards. So even though, on the one hand, it's ridiculous to have to explain to someone that you don't do your job for free, on the other hand it feels transgressive to set those boundaries.

Comments

[nelc.livejournal.com]

I think it's not a useful way to think about things, to go down the "amateurs feeling qualified to advise" route. What people are, is concerned about these things, and naturally want to share what they think they know. This isn't a bad thing, especially when the pros are reluctant to, for equally good reasons. There has to be lay knowledge, which people have to be able to communicate to each other, if only so that pros have something to build on.

[rivka.livejournal.com]

Oh, of course. I wasn't meaning to come off as "laypeople should shut up." Heaven knows that I opine about all kinds of things that I'm not professionally qualified to pass judgment on. As you say, it's part of expressing human concern and making human connections.

[johnpalmer.livejournal.com]

Nod. People asking for advice can be a really awkward thing in a lot of ways.

I work SQL Support for Microsoft, and I see one of your main points. If I say "I'm from CSS SQL Support at Microsoft" and say anything after that, people will view what I say as Official Microsoft Documentation And Best Practices.

But you can't just elide the introduction - you *are* a psychologist, and you're trying to represent what we know and understand, not just what a particular software company recommends.

Thinking about this from my perspective (because that's what I do when I care about the issue and the person/people involved), I might try to confine my advice in circumstances like that to "While a professional might help, that is relatively normal - a challenge, but one many people overcome" versus "that's a huge challenge, and many people will need professional help managing it."

In the "old days" they'd have said "it's just a phase" or "maybe you should see a doctor," to make the same statements.

As for "someone is wrong on the internet" - yeah. I remember the old "so you're about to become a parent" joke that says "first, find a couple with a child or children. Tell them what they're doing wrong, and revel in the notion that this is the *last* moment in which you'll have all the answers." Far too many situations end up working *in spite* of all the wrenches we throw into the clockworks.

[naomikritzer]

The thing I find sort of fascinating and startling about professional advice on the Internet is that I have several RL doctor friends who will share vast amounts of medical advice online with friends and acquaintances. To the point that one of them set up a secret Facebook group where all her friends can hit her up for her expertise. This woman has three children and works the ridiculous hours you'd expect for a family-practice doc. I'm not sure if it's generosity, or compulsiveness, or what. I totally appreciated the diflucan the time she called it in for me, though. (I also have several doctor friends who keep their professional life OFFLINE. I support this decision, too, FTR.)

Another anecdotal angle on this: there was this woman I knew vaguely through a message board. I think her name was Lisa. I knew her through breastfeeding.com's message board, which was breastfeeding support and advocacy with a side of political arguments. She also posted at a couple of other boards, most of which were a lot less oriented toward the "breastfeeding will cure all ills and probably bring about world peace" attitude of the breastfeeding board. She got super frustrated by the fact that people would not listen to her when she warned them that supplementing with bottles would hurt their supply, or when she'd tell them their ped was giving them bad breastfeeding advice (FTR, she was right that a lot of peds give bad breastfeeding advice, unfortunately). Sooooooooo she set up a new account, called "Dr. Sally," and claimed to be a pediatrician. You know how on the Internet, no one knows that you're a dog? They also totally don't know that you got your M.D. from the University of Google.

She started this game because she wanted to be able to give ALL THE BREASTFEEDING ADVICE and have people take it seriously. But, of course, once she'd set herself up as a medical expert on a message board, people asked her for advice on EVERYTHING. Do I need to worry about this fever? could this cough be pertussis? what's up with this weird rash? etc. etc. etc. And so she'd google for answers and try to do her best.

When this all came out, another woman who I think really was a doctor online (though I don't remember if I had a chain of real people leading to her, so maybe she was also a faker? I remember finding her really credible, though) looked through the advice she'd given and said that most of it was fine. There were two or three examples, though, of advice that could have been EXTREMELY harmful, where a real MD would have seen some symptom as a red flag. Along the lines of, "it's not super likely, but that thing she said could indicate that the kid has [rare, treatable, potentially fatal condition]. A doctor would screen for this if the kid were in her office. She should have told this parent to take her kid in."

It was a good, eye-opening experience, actually. No one should assume that someone claiming to be a professional on an Internet message board really IS a professional. (My personal basic verification strategy is the chain of real people: I have never met Rivka in real life, but I've met people in real life who've met Rivka in real life and therefore if she were making up significant details about her life, like her children or her PhD, I'd have heard.)

[gerisullivan.livejournal.com]

For Rivka: Setting appropriate boundaries is an important life skill. The fact that it feels transgressive serves only to point out how important and undervalued the skill is.

For Naomi: Woah, I am not a lawyer, but I do believe Lisa-or-whatever her name-was is lucky that misrepresenting herself as a doctor and giving people medical information and advice didn't land her in jail or cost her a minor fortune in legal fees. I'm pretty sure that's blatantly illegal everywhere in the US and would expect similar laws in most other countries.

Your advice about being wary of people's claims is spot-on, and even those who truly are professionals in their field aren't always right. But claiming medical credentials one doesn't have is several steps over the top.

[naomikritzer]

That is an interesting point. I have no idea what sort of legal trouble she could have gotten into. I will say, though, that on another message board I post at, someone committed actual theft-by-deception and despite going to the authorities, the administrators were unable to get her prosecuted. (She claimed to be a battered wife, to have left her husband after he tried to run her over with the car, and in desperate need of funds to pay for a lawyer / get an apartment, etc. It turned out that not only was this a lie, she'd volunteered to help with a charitable auction the board had done some months earlier, had gotten some donations, had sold the donations on Ebay and pocketed the money, then sadly claimed they were lost in the mail.)

Anyway, while in theory I'm sure you're right, in practice she'd have had to make one hell of a splash as Dr. Sally to actually get prosecuted. (To file a lawsuit, there generally need to be some actual damages. If someone had taken her medical advice and been damaged by it, they could have sued her, but ... she had no money to speak of, making it kind of pointless. A real doctor has malpractice insurance, but Lisa, needless to say, did not.)

[rivka.livejournal.com]

(My personal basic verification strategy is the chain of real people: I have never met Rivka in real life, but I've met people in real life who've met Rivka in real life and therefore if she were making up significant details about her life, like her children or her PhD, I'd have heard.)

You can go to the Maryland Board of Psychology Examiners website and type in my name, and I'll come back listed as a licensed psychologist! I do that sometimes, just for validation.

Of course, that would be assuming that you believe my name is what I say it is on Facebook...

[elisem.livejournal.com]

Strength to your boundary-setting arm.

[ailbhe]

Mmmm, boundaries are my favourite.

so glad you are back

[sm255.livejournal.com]

I'd totally given up on ever hearing from you again - am so glad that I happened to look for you today and found that you have come back to blogging. Great! I'm a very long-term reader and was always wanting to hear more of your story. I miss blogs - everybody's gone to Twitter or whatever and that just isn't interesting to read at all. so am very glad to see that one of my favourites has come back.
--Stephanie

Re: so glad you are back

[rivka.livejournal.com]

Aww! That's really nice to hear. Thank you. I am not sure how "back" I am, but it's nice to hear all the same.