Posted by: counselorcarmella | May 3, 2012

Technology and Therapy: A Case Example


Technology is impacting the field of counseling in many ways, from how we do research to how we keep records. We are now able to communicate with other therapists and obtain CEUs on line and via video/web conferences. Such easy accessibility can be very rewarding, particularly for those in private practice who used to face much more isolation and   difficulty staying in close contact with colleagues for consultation and peer supervision. Most of us are familiar with the controversy surrounding on-line counseling and therapy via email.


Technology is also making its way into therapy sessions. Communicating via email, on line chatting, and text messages  is the norm now. I have had numerous clients bring emails or pull up their text messages or FaceBook in boxes on their phones to share content with me in sessions. I appreciate clients sharing their electronic communications with me and am willing to use them therapeutically in any way that seems appropriate.


 With one of my clients, however, technology was involved to an extent I would not have expected. I believe  my willingness to embrace technology with this client was very helpful in our work together, and  found it to be an important way of learning about him in ways that might not have been possible otherwise. I worked with this client during my graduate  internship. This new client was a single male in his mid20s who had been struggling with depression for about ten years.  He also had experience neglect and emotional abuse during his childhood. His current social relationships were impacted by both of these factors.


 During our second session, we began talking about his difficulties around relating to other people and feeling comfortable in social situations. He had a lot of trouble with face-to-face interactions.  He struggled to come up with things to say and  felt very awkward around his peers. At some point during our discussion, he began telling me about all the friends he was making on line .  He’d started blogging and had met many friends through their interest in his writing and vise versa. He seemed to really enjoy being a part of this culture, and gained valuable insights and experiences through interacting with others in this way. I often encourage clients to participate in journaling and letter writing, so was very pleased to hear that he was already utilizing what can be a very positive means of expression. As I have done with other clients, I let him know that, if he ever wanted to bring portions of his writing with him to discuss in therapy, he was more than welcome to do so.


 “You can just read it,” he said. “I can give you the website.”


I was taken aback by his suggestion. I wondered if this was appropriate. I knew I would not simply take home a client’s entire personal journal and read it, even if the client wanted me to.  I couldn’t immediately think of an ethics code forbidding such an action, but I knew it didn’t feel right to me. Doing something like that would cross some sort of intimate boundary I was not comfortable with. “Journals are something very personal,” I said to my client.


“Its on line for anyone to see,” he responded. “If I didn’t want people reading it, I wouldn’t put it out there.”


That was true. The Internet is public, and this method of online journaling was also public. People read and respond to each other’s blogs all the time. Writers knew they were sharing thoughts and feelings with an audience. It would be like reading a published memoir, I reasoned. If I had a client who’d written an autobiography available in bookstores, I would not feel uncomfortable reading it, if the client asked me to do so to help with their counseling.


 “I’d like to read your blog,” I finally said, “But how would you feel about me, as your counselor, reading it? I mean, I’m not just some anonymous person.”


“It would actually make this easier for me,” he said. “I’ll know you know about certain things and understand some of my thinking without me having to find words for it on the spot.”


Hearing that having me read what he’d previously written would actually help my client be more comfortable clinched the decision for me. It would help to address a problem I had already discussed with him related to our work together.   I knew he often felt very uncomfortable and overwhelmed when trying to come up with how to answer a question or explain his thoughts. All sorts of ways to answer or words to use would fly through his head, and he would seem to freeze up trying to choose from among them. I knew from personal experience that writing allows one to choose words, go back and change things, and think through ideas in  a less hurried or reactionary way.


He gave me the web address, and I told him I would read some of it before our next session. That weekend, I logged on and pulled up the site. Entries were posted in descending order, and I began to read with interest, even taking notes. I was very impressed with my client’s writing ability and expressiveness. His personality was clearly visible in his writing. He had a sense of humor, too, and was very clever with words. Some of his sarcastic observations or descriptions of personal humorous experiences actually made me laugh out loud. I had approached this task as an alternative way to get to know my client outside of session, but quickly found my clinical impartiality being joined by genuine fascination. I kept reading, enthralled by what my client had to say and how he interacted with others who wrote comments and asked him questions. His blog had shown me some clear strengths concerning his intelligence, kindness, and sense of humor that I could reinforce in counseling.


He was also very honest about his thoughts and life experiences. He had been through some very difficult things, and wrote about them with brutal candor. We would discuss some of these things in later therapy sessions. Having already read about them was helpful for me as I recalled what he’d written while listening to him describe the events.  


During our next session, I told him how impressed I’d been with his writing. “I really enjoyed reading it,” I said. “You are an excellent writer.” 


Because of his depression, this particular client found open-ended questions rather overwhelming. He much preferred beginning narrow and moving outward. Once he began discussing a topic, he was able to express himself. Deciding what to talk about, however, was often difficult for him.  If he did not feel comfortable choosing a topic for the session, I would comment that I’d noticed something in his journal I’d like to ask about. Referencing his writing served as a spring board to get conversations started, and these dialogues usually were very productive and process-oriented. I wonder how our work together would have been different if I had not been willing to read my client’s online journal and use it in therapy.


I don’t know if I would do the same thing if a client asked me to now.  For one thing, I have a  larger case load and don’t have that kind of time anymore.  A possible alternative might  be to  encourage clients to  bring in certain blog entries for me to read, just as they do with  hand-written journal entries or poetry. This would only  allow me to  read certain parts  rather than the whole  blog, though. Obviously, that is a different experience and limits the insights I  could obtain. Another option would be to ask the client to write about a certain  topic I’d brought up in session if it was difficult for them to know what to say at the time so we could discuss it next session. Other clinicians might not have agreed to  read  this client’s blog because they felt he needed to take more initiative in   deciding what to discuss in session. Others would probably insist that he be stretched to communicate without using his journal as a buffer or crutch. To me, though, this client was willing to put up with tremendous discomfort by participating in face-to-face therapy at all. He might have been much more comfortable doing on-line therapy and never setting foot in a counselor’s office to have to interact and talk in real time. I believe my willingness to be flexible made our work together more productive, and it allowed me to meet my client half way. We could use what was somewhat more comfortable to usher us more gently into what was more uncomfortable.  I would encourage other therapists to be open to such “out of the box” ways of working with clients when  getting conversations going is difficult.


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