Abstract
Background: Despite the rise in therapist use of social media, current ethical guidelines have not provided clear guidance on how to use social media. Ethical guidelines commonly suggest therapists apply the same ethical principles advised
for their offline work, without thorough consideration of differing potential ethical dilemmas online.
Methods: A systematic review was conducted to explore the main ethical dilemmas encountered by therapists who use social media. Three databases were searched: PsycINFO, Web of Science and CINAHL Plus. A total of 52 studies were screened
by their titles and abstracts, with a subsequent 36 studies analysed against inclusion and exclusion criteria. The remaining 14 studies were assessed using quality standards and included within the thematic synthesis.
Findings: Data analysis conceptualised three themes: therapist searches risking the therapeutic relationship with subthemes of loss and trust and power imbalance; therapist defensiveness in response to client searches with subthemes of
self-disclosure and self-protection; and societal normalisation of social media with subthemes of familiarity and ease and blurred boundaries.
Conclusion: The societal prevalence of social media use suggests it is now inevitable that therapists will experience some form of ethical dilemma regarding social media. Therapists need an awareness of how online searches for clients
may impact the therapeutic relationship. The risk of boundary crossings from clients online can be minimised through increased privacy settings and reflexivity on what therapists self-disclose online. Ethical dilemmas on social media should be discussed
in supervision, with further guidance needed for the ethical use of social media as a therapist.
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