Of particular note is the current generational difference in older, more traditional therapists who are digital immigrants and younger age clients, who were born into and are native to the digital world and who much prefer this method of communication, even when sitting together with whomever they’re communicating.
This may work well (or not) for relationships with friends and families of millenials, but it spells disaster for the unique psychotherapeutic relationship. I am surprised at the number of therapists who espouse the benefits of electronic appendages with clients and who readily share cell phone numbers with them for texting. This has enormous implications and contraindications for psychotherapeutic work.
Traditional training emphasizes the crucial importance of establishing secure frame treatment. This includes having a set time each week to meet in a treatment room that affords a completely private and confidential setting for clients to feel safe and secure in working on their issues without intrusion or interruption.
Sessions begin and end on a specific day and time each week, which maintains the integrity of the unique work and therapeutic alliance with the therapist.
Enter the digital world in which clients can, and do, contact their therapists – sometimes daily – between sessions.
The gold rush of non-face-to-face exchanges afforded by wireless umbilical cords runs contrary to this essential element of therapy and is fraught with clinical disasters.
Confidentiality is challenged. Any number of people can witness the exchanges and the texts can be readily accessed by friends or family members who can snoop through the clients’ phones.
Some therapists feel that texting strengthens attachment and therapeutic alliances. What it does, however, is encourage dependency and disregard boundaries and the importance of maintaining the therapeutic alliance in ways that establish and promote the integrity of the psychotherapeutic work.
The sanctity of the treatment space becomes non-existent. Clients can intrude into the therapist’s life whenever they feel the need.
Sessions never end and can be continued at the client’s whim because electronic appendages make it possible to communicate with the therapist 24 hours a day, every day. With that comes a demand-quality that the therapist return texts quickly and often.
Electronic communication is wide open to miscommunication. It lacks tone, timing and the emotional/psychological feel of in-person sessions with the wealth of information that non-verbal communication supplies.
Therapists are known to even allow clients to text others during sessions. Cell phones are inches away from clients’ fingers and it’s felt that “if they’re only texting it’s not like they’re actually talking on their phones.” Often clients will say that they have to be accessible to text for work-related reasons and therapists will accept that without question or interpreting it as resistance.
Therapists often charge for outside-of-session communication, which is not insurance reimbursable. Fees of up to $210 per “‘session” are common.
I recently saw a most abhorrent on-line ad with a picture of a young father bottle-feeding his infant, which is a very special bonding time because of the cuddling, eye contact and opportunity to coo and connect.
In one hand he held the baby bottle from which the infant was feeding. In the other he held a cell phone with which he was texting. The ad read: “ ____ allows you to complete life’s tasks without losing valuable time to devote to other demands.”
It’s time for us to get a reality check and reclaim our humanity and not let digital devices dictate how we are to function.
Therapists also need to reclaim and maintain the integrity of our work and the uncompromising essentials that are in place to provide clients with the best possible treatment outcomes.
Noreen M. Keenan, LCSW, Ph.D., is a licensed clinical social worker in private practice in Albany, N.Y. She specializes in individual, couples and family therapy. She is originally from Canada, where she was trained in a psychoanalytic orientation, and has worked extensively and eventually supervised in agencies, schools, court and hospital settings. Her email is: firstname.lastname@example.org.