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|The New Technologies of Change|
The New Technologies of Change
21st Century tools are transforming therapeutic practice
by Jordan Magaziner
One of my college professors liked to say that to interview someone effectively, you have to be able to "see the whites of their eyes." To really get to the heart of another person, she insisted, you have to take in all of their nonverbal cues and quirks—do they have permanent laugh lines, or frown lines? Do they gesture dramatically, or keep their hands in their lap? Similarly, many believe that to treat clients effectively, therapists should be able to gaze into their eyes and engage them through every one of their senses. But more and more these days, technology is challenging the idea that therapy must revolve around the traditional, face-to-face clinical encounter.
The movement to apply new communication technologies to therapy seems to have started over the last 10 years with online therapy. Many of its proponents believe that not only is online therapy a convenient way to deliver services, but that some clients feel freer when using their keyboards in their own homes than they do in person. New York therapist Elizabeth Zelvin, who's been practicing therapy online for the past decade, says that her largest group of "e-clients" is composed of individuals who have "shaming" issues, such as eating disorders and sexual abuse. Working online helps them feel safe, making it easier to reveal issues at their own pace and giving them more time to express themselves. "The Internet is an egalitarian environment," says Zelvin. "There's no intimidating office with a big leather chair."
To build an effective therapeutic relationship online, therapists need to be sensitive to "reading between the lines" of text to detect emotional nuances. Working with clients in this way means intuiting a lot through how clients use humor and irony. Therapists need to be able to "express warmth through your fingertips," as Zelvin puts it, by incorporating common Internet shortcuts—emoticons, smiley faces, and acronyms. At times when it may seem like she's being critical, Zelvin adds a "winkie" face to soften her tone and convey that she's giving "tough love" because she cares, not because she's trying to attack her client. While miscommunications happen, she says, they happen no more frequently than when working face-to-face. "There's more opportunity, not less, to straighten out a miscommunication," she insists, explaining that if either the client or therapist feels uncomfortable after the session, a brief e-mail might be appropriate, or, the therapist could wait to see whether the client brings it up during the next session. Zelvin says that even after 10 years of practicing "e-therapy," she's still amazed by how powerful these online sessions can be. As younger clients who've grown up in the age of the Internet shape the future of psychotherapy, she believes technology will play more and more of a role in therapy. "I think it's therapy, not online communication, whose future may be shaky," notes Zelvin. "People want quick answers, and Internet users aren't used to paying for services, so it's a challenge."
Although there are many advantages to online therapy, not the least of which are scheduling flexibility and comfort, some therapists may find it nearly impossible to conduct sessions exclusively on their keyboard. Skype is one option that makes online therapy more like a traditional face-to-face session. Increasingly, therapists are using Skype's free video-chat program to reach clients long-distance or during times that they otherwise would have had to cancel the appointment. For example, when one of clinical psychologist Jonathan Douglas's clients could no longer travel to therapy because of physical disabilities, the client suggested that they communicate via Skype. Although initially concerned about confidentiality, Douglas soon concluded that it was no riskier than phone therapy. Another of Douglas's clients prefers webcam sessions to driving to the office, particularly in the harsh, Canadian winter.
For some therapists there isn't that much difference between treatment via Skype and therapy-as-usual. "With Skype, I'm able to get the cues that I need," insists one clinical psychologist. "I can see facial expressions, lip movements, and hand movements. I don't need to see a client's leg!"
Today there are already tens of thousands of apps—specialized software that can efficiently calculate a tip, check movie listings, provide sports statistics, translate languages, and much more—available for smartphone users. These now include at least a few dozen for mental health issues, some developed to be used in conjunction with therapy, and others intended as free-standing self-help resources.
The mym3 app, by My Mood Monitor, is a questionnaire that asks users