The cell phone, now part of everyday life, is still mostly underutilized for therapy, a traditionally face-to-face profession, though growing evidence shows it can be an effective adjunct tool. An article on the December 31 BBC News describes an innovative program for bipolar clients. Every morning at 10 o'clock, clients receive a phone prompt asking them to record on a simple scale how depressed or manic they're feeling.

Consequently, when they go to their appointments, therapists have an accurate daily record of how their clients are doing. Clients report that the structured reporting serves as ongoing support. The mood swings of some have mitigated, and they can get along with fewer appointments. The program is so successful that the British National Health Service plans to use it nationwide, and it's being tested in Colorado.

In the October issue of Professional Psychology: Research and Practice, psychologist Mark Boschen, of Griffith University in Queensland, Australia, points out that cell phones are more convenient than computers for therapy. Because they're small, portable, stigma-free, and integral to most people's lives, they're useful virtually anywhere, at any time, for adjunctive therapy tasks. On the simplest level, they can deliver daily reminders via text messages or chime prompts to do homework assignments or reinforce important points from the last session. It isn't even necessary to call clients: phones can be programmed to contact them automatically.

Cell phones, says Boschen, are especially useful for clients who can't afford frequent therapy, who have difficulty getting in to see their therapists regularly, or who'd benefit the most from daily homework, such as phobic clients working on exposure therapy. He believes they'll be used increasingly as a therapy tool in the near future.

Paranoia on the Rise

At a time of rampant social isolation, the proliferation of online support groups has given millions of people solace, information, resource tips, and a sense of connection. But some online groups may be exacerbating disorders. "Pro-Ana" websites, for example, encourage anorexia, posting photos that extol anorexic bodies and imparting tips for anorexics on how to fool parents and therapists into thinking they've given up their eating disorder. Now a growing number of sites devoted to conspiracy theories and the threat of widespread mind control have spread across the Internet, supporting people in their belief that our everyday movements and minds are continuously monitored.


On one such site,, people report that their neighbors, their children, and the government are continually monitoring them. They claim that their cell phones, under the remote control of others, take pictures of them and listen in on their conversations, even when the phones are turned off. They report mysterious scars on their skulls where listening devices were secretly implanted. Mind-control sites like this also offer survival tips, such as lining certain rooms of your house with reflective materials, or shining headlights or flashlights directly at anyone who's watching you.

Are such sites helpful or harmful? In an article in the November 13 New York Times, Yale psychiatrist Ralph Hoffman, an expert in delusional thinking, says that delusional belief systems are "like a shark that has to be constantly fed. If you don't feed the delusion, sooner or later it will . . . diminish on its own accord." But though such sites reinforce delusions, they provide a comforting community and greater sense of empowerment for people whose tormented thoughts would normally drive them deeper into isolation and despair. Of course, they might be better off seeking treatment, but people with paranoia don't generally seek out therapists.

In our scary post-9/11 world, paranoid thinking is increasing so fast that British psychologist Daniel Freeman, who's written several books on it, says we may be entering the "age of paranoia." He insists that one in four Londoners now have regular paranoid thoughts. Dennis Combs, a psychologist and paranoia researcher from the University of Texas, Tyler, says the number of college students reporting paranoid thoughts has tripled, from 5 to 15 percent, in the last decade. While no one claims that the websites are responsible for increasing the general incidence of paranoid thinking, like so much else going on in the world, they're probably part of the amplifying feedback loop.

The Cancer Group Support Debate Continues

For some time, psychologist James Coyne, of the University of Pennsylvania, has been arguing that psychosocial support groups and other psychological interventions don't prolong the survival of people diagnosed with cancer (see Clinician's Digest, May/June 2008). But now, a new study by psychologist Barbara Andersen of Ohio State University claims that 11 years after a psychological intervention, women who'd been treated for breast cancer and attended 26 sessions of support groups over a one-year period had fewer recurrences and longer survival rates than the control group. Andersen's study seems especially significant because, like Coyne, she'd originally been skeptical about such claims. Her 2002 review of the research in the Journal of Consulting and Clinical Psychology concluded that survival studies of psychological interventions for cancer survivors were riddled with methodological problems (see Clinician's Digest, May/June 2003).


Since then, however, Andersen has conducted her own studies, focusing on whether support groups affect patients' immune systems. In the November 2004 Journal of Clinical Oncology, she assessed the immune systems of 227 women with breast cancer, half of whom attended small-group sessions focusing on stress-reduction techniques, exercise, diet, and garnering support from doctors, family, and friends. She found that the T-cell counts of the women in the psychological intervention group had remained stable or increased, indicating a strengthening of their immune systems, whereas the T-cell counts of the women in the control group had decreased.

