Does Social Media Belong in Therapy?

As our patients’ online lives expand, how do we address it therapeutically?

Posted Apr 09, 2019

Source: Pixabay

“Look at this, just look! Look what they said! And what I said back! Read it, please!” My patient thrust their phone towards me, having spent several minutes scrolling through it in frustration, to find the offending interaction. I felt like a lawyer, rejecting a process server with a summons, as I held my hands up to avoid touching the phone.

I want to help my patients. I truly do. But when it comes to social media interactions, explored in therapy, I find myself struggling with many conflicts.

Most therapists who didn’t grow up with the digital world at their fingertips, simply don’t understand what a vital, real part of the world those online interactions are, for many of our patients. We often view internet friends, social media interactions, Facebook spats, online bullying, and Twitter mobs as less substantial than the real world. If you don’t spend much time online and haven’t made social media a real part of your life, then it’s deceptively easy to look at those interactions as being less intense, less impactful, and less important than “the real world.”

Many therapists bemoan the ways in which electronics, smartphones, and social media have changed human interactions. They encourage couples to set rules around smartphones at dinner, or in bed. It’s a funny, modern version of the old mind-body split, where our spiritual existence was viewed as purer and more valuable than our physical existence. As a result, things such as masturbation, sex, even spicy foods, were decried as distractions from our spiritual development.

Today, the coin is flipped. Now, we are told to deny ourselves the reality of the online world and to focus on the physical world around us, and the physical people around us. People who live online too much are painted as deficient, deprived, and even damaged.

So when my patient wants me to look at their phone, wants to recount and explore an online interaction that they are struggling with, it’s tempting to resist, because “those interactions aren’t really real” anyway. But they are, and in many ways, they may hold significant emotional triggers and hooks, that don’t come up in other aspects of life.

The online world of social media allows people to expand their village, to find friends and intimate emotional connections with people they couldn’t maintain a connection with otherwise. They can share their lives with chosen friends and communities who share their interests and values, despite where they physically live. Those online interactions are as real, perhaps even more real than our physical interactions. In the physical world, the influence of our choice, our self-determination, is somewhat muted by environmental limitations. But online, we go where we will, by choice. We hold greater ability to exert control over our surroundings and interactions, than we may be able to in the physical world. I suggest that our online existence may actually be a greater reflection of our "true selves," than is "IRL" (In Real Life). 

So, I’m not a therapist who is scornful of the online world, or who shames (even inadvertently) my patients for making those online interactions an important, impactful and vital part of their life.

Source: Pixabay

But, I will admit that taking my patient’s phone from their hand, and reading stuff on it, feels concerning to me, for a variety of reasons:

  • First, my job in therapy is to engage with my patient. When the phone is between us, I’m engaging with the device, and the words on it. Not the person on my couch.
  • Secondly, my patient is the person, not their phone. The words on the screen matter less, than my patient’s reaction, interpretation, and emotional responses. I find that the actual words on a screen are less therapeutically valuable, than unpacking and exploring how my patient internalized them and interpreted them. What the words (or their perception of the online interaction, because we all easily misunderstand things) actually triggered within them is what I find therapeutically valuable. That’s the “grist for the mill,” to quote a very old therapeutic concept.
  • Finally, I know that there’s a lot of private material on my patient’s phones. Financial information, passwords, photos, etc. I’ve known therapists who opened computer files from a patient, given via email or flash drive, and found the patient had inadvertently given them illegal images. If I’m holding my patient’s phone, and a text pops up, or my clumsy fingers accidentally delete something or click a wrong button, we suddenly have new problems and issues to deal with, taking us away from therapy.

The worlds of social media and behavioral health treatments are increasingly intertwining. Facebook tracks, reports and intervenes in posts indicative of suicide, depression, and bullying. Crisis hotlines now offer chat and text support, because so many young people prefer to engage in that way. Online therapy applications are a button-push away. Social media interactions and texting conversations are making their way into modern journalism, into legal cases involving threats, defamation, and plagiarism. Family and divorce courts are seeing more and more electronic conversations being presented as evidence.

(And I'm not even talking about all the complex ethical and privacy issues involved in therapists who are on social media, and may interact with patients, or patients' relatives online, about therapists and patients who may "google stalk" each other, about encountering patients and therapists on dating or hookup apps, and on and on...)

Like it or not, therapists need to be dragged, kicking and screaming, into the world (including the digital ones) our patients inhabit. I think we all have a lot to learn, developing best practices and guidelines for how to effectively support our patients. If you’re a patient or a therapist, how has social media entered the therapy relationship for you? I’d like to hear.