Through the mid-’90s, my writings about technology and self were mainly hopeful about the psychological impact of digital culture. Indeed, in 1996, I was on the cover of Wired magazine for my work portraying online avatars as part of a new kind of “identity play” that expanded people’s sense of themselves. Ironically, that cover story appeared just as I was changing my mind about where we were allowing technology to take us. I had two related concerns: we expected more from technology and less from each other. We were increasingly willing to talk to machines, even about intimate matters. And increasingly, with the rise of mobile devices, we were paying attention to our phones rather than each other. In both cases, there was a flight from face-to-face conversation. In both cases, technology was encouraging us to forget that the essence of conversation is one where human meanings are understood, where empathy is engaged.
Teaching at MIT, I was in the heart of the presentation of machines as companions and conversational partners. Indeed, some of my closest colleagues were beginning to develop programs that would be stand-ins for psychotherapists, even though there was no way that these machines could do anything except offer responses that fooled people into thinking that they were actually understanding the human meaning of what was being shared with them.
These technical proposals were seductive. In my studies of artificial intelligence, I interviewed hundreds of people across generations who, in the course of the 1990s and early 2000s, warmed to the idea of robots as friends, of computer programs as counselors. In this, they were not only willing to take the simulation of understanding as genuine understanding, but the simulation of feeling as feeling itself. Consider a high school senior who told me that a computer program with artificial intelligence would be a better resource than his father for talking about girls and dating because the program would have so much more “information” and “cases” to work with. It was essentially the argument I encountered when I appeared on a panel of engineers and social scientists to talk about the introduction of Siri, the conversational agent on Apple’s iPhone. The topic turned to how much people like to talk to Siri, part of the general phenomenon that people feel uninhibited when they talk to a machine. One of the social scientists on the program suggested that soon a souped-up and somewhat smoothed out Siri could serve as a psychiatrist.
It didn’t seem to bother him that Siri, in the role of psychiatrist, would be counseling people about their lives without having lived one. If Siri could behave like a psychiatrist, he said, it could be a psychiatrist. If no one minded the difference between the “as if” and the real thing, let the machine take the place of the person. By the early 2000s, I found this kind of reasoning to be so widespread that I gave it a name. This was the pragmatism of the “robotic moment.” We hadn’t made machines that could serve as therapists or as companions, but we were willing to behave as though we had. Before we’d created machines that could understand us, we’d changed ourselves to be ready for them: we’d diminished our appreciation of our own human conversation.
What an artificial intelligence can know is your schedule, the literal content of your email, your preferences in film, TV, and food. If you wear body-sensing technologies, it can know the degree to which these things emotionally activate you because it may infer this from physiological markers. But it doesn’t understand what any of these things mean to you, because it’s not judging them from the point of view of being human.
Our willingness to talk to machines is a part of a culture of forgetting that challenges psychotherapy today. What we’re forgetting is what makes people special, what makes conversation authentic, what makes it human, what makes psychotherapy the talking cure.
These are some of the consequences of expecting more from technology than technology can offer. I’ve also said that in our flight from conversation, we expect less from each other. Here, mobile communication and social media are key actors. Of course, we don’t live in a silent world. We talk to each other. And we communicate online almost all the time. But we’re always distracted by the worlds on our phones, and it’s become more common to go to great lengths to avoid a certain kind of conversation: those that are spontaneous and face-to-face and require our full attention, those in which people go off on a tangent and circle back in unpredictable and self-revealing ways. In other words, what people are fleeing is the kind of conversation that talk therapy tries to promote, the kind in which intimacy flourishes and empathy thrives.
In this cultural environment, what happens in the consulting room? When I talk to therapists, they tell me that clients today find it harder to concentrate on face-to-face conversation. They may not even see its value, feeling more comfortable with the self they can present on their screens. And in the spirit of the robotic moment, they may be comfortable with apps on their phone that, for them, serve at least part of the job that therapy once did. Rather than relating directly to a real-life therapist, they use apps in which you tell your story, and apps that analyze it. They’re drawn to apps to calm you down and let you know if you may be guilty of distorting your cognitive field. We now face a generation of clients who may need talk therapy in order to be schooled in the very rudiments of emotionally revealing talk.
Technology Creates a New State of the Self
In the past decades, technology has changed not only what we do, but who we are. Some of these changes have crept up on us, until seemingly, and all at once, we face a generation that seems radically different from those that came before. My research across generations shows that some of the most impressive changes are connected to the social practices we employ with our phones and other devices.
