Therapists: Is Your Practice Dealing With Technology?

Are therapists adapting to the online milieu? Sadly, we are not.

Posted Apr 25, 2018

Source: Shutterstock

Disruption is Coming!

Did anyone in the therapy world notice what happened in major cities when “rideshare” services like Uber and Lyft came along? If not, I’ll tell you. The old school way of selling rides to needy travelers—i.e., hailing a cab—fell off the proverbial cliff. It’s just so much cheaper and easier and more appealing (especially to people under a certain age) to open an app and press a virtual button, assuring the arrival of a chosen car and driver (who already knows your name and where you are going) within a few short minutes. And to then have payment for the ride handled electronically.

No, taxicabs are not entirely a thing of the past. But the income once derived from taxis is greatly diminished. And as more and more young people come of age, this trend is certain to continue—because young people shop digitally for good and services, even when all they’re looking for is a cheap ride to the coffee bar across town.

So, I ask you from a therapy perspective, do you honestly think that a couple in their early 30s with two young kids wants to find and pay for a babysitter and then fight their way through 40 minutes of post-work traffic so you can charge them $150 (or more) for a one-hour couple’s session?

If you think they do, I suggest that your clinical practice may soon join cassette tapes, taxicabs, paper maps, and the dodo bird on the scrap heap of history. Because these days half (or more) of our clientele would much rather do their shopping and conduct their business, including their therapy business, online. They already buy groceries, watch movies, play games, shop for furniture, and visit their medical doctor online. Why not therapy? 

Changing With the Culture and the Times is Vital to Good Therapy

When I went to social work school, I was told that an essential element of helping clients was understanding and feeling comfortable in their culture. I was told that if I was working with a Latino client, I should have at least a basic understanding of Latino culture. The same was true with Jewish clients, African American clients, LGBT clients, etc.

So why are we suddenly ignoring this standard when it comes to technology?

How many university and continuing educations courses in the clinical world are devoted to online life, online interactions, online stressors, online values, etc.? How many therapists fully understand the ways in which online life affects and guides our clients, especially our younger clients, in romance, business, friendships, politics, socialization, entertainment, self-esteem, and on and on and on?

As therapists, a basic requirement of our job is that we gain cultural competency and insight into the upbringing and background of our client populations. If we don’t fully understand a client’s culture and belief system, we can’t fully trust our responses to his or her experience. Without cultural insight, or without at least acknowledging that there are cultural arenas in which our client has more knowledge and experience than we do, we risk unintentionally offending or alienating that person, thereby eroding the therapeutic alliance. Even worse, we might suggest actions based on our own background, values, and life-experience that are counterproductive or even damaging.

In today’s therapeutic milieu, the most commonly encountered “foreign culture” is the digital universe. As Internet-age therapists, we need to understand—in fact, we are obligated to understand—that many of our clients were born into a digital universe, with its unique and very specific expectations, rules, taboos, and endemic problems. We must further understand that this world is comprised of hundreds of separate subcultures, each with its own distinct code of conduct. Facebook, LinkedIn, WOW (World of Warcraft), Instagram, Snapchat, Tinder, and the like are all very different. They are utilized for different purposes, and they have different rules (both official and unspoken). Behaviors that are perfectly acceptable in one venue may be abominable in another. Interactions that are sought after in one venue might be taboo in another. Etc. As therapists, we must be cognizant of this.

While no therapist can or should expect to be conversant in all languages and cultures, close clinical work requires us to make a serious and meaningful effort to learn about our client’s world. Right now, a client’s world is as likely to be online as off. As therapists, we need to accept this and adapt to it. We need to understand our client’s universe, and we need to adjust the ways in which we provide treatment so we can better meet our client’s needs. I’m not saying that we all should be active on Snapchat or engage in hour after hour of online gaming; I am, however, saying we’d better know what those arenas are and what people do there. Because that’s part of our job. 

Change or Fade Away  

If you find yourself bristling at the thought of having to learn another set of cultural rules, you might take heart in the fact that you are not alone. The late science fiction author Douglas Adams may have stated the natural reaction to new technologies better than anyone in The Salmon of Doubt when he wrote:

  • Anything that is in the world when you’re born is normal and ordinary and is just a natural part of the way the world works.
  • Anything that's invented between when you’re 15 and 35 is new and exciting and revolutionary and you can probably get a career in it.
  • Anything invented after you're 35 is against the natural order of things.

As a person over the age of 35, I completely understand Adams’ statement. The technologies available when I was a kid seemed (to me) indispensable to the world’s very survival. The technologies that arrived in my early adult years (DVDs, CDs, websites, and Internet chats, for instance) were, in my mind, logical developments that I easily grasped and learned to use. However, the technologies of the last few years occasionally freak me out. Social media, virtual reality, augmented reality, etc. Sometimes it all just feels like too much. I mean, I earned my degree, I understand humans and human connections, and now I need to learn it all over again from a digital technology perspective?

Well, yes. I need to learn and grow and keep up with the times if I want to continue to effectively assist my clients. 

Our Industry Needs to Rethink… and Fast

Doctors and nurses are increasingly licensed across multiple states. But therapists—whether we are psychologists, social workers, MFTs, or part of some other licensed counseling profession—are not. This means that as a therapist I can provide counseling in-person or online. However, if I offer therapy online I can only work with clients who live in my home state. Because that’s what my license allows. So, I either stay offline or I become a “coach,” which means dumbing down my credentials and the nature of the work that I do to protect my all-important license.

To me, that’s a ridiculous situation. In today’s increasingly digital world these restrictions make no sense. The world around us is changing, and as therapists—both individually and as a profession—we need to change with it. My concern is that very few of us seem to realize and care about this. In 2014, I wrote a book about the ways in which technology is impacting our culture, Closer Together, Further Apart, and since that time I’ve been educating therapists about techno-changes that are clearly on the horizon (and in many cases already here). But I’m not sure anyone is listening.

Sure, it’s possible that I’m wrong and therapy just doesn’t work online. Maybe therapy really is an in-person, in an office endeavor. If it is, maybe we’re all better off staying away from tech and signing a long-term lease on a nice clinical space. But I wouldn’t recommend that. I’ve been testing VR headsets as part of my work around technology and psychotherapy, and guess what? When a client puts on a headset to talk to me about his or her problems, within a few seconds both I and the client forget that we’re not in the same room. That’s how real virtual reality is getting.

But right now, thanks to our industry’s licensing restrictions, I can only do this with clients in my state. Never mind the fact that I get requests for counseling and advice from all over the country (and around the world) on an almost daily basis. If you’re sitting at your desk reading this post and thinking, “Well, that’s you, but my practice is local,” let me remind you that there are already hundreds (maybe thousands) of credentialed but unlicensed coaches and counselors practicing across state lines and abroad, while those of us with licenses are limited to the state in which we are licensed. And these hundreds or maybe thousands of credentialed but unlicensed coaches and counselors are doing most of their work online—which is the preference of countless clients.

If you’re not interested in learning about technology and finding a way to practice online, maybe you’ll care about the fact that your old school bricks-and-mortar practice is rapidly being left behind. In the same way that Amazon is chewing up mom and pop stores (and even major retailers), credentialed but unlicensed online coaches and counselors are chewing up traditional therapists. And what, I ask, are we doing—as individual therapists and as a professional community—to ensure that our jobs and practices are not being usurped by those who are less trained, less vetted, and have less to lose? So far, not much.

Maybe it’s time for us to get on board with tech. Before it’s too late.