The communication between psychologists and patients has been impacted by the revolution in communication that has occurred due to cyber technology and global communications networks. When, where, and how therapists and clients “talk” is not what it was when I started practicing psychotherapy in 1973! It is the responsibility of psychotherapists to examine how they use technology and new methods of communication in their work, and to question the impact on the psyches of both the therapist and the client.
There are many areas of cyber technology and communication methods that I can address, including emails, cell phone calls and texts between sessions, but for the purpose of this blog lets look just what has happened to the distinction between public and private time and space for therapists and clients because of the increased use of smart phones.
Because definitions of time and space have changed (just look at quantum physics) in our techno connected world it is increasingly difficult to understand and maintain a boundary between personal and public space, time and identity.
Last year, while on vacation in Bhutan, I received a cell call from a patient (at 4 AM Bhutan time) asking if I could talk sometime today, as she was depressed. My office phone clearly stated that I was away from the office, and gave names of covering professionals. My cell was on for emergencies with family or friends. The patient believed, nevertheless, if I can find you I can talk to you, and that her need to be calmed trumped my need for personal reparative time. More recently, while on a yoga retreat, I received disturbing middle of the night texts from a patient in marital distress. Neither my email “away message”, my office phone “away” message, nor having my cell phone on vibrate, guaranteed me personal “off work” psychological space.
Knowing from experience, that I can be reached anytime anywhere has made me much more cautious about what I tell patients about using my cell number to contact me. (I questioned whether or not to have two cell phones numbers, one for work and one for family and friends and decided that it was too cumbersome). Although I continue to leave my cell phone number on my land line phone, I clearly state boundaries for how I use my smart phone professionally. I state and demonstrate that I do not answer phones, cell or land, when in session with patients because it is an intrusion to their space and distracts from intense psychological work. I open inquiry with them about how they feel about turning their cell phone off (or on vibrate) while their own psychotherapy session. This inquiry is often grist for the mill as many patients are not used to having time off from the external world. Furthermore, I state that just as I respect their time and space as closed to the outside world when I am dedicated to exploring their psyche with them, I trust that they will respect my personal space and that cell calls are for emergency in off business hours only. Most of the time this sequence of explain and demonstrate, explore, then request is honored.
Expectations of what should be private and what should be public identity are not what they used to be since “googling” has become common parlance and practice. The difficulty in carving out a private life poses a particular challenge to psychotherapists, for whom a basic working principle was that the therapist should be a tabla rasa, a blank slate onto whom the patient projects her fantasies. Patients have googled me before and during therapy. I have been told where I live, my marital status, age about a zine my daughter published! Perhaps we need Hippa regulations for providers?
Incorporating new methods of communication without compromising the privileged and intimate nature of the communications shared in the psychotherapy relationship, is our challenge.
Barbara L. Blum, Ph.D.