Online we can curate the self as we want it seen. We can edit our conversations. We can cultivate the illusion that we can say the “right thing.” Being “polished” and indulging in the fantasy of perfection becomes more highly valued than authenticity. Contrast all of this with the simplest lessons of talk therapy: there, we quickly learn that when we stumble and lose our words and are left in silence, this is when we may reveal ourselves most to each other.
So today, talk therapy finds itself an actor in a dramatic moment. Digital culture threatens our capacity for spontaneous talk, and, perhaps even more importantly, it undermines our ability to understand the value of talk. These days, we’re tempted to stay in the safety of our screens when we communicate. One young man I interviewed put it this way: “Conversation? I’ll tell you what’s wrong with conversation. It takes place in real time, and you can’t control what you’re going to say.”
While technology seduces with its offer of control, in-person talk offers the chance to directly experience imperfection, empathy, and relationship. And so we find ourselves in a cultural moment in which talk therapy is being marginalized for not being “scientific” enough, for not providing enough outcome studies to legitimate it for insurers and make it seem cost effective. At the same time, it’s needed more than ever in a larger culture that has, in important ways, gone silent. Otherwise put, psychotherapists are experts at the kind of talk that digital culture needs most, the kind of talk in which we give each other full attention, the kind of talk that’s relational rather than transactional. But in order to take this role, to step up in this way, therapists have to take themselves out of the defensive posture they too often take when it comes to matters technical and scientific.
I speak to therapists in many contexts, as colleagues and also as informants in formal interviews as I pursue my studies. In all these situations, I find that so many talented clinicians suffer from a crisis of confidence, unsure of the relevance of their profession in a high-tech world that in many ways seems to have passed it by. This demoralization can take many forms. It can be harder to find psychotherapy clients, for instance, as more and more people ask for medication and a “check in” every few months, even as you encourage them to try two or more sessions of psychotherapy a week.
For one psychiatric social worker in a hospital setting, demoralization is this: she works in a clinic that will lose funding if she doesn’t produce evidence of effective therapeutic outcomes for her mixture of talk therapy and cognitive behavioral techniques. It’s not clear to her that she can produce these papers. For one thing, she admits that she doesn’t fully believe in the ways she’s measuring “success.” She feels she’s leaving out something she’s giving to her patients that she hasn’t known how to capture in an instrument. As she puts it, “My patients feel in a relationship.” While she thinks that this fact alone is success, she realizes that it’s not easily measurable.
The Empathy Gap
More and more, we turn away from each other as our face-to-face communication competes with our phones. We want to be with each other, but to also be connected to other people and places online. In my fieldwork, college students tell me how they navigate this when eating with friends in the dining hall. They observe “the rule of three.”
This means that in a conversation, say among six at dinner, you have to check that three people are paying attention to the speaker—with their heads up—before you give yourself permission to look down at your phone. So conversation proceeds, but with different people having their heads up at different times. The effect is what you’d expect: conversation is kept to topics that people feel they can easily drop in and out of.
In fact, research shows that when people are together, say for lunch or a cup of coffee, even the presence of a phone on the table (even a phone turned off) does two things. First, it changes what people talk about—it keeps conversation light because the phone is a reminder that at any point, we might be interrupted, and we don’t want to be interrupted when we’re talking about something important to us. Second, conversation with phones on the table or even phones on the periphery of our vision, interferes with empathic connection. Two-person conversations that take place with a phone on the table leave each person feeling less of a sense of connection and commitment to the other.
Since it’s so often that we speak to each other while literally holding our phones, it’s not surprising that we begin to see evidence of an empathy gap. In 2010, a team at the University of Michigan led by the psychologist Sara Konrath put together the findings of 72 studies conducted over a 30-year period and found a 40 percent decline in the markers for empathy (measured as the ability to recognize and identify the feelings of others) among college students. Most of the decline took place after 2000, which led the researchers to link it to the new presence of digital communications.
Considering an empathy gap underscores the importance of the therapist’s role in our digital culture. The basic work of therapy is now the work that’s most needed: sitting quietly with a client, giving that person your full attention, creating a space to pay attention to one’s own thoughts and to listen to another. Making the point that these things are important is a point that life today doesn’t make. Conditioned by the experience of life on the screen, people’s expectation is that the world will come to them in a constant, steady stream. Solitude becomes painful. At a stoplight, at a line at a supermarket, you see people turn immediately to their phones. As a culture, our capacity for solitude is challenged by the culture of the continual feed.