Her current study, published in the November issue of Cancer, follows the same women to assess their cancer recurrence and survival rates. She reports that 11 years later, 29 in the intervention group and 33 in the control group had experienced a recurrence of their disease, and 24 in the intervention group and 30 in the control group had died. Tying these statistics to her earlier research on immune systems, she concludes that support groups strengthen immunity—which results in fewer cases of cancer recurrence, longer times to recurrence, and longer survival.

Coyne calls Andersen's findings of intervention effects on the immune system "weak and inconsistent." Citing the small differences between her intervention and control groups' recurrences and deaths, he insists that the results are no better than what could be attributed to chance. Her study's sample size, he says, is too small to detect any survival effects. Another problem he sees is that Andersen's original study, which determined the sample, was designed to test a completely different hypothesis.

Coyne insists that psychological research that makes claims about extending lives ought to follow the same demanding protocol required of medical studies: a detailed declaration of the study's design and hypotheses ahead of time, with subsequent analyses restricted to that declaration. He adds that while he personally wishes Andersen's findings were true, as a scientist, he must raise legitimate research issues. "Like my grandmother used to say, ÔIf it isn't true, it ought to be,'" he says. "But no study claiming an effect of psychotherapy on cancer survival has ever been replicated, and there's no reason to believe that Andersen's study would be any different."

Sweet Revenge, Bitter Aftertaste

Colgate University psychologist Kevin Carlsmith challenges the notion that revenge is sweet. In a study published in December's Journal of Personality and Social Psychology, he and his team asked participants to play several rounds of a "cooperative" investment game with three anonymous players. In actuality, the other players were computer programs, which enabled the researchers to control the game.


One of the "players" promised that he'd cooperate so that everyone could maximize their earnings, but as the game progressed, that "player" began playing uncooperatively, increasing his own earnings while costing the human player money. In case the humans didn't catch on, researchers pointed it out to them and then let the game resume. In a series of variations, the real players had an opportunity to punish the selfish double-crosser anonymously by costing him money, to simply be left with the knowledge they'd been double-crossed, or to think about how it would feel if they could punish the double-crosser.

Those who had the opportunity to punish the double-crossers ended up feeling worse, not better—continuing to seethe and ruminate—after they'd given the double-crossers a taste of their own medicine. People who didn't retaliate felt less anger and ruminated less. Remarkably, not only did punishers and nonpunishers wrongly predict that punishing would make them feel better, but the punishers, who felt bad after retaliating, contended that if they hadn't punished the player, they'd have felt even worse—a forecast clearly contradicted by the evidence of their own emotional reactions.

Carlsmith speculates that avengers end up empathizing with the feelings of their victim and seeing themselves as the kind of people they don't want to be. People freed from the "opportunity" to exact vengeance turn their mental energy toward more effective coping strategies, like distraction or minimization: they're more apt to think thoughts like "It was only a game," or "I've got more important things to think about."

If taking revenge actually makes people feel worse, why haven't we realized its self-defeating cycle by now? Carlsmith speculates that revenge may have the evolutionary function of helping ensure group cooperation. Knowing they'll likely get punished for antisocial behavior may deter some people from acting against the best interests of the group. Revenge may make the avenger feel worse, but it may help the group in the long run.

When Is a Parent Truly There?

The Pew Research Center's Internet and American Life Project's report on modern communication and families, "Networked Families," concludes that technology such as cell phones, e-mail, and instant messaging are playing a key role in connecting our overworked, overscheduled families. Eighty-five percent of more than 2,200 respondents say that, thanks to the Internet and cell phones, their family is as close or closer today than their families of origin were. But does this "closeness" have any relationship to intimacy? The survey finds that the more communications devices a family owns, the less likely they are to eat dinner together, and the likelier they are to report lower levels of satisfaction with their family time.


Our many electronic devices keep us wired together, but remain fundamentally impersonal. As Michael Ventura pointed out in the January Networker, electronic connection is bereft of an enormous amount of information that we take in through all five senses. "Nothing," he says, "has more potential to shift our experience of ourselves than a frank, face-to-face encounter."

The intimacy limits of electronic connection may be seen in the Pentagon's plan to help children aged 3 to 5 cope with their parent's deployment overseas. The Pentagon plans to award three contracts worth up to $100,000 each for companies to develop a system to enable young children to talk with a simulacrum of their parent on a computer. The solicitation guidelines call for "innovative applications that explore and harness the power of advanced interactive multimedia computer technologies to produce compelling interactive dialogue between service members and their families via a PC- or Web-based application using video footage or high-resolution 3-D rendering." In other words, children will see a hologram or video image of their parent and hear the parent's actual voice, and it'll feel more like a dialogue than a prerecorded video.

