Our last Clinician’s Quandary received an overwhelming number of responses. Here are a few more that didn’t make it into Part One but offer other useful perspectives on addressing this tricky clinical scenario. Respond to next month’s Quandary here.
1) Give Permission, Build an Alliance
The dynamics of therapeutic engagement can be paradoxical. Asking a client to betray their impulses can often reinforce the very unconscious behavior the clinician wishes to transform. If I was Jonathan’s therapist, I’d avoid asking him not to check his phone during sessions. Instead, I’d use this permission-giving as an opportunity to get closer to him. Why set myself up as a prohibiting parent type who casts Jonathan as a misbehaving child? Instead, I’d express curiosity about Jonathan’s phone use. If he’s checking Twitter, I might ask, “Hey, what are those tweets you’re reading?” Bring the phone into the session, don’t banish it.
When the therapist feels the impulse to ask Jonathan to put away his phone, I’d recommend that she take a moment to reflect on countertransference reactions. Why does she insist upon Jonathan’s full engagement? Is it the idea that he must see her as an effective therapist? That she must educate him about intimacy? If the therapist is focusing on her own needs, she should ask herself how that might distance her from clients like Jonathan.
The therapist should also ask herself what kind of message she feels Jonathan’s phone checking sends. Maybe it’s something like, You really don’t deserve my full attention. Or, I’m afraid to give you my full attention. Or, When you demand my full attention, I have a reaction that drives me closer to my phone. We can use these unconscious reactions as starting points for conversations. How might Jonathan learn to pause in silence and achieve deeper, nonverbal intimacy?
When we work this way, we’re making room for a relationship that may have been impossible in the client’s family of origin but is waiting to blossom in the space of the therapeutic relationship.
Sean Meggeson, MA, RP
2) Create Short and Long-Term Goals
From what I can tell, Jonathan seems to have trouble being alone with his thoughts. When there’s a gap in a session, he’s left to think. I believe his phone use is an attempt to put a Band-Aid on old wounds. Maybe he can’t forgive himself or others for an old infraction and sees himself as a victim, and distances himself from potential real-life relationships as a result.
In working with Jonathan, I’d want to ask him several questions about his habits and symptoms: does he fall asleep to the television? Does he look at his phone while eating meals? Does he think his anxiety could be linked to the content of therapy sessions or past relationships?
Next, I’d propose we try an experiment. I’d ask Jonathan to go an entire day without using social media, or a couple hours without looking at any electronic device at all. During that time, I’d ask him to write down his thoughts and symptoms, and share them with me at our next session. I’d ask him a few follow-up questions: what did he do during that time? Did he feel a sense of impending doom when he wasn’t distracted? If so, what did he worry would happen?
As part of our larger goals, I’d ask Jonathan to tell me what he wants out of a long-term relationship and partner. What does he feel is the purpose of a relationship? What does he think love and intimacy look like? His answers may shine light on whether he views a relationship as something that merely provides temporary satisfaction—as checking his phone does—or something that lasts longer.
Ryan Engar, LCSW
Salt Lake City, UT
3) Put Yourself in the Client’s Shoes
Jonathan seems stuck between choosing what he desires the most—a relationship—and avoiding his fear. It seems that in therapy, when he feels forced to interact, his unresolved fear about emotional connectedness flares up and takes over, which results in his phone checking. We have to accept that maybe Jonathan can’t control how he’s handling his anxiety, even when the therapist asks him to put his phone away.
I’ve found that work with clients like Jonathan is most successful when I approach it with gentle persistence. Even if Jonathan has chosen to enter therapy, it doesn’t mean he’s ready or eager to work on his anxiety about closeness. All it says is that he hates what he’s experiencing. Maybe he still has trouble openly talking about it. Gentle persistence avoids triggering him. I’d choose to follow Jonathan’s lead and try to understand what he’s experiencing. I’d want to be supportive throughout our work, even if Jonathan’s behavior doesn’t make logical sense to me. It’s taken me years to recognize that being supportive doesn’t discourage the client from dealing with their problems.
Jeffrey Von Glahn
Ann Arbor, MI
4) Acknowledge Anxious Inner Parts
If Jonathan was my client, I’d invite him to be curious about why he looks at his phone when he does. Does he make a conscious decision to check it, or is it more of a reflex? I'd also want to know why he looks at it “slyly.” Is he afraid something might happen if he looks at it more openly? What’s so scary for him about silences? Does he act similarly when he encounters silences in conversations outside the therapy room?
In working with Jonathan, I’d frame his phone checking as an opportunity for him to learn something about himself. The need to check could be a signal that something is “cooking” inside—that there’s a part of him that’s triggered by the silence. In Internal Family Systems (IFS), this part is called a Protector. I’d ask if he’d be interested in learning more about these parts and would help him understand the value of increased self-awareness as it relates to intimate relationships.
I’d also propose to Jonathan that we try an experiment: I’d allow him to look at his phone in session whenever he felt the need to. When he’d check it, I’d ask him to notice what he’s feeling in his body. Any changes in breathing? Heart rate?
Last, I’d want to normalize Jonathan’s feelings. We can all feel awkward at times during pauses in conversation. I might even do a little self-disclosure and admit that I try to remember to take deep breaths during lulls in conversation, tending to my own anxious parts.
Tish Miller, LCSW
5) Remember That All Behavior is Communication
I can relate to this clinician’s dilemma. When I get frustrated by clients checking their phone during a session, I have to remind myself that all behavior is a form of communication. It’s my job to stay curious about what that communication could be, rather than become judgmental or annoyed and tell the client to stop.
I wouldn’t be surprised if Jonathan got defensive if I’d asked him to put away his phone several times and then later asked to explore this issue deeper. First, I’d consult with myself and reflect on what gets triggered in me when Jonathan checks his phone. When the timing is right, I might say something like, “I was thinking about what you said about your phone not being a problem and how I could be more in touch with the times. As I'm sure you've figured out, I find your use of the phone in our sessions to be a bit of problem for me. Can you help me understand what I’m missing about this phone thing and help me get more with the times?”
By taking responsibility for the rupture between us, I might increase the chances of Jonathan being more open to exploring ways that his phone use might be getting in the way of his relationship goals.
We'll post a new response to each Clinician's Quandary on the first Tuesday of every month! See how to submit to next month's Quandary here.
September Quandary: I recently moved to a small town and found out that one of my client’s children attends the same school as my nine-year-old son. The two get along well, and our family was recently invited to attend a barbecue at my client’s house. I feel uncomfortable attending, especially since my client has spoken to me about issues in her marriage, but don’t want to jeopardize my son’s friendship or my chance at having a social life in this new town. Should I stay home or go?
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