Consider Vanessa, a college junior who talks about her trouble sitting alone with her thoughts and her habit of using the phone to avoid talking to other people. “As long as I have my phone, I’d never just sit alone and think,” she says. “My phone is my safety mechanism from having to talk to new people, or letting my mind wander. I know that this is bad, but texting to pass the time is a way of life.”
Vanessa describes a way of life that takes a toll. The capacity for solitude is a cornerstone for the capacity for relationship. Only when we can gather ourselves can we turn to others and really hear what they have to say, really hear who they are, rather than projecting onto them what we need them to be saying to support our fragile sense of self. To paraphrase Winnicott, “If you don’t teach your children to be alone, they’ll only know how to be lonely.”
Children learn the capacity to be alone by being “alone with” caring adults. Gradually, the child becomes comfortable being alone with him or herself. As a therapeutic enterprise, therapy is, crucially, a place where clients can learn to be alone with themselves by being “alone with” their therapists. What’s changed is that, these days, clients need this from their therapists more than ever. And not just clients. The culture of therapy affects our culture as a whole. How we seek help, what we expect help to look like, changes our values in a broader way. Right now, digital culture closes down the questions that talk therapy knows how to open up.
The mores of therapy—the value it places on being with, forming an empathic bond, and the quiet attention necessary to do this—become more central as a cultural corrective. If therapy once allowed patients to develop the capacity to talk about sexuality in a way that was prohibited outside of the consulting room, now there’s a new imperative: to experience solitude and an experience of quiet, empathic connection.
Some therapists tell me that when clients tell them that they want to keep their phones out during sessions, the therapists often say yes. Perhaps, say the therapists, this will be calming. Perhaps, this is how we all will live our new lives, including our lives in treatment. And therapists, too, are tempted to leave their phone screens open to their view. This means that they, too, can see who sends a text or calls during a session. But a phone in our sights puts us in a state of attentional disarray. A client who has a phone out isn’t cultivating the capacity to pay full attention to another person. And as for the therapists who leave their own phones out so that they can see incoming texts and calls, arguing that this will alert them to “emergencies,” this needs to be addressed as bad practice. It models the problem, not the solution.
Indeed, as a profession, psychotherapists today are tempted to turn away from the complexities of face-to-face conversation for the convenience of doing therapy online. This is a temptation that extends across all branches of the profession, and across all therapeutic “ideologies,” from cognitive behavioral therapists to psychoanalysts. Of course, doing therapy sessions on the phone has been a standard practice for decades. Many therapists felt it served them well during vacations, for clients whose work involved frequent travel, or when clients moved and decided to continue to work in established relationships. More recently, however, a sometimes convenience has escalated into a way of life. Therapists argue that Skype and Facetime make it possible to treat clients from any part of the world. One need no longer have a local practice in any sense.
I’ve been struck by how the therapeutic community, including those who’ve brought us some of the most moving writing about presence and the body, seem quick to overlook the body’s importance in treatment. That understanding of how bodily experience is part of intimate conversation is part of how therapeutic tradition has contributed to our larger culture: we’re with each other body and mind, words and bodies, all tied together. Therapists have elaborated on how, when we deeply listen to each other, we have immediate bodily experiences of each other’s words that demonstrate our connection and complexity. Yet in my meetings with therapists, I find that when Skype treatment is up for discussion, the body is sometimes presented as close to irrelevant. And I often see a progression in thinking. At first, treating a client by Skype is presented as “better than nothing.” Gradually, what you can do on Skype begins to be presented as equivalent, or maybe better than what you can do with the client in the room.
In one exchange with a clinician, this one at a psychoanalytic meeting, an analyst tells me that in a treatment she’s doing via Skype she feels “a quickening,” and sessions “feel more intense” than when the client is with her in her office. I feel sad when I point out that there’s a literature on how the online experience puts us into a state of hypervigilance, in which it’s natural to feel a quickening. Our online experiences with each other may be exhilarating, but they don’t necessarily encourage the relaxed, free-floating attention that the analytic tradition has so long argued is a privileged way to access the unconscious and deeper levels of awareness.
Why are therapists so quick to abandon the body and what it brings to our understanding? Or have we always wanted to run from our bodies, from the anxieties of being together in this messy way, and now we’re given a chance? This is my belief and why I believe technology calls us to a great challenge. We’ve always wanted to escape what’s most difficult in our relationships, and now technology gives us a way. At the same time, we’re being challenged to affirm the values that are at the core of what it means to be human and to stand up for a kind of therapeutic work designed to speak most directly to our full capacity for meaning, empathy, and relationship. And for the untidiness that all of these bring.