There's been some debate about the value of the Pentagon's proposed project. "No matter how sophisticated the technology is," says Susan Linn, associate director of the Media Center at the Judge Baker Children's Center, "the computer-generated parent won't be able to respond empathically to a child. And a three-dimensional, nonsubstantive, talking representation of a parent comes awfully close to being ghostlike, which could be a little confusing and scary for young children—especially if the parent dies." It would be better, she says, and diminish the parent less, to help children digest the parent's absence instead of giving them an illusory parent.

In a January 9 Time article, Navy psychologist Russell Shilling focuses on the upside of the project: "The need to say goodnight or to continue to feel connected to a parent is very important," he says. And if they get the technology right, sophisticated programming could make these conversations flow well enough to reassure young children that the parent is really there—wherever and whatever "there" is.

Scamming the Scam Expert

Psychologist Stephen Greenspan, whose book Annals of Gullibility describes some of history's greatest financial scams and explains why people fall for them, ruefully notes that he himself lost a significant chunk of his retirement savings to indicted financier Bernie Madoff. In an article in the online magazine Skeptic, Greenspan matches his own experience against his theories about what causes gullibility. What made him suspend his usual mildly skeptical, analytic faculties? How could an intelligent person fall for this?


Greenspan argues that the strongest inducement to falling for a con is the social-feedback loop. When enough people start whispering or shouting about a good thing, the scam acquires a credibility and excitement—an "irrational exuberance," in a phrase made famous by economists Alan Greenspan (no relation) and Robert Schiller to explain the once-soaring stock and housing markets. Call it the sunny side of mob psychology.

Greenspan listened to a financial advisor who was a close friend of his sister and had himself invested heavily in Madoff, as had many of his sister's friends. So strong was the social-feedback loop that when a friend known to be financially savvy warned him about investing, Greenspan reminded himself that his friend was prone to "knee-jerk cynicism."

The easy assumption is that people fall for scams because they're greedy, but Greenspan says it's often the situation, not greed, that draws people in. For him, the promised investment returns were steady and modest, exactly the investment strategy he wanted at this stage in his life; he'd have been suspicious of extravagant promises. Personality ties into gullibility, too: "I'm a highly trusting person who doesn't like to say no," he writes—which makes him vulnerable to sales people and friends who urge him to do something for his own good. His trust level, combined with his occasional bursts of risk-taking and impulsive decision-making, made him a sitting duck.

But his gullibility had some limits. He retained enough skepticism so that he didn't toss his entire retirement savings into Madoff's maw. "As I avoided drinking a full glass of Madoff Kool-Aid," he consoles himself, "maybe I'm not as lacking in wisdom as I thought."

Therapists as Clients

Surveys find that about 20 to 25 percent of therapists have never sat in the client's chair. So Scranton University psychologist John Norcross, who began studying therapists in therapy 20 years ago, wondered who they were and why they'd avoided the experience. He and his coresearchers compared 119 therapists who'd never been in therapy with 608 who had, to find out why they'd abstained and how they might differ from their colleagues.


The results, published in the December Journal of Clinical Psychology, show that cognitive and behavioral therapists, as well as therapists who identified themselves primarily as academicians or administrators, were the likeliest to have avoided therapy. Their personal reasons for abstaining boiled down to the idea that they hadn't really needed it—they had alternative methods of dealing with stress, had the support of family, friends, and coworkers, or "were able to meet challenges on their own."

In another study, soon to appear in Psychotherapy, Norcross found that therapists consistently rate their experience in the client's chair as extremely useful in helping them establish rapport with clients and renewing their faith in the effectiveness of therapy. Nevertheless, he points out, no research demonstrates an association between therapists' being in therapy and their professional effectiveness.

Norcross, one of the leading researchers into the components of effective therapy, doesn't think that experience as a client is essential to developing clinical effectiveness. "What keeps coming out of the research," he says, "is the importance of a therapist's heightened sensitivity to the therapy relationship." While being a client certainly produces that, he believes that clinicians can learn that kind of attunement through other experiences, such as yoga, meditation, or empathic supervision—anything that helps a therapist "know the power of empathy and presence" and "feel the vulnerability of being on the other side."


Cell Phones:; Professional Psychology: Research and Practice 39, no. 5 (October 2008): 546-52. Support Groups: Cancer 113, no. 12 (November 17, 2008): 3450-58. Revenge: Journal of Personality and Social Psychology 95, no. 6 (December 2008): 1316-24. Parents Not There: Pew Report at; Pentagon project at Scammed: Skeptic, December 23, 2008, Therapists as Clients: Journal of Clinical Psychology 64, no. 12 (October 21, 2008): 1368-76.

Garry Cooper

Garry Cooper, LCSW, is a therapist in Oak Park, Illinois.

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