In its desire to run away from the messy toward something that feels more tidied up, the therapeutic community isn’t alone. Our clients, too, dream of a tidier world, where they won’t have to deal with the messiness of words and the actual presence of other people. One expression of this attitude is to think of conversation as providing information, rather than offering relationship. Recall the high school senior who thought a computer program had more to say to him about dating than his dad because of the size of its database. This informational, transactional attitude about conversation has made it easier to accept the idea of therapy, too, as being about information, and thus open to being delivered by a machine and boiled down to a program or an app.
In my research, I find that many people who are attracted to the notion of therapy by an information-rich program also like the idea that the machine would be nonjudgmental. One mother of a 9-year-old says, “Nonjudgmental, isn’t that something that therapists should be but so rarely are?” She goes on to tell me that her daughter vents to Siri on Apple’s iPhone. The girl feels free to let her feelings out to Siri. With people, says her mother, she’s more likely to play the role of the “good girl.” Isn’t this self-expression a good thing? Perhaps, but one of the most important lessons for children to learn is that saying something angry to a parent doesn’t destroy a parent—that the fantasy that one can destroy a parent with angry thoughts is only that, a fantasy. This lesson, that words don’t destroy, frees up the child’s capacity for feeling and expressing emotion. But the opportunity to learn this crucial lesson is lost if a child turns to a machine when she wants to say the “hard things.” That’s exactly what this mother should not want to teach her daughter. And yet to her and to many others, it seems an increasingly acceptable solution.
The Path Forward
I recently met Sara Konrath, the lead author of the study that established the “empathy gap” among college students over the past 30 years. She told me that after she’d surveyed the findings and the study had been published and widely reported in the media, she’d become despondent. The picture for the future seemed bleak. Konrath’s first response: she went off to design what she called “empathy apps” for the iPhone. She thought it a sensible move: if you practiced on these apps, you might do better at developing empathy.
In this, Konrath followed a common impulse—if technology got us into a problem, technology will get us out of it. We’re all tempted by this idea. But I believe it’s a myth that takes us away from the obvious—we are the empathy app! This simple truth should place the practitioners of empathic listening, of quiet space and self-reflection, at the center of today’s most important cultural conversations. But I see too many therapists held back by a crisis of confidence about their core beliefs in the power of words and relationships. They’ve been told too many times that “scientific methods” use psychopharmacology and protocols. And I also see them held back by the temptations that they share with their clients, among these the temptation to use technology to make their lives more convenient and give the impression of tidying up conversations.
I’m no longer a practicing therapist, but I’ve recently had experiences with my students that allow me to relate directly to such temptations. I find that my students no longer want to come to office hours. They want to send me emails, some actually talk about wanting to send me “perfect emails” that ask their questions in the most direct and exact way. And they want me to send them just the right emails in return. I try to explain to them what I know: that anyone who’s been lit up by learning didn’t have this experience because they sent out a perfect question and got back a perfect answer. More likely, they went in to see a teacher with a very imperfect question and that teacher said, “That doesn’t seem right to me. But work on it. And come back next week. I’ll be here. We’ll look at it again, together.” Again, together. The key here is the offer of being there again, and again. What makes the difference for learning is the offer of relationship. The fantasy of the perfect email exchange is a fantasy of changing a relationship into a transaction, a conversation into a connection.
And yet, when a student tells me that she doesn’t want to come to office hours and asks, “Would I please just answer this email?” there’s a moment when I want to relent. For if I let this contact happen by email, I can have more control over my schedule. I know that her email will probably be more on topic. This means I don’t risk being confronted with all the other things that come up in office hours when students are off guard—learning about family problems, financial troubles, romantic panic, roommate stress. These are things that will cause me to get involved, to pay out dearly in time, attention, and energy.
Studies show that what students get out of college depends in large measure on faculty getting them to come to office hours and ask their imperfect questions. And yet, like every therapist who considers a Skype session in order to take a long weekend, I’m tempted when a student wants to substitute an email for a face-to-face exchange. Digital connection is a way to keep my job simple and my life tidier. We have to remember why it’s important to be the messy, complex, people that we are. We have to support each other in remembering that the kind of conversations that may seem old-fashioned are actually, of our moment, and most necessary and essential. And all the more essential because they can be portrayed as superseded by something faster, cheaper, and more precise. What therapists need to recognize is the reason we need to talk: to forge relationships that are the triumph of messy, breathing human connection over the cold instrumentality of treating each other as apps.
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