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Therapy’s Digital Disconnect

Some digital natives struggle with a psychological culture that they say doesn’t understand the effects of life in the internet age

(Getty Images/Ringer illustration)
(Getty Images/Ringer illustration)

Earlier this year, Andrea Jones began seeing a therapist. They began meeting every other week to discuss her job, family, and relationships.

Over 10 months, the 26-year-old Jones (whose name has been changed to protect the patient’s identity) sensed a disconnect with her 60-something therapist. Sometimes she’d catch her doctor fumbling with a browser on her computer, opening new windows instead of new tabs. During one session, Jones said she was stressed out because someone hadn’t texted her back, to which her therapist replied, “Why didn’t you just call them?” Once, after a lengthy explanation of the key performance indicators for web traffic, her therapist simply nodded and said, “Oh, OK.”

Jones gave up explaining the nuances of her digital life during a discussion about an on-and-off romance. She hadn’t communicated with him much recently, and her doctor wanted to know to what extent.

“The example I wanted to use was that we still liked each other’s Instagrams,” Jones said. “But then I realized, knowing a little bit about her non-background with technology, I was going to have to back up and explain the framework of: What is an Instagram? What function does it serve in people’s friendships? And I would have to explain to her that liking someone’s Instagram was just another way of pinging their consciousness for a second.”

She decided to forgo the topic. “That would’ve been like a three-minute detour,” Jones said. “But when you’re on the clock, three-minute detours in an hour session are expensive.”

Jones is one of the 500 million people who use Instagram to connect with people every month, so her experience is not an uncommon one. She was just seeking help from someone who couldn’t, or wouldn’t, understand it. That problem is not uncommon for a growing population whose lives have been profoundly shaped by the internet, and who now find themselves seeking professional help to better navigate their communities, tangible and digital. A 2016 report from the nonprofit Mental Health America found that more than 40 million Americans have experienced some form of mental health issue. Another, from the Center for Collegiate Mental Health, showed that the number of students seeking mental health services continues to grow. There’s no way to know how many of those people want to see a therapist to discuss what they see as a potentially passive-aggressive Twitter fave, but for a generation of people whose social and professional lives revolve around the internet, it feels more common than not.

That’s exactly why the ability of mental health providers to talk to the children of the internet about their online lives is more important than ever, especially considering the landscape that they encounter each day. Consider the challenges that digital natives face: It’s likely that they will encounter or have encountered harassment, they may feel guilt or anxiety about logging out of Slack for an evening, and they carry the urgency of the internet on their shoulders, all while maintaining profiles on myriad platforms. Like anything in life, when this set of responsibilities overwhelms your daily routine, it can lead to feelings of estrangement.

As a veteran of therapy and an internet dweller, I can attest. One of my most vivid memories from my three years of treatment was the morning when my therapist — after silently listening to me obsess over the emotional weight of communication via Gchat, iMessage, and Twitter — asked me if I could show her how to open an emailed PDF attachment. But internet-related issues in therapy go far beyond Computer 101 tutorials. One freelance public relations professional told me it had taken “years” to find an analyst who would communicate via email and Skype. A communications officer for a tech company said she switched therapists to find someone who was more digitally savvy because “90 percent of my sessions are about the internet and social media.” In some cases, lack of confidence in a counselor bubbled up at what might seem like an innocent question. “My therapist once asked me what ‘humblebragging’ was, and I knew I had to get a new one,” one tech website editor said.

A generation of therapists who grew up with the internet places a similar importance on the ability to navigate certain online terrain. “It’d be really hard to talk about dating dynamics with a therapist that had never used an app before,” said Chloe Carmichael, a clinical psychologist who runs a private practice in Manhattan. “It would be like trying to discuss a date in a bar or a nightclub with a therapist who had never been to a bar or a nightclub.” Some people who have seen more traditional analysts have complained that the advice they gave was contextless and hollow. “It’s sort of like a square-peg, round-hole thing, where of course their therapist might want to help but they just don’t,” said Melody Wilding, a therapist who specializes in coaching female entrepreneurs and millennials.

And the essential concern is that some of the effects of online life are serious, and many people could benefit from talking about them. “What I hear from a lot of my clients is there’s that disconnection,” Wilding said. “It’s isolating in so much that you’re constantly managing your persona and there’s also a lack of realness. Yes, you might be sharing the highlights of your day when you call the people closest to you, but it’s sort of glossed-over updates. No one really gets into talking about the nuts and bolts of what’s even happening in their life anymore.”

For the psychological community, strict institutional rules and long-practicing therapists have created a hesitancy — sometimes even an unwillingness — to address the online culture that shapes some of their patients’ lives. In the case of the latter, not all mental health workers see the value in understanding technology when treating younger patients. And as a result, a kind of binary has emerged: the digital native versus the digital immigrant. Coined by educator and author Marc Prensky in 2001, these terms are a basic way to categorize two types of people: those who have known little else but a life with a constant internet connection, a smartphone, and the necessity of an online persona, and those who have had to adapt to our new web-obsessed society.

The difference in experience between natives and reluctant immigrants can be so profound that it can create animosity between groups, or a fear of the future. (See: every story ever written about millennials.) “A new technology can be enriching and exciting for one group of people and create alienation for another,” John Herman wrote for The Awl last year, in response to a story about “screen addiction” that pitted grandparents against their electronics-obsessed grandchildren. “You don’t have to think the world is doomed to recognize that the present can be a little cruel.” For digital immigrants, there’s a tendency to misidentify technology as something that sparks certain behavior, when it is simply a new landscape for people to act out normal human desires.

“When selfies first appeared on the scene, we were blaming [them] for just damn near everything,” said Pamela Rutledge, a media psychologist who studies how people interact with technology. “But that’s a manifestation of people’s behavior. It isn’t a cause of people’s behavior.”

In other cases, it can be easier for digital immigrants to simply view digital communication as a foreboding Narcisse snake pit to avoid than to adapt to the state of modern American existence.

“There is a fundamental anti-technology bias in people who didn’t sort of grow up in the midst of it,” Rutledge said. “This is a really normal response because, physiologically, we are not predisposed to just instantly embrace something that’s new. So a lot of therapists who have been working for a long time who are very skilled at working with people are naturally hesitant about this new environment, because they haven’t spent a lot of time there.”

A similar dynamic exists within organizations that influence mental health professionals’ practices. After years of relatively strict recommendations, the American Academy of Pediatrics recently loosened its electronics guidelines for kids, walking back the theory that all “screen time” is detrimental to children. Institutions like the American Psychological Association and American Counseling Association have offered little guidance for how to approach clients who want their therapists to engage with their online personas, let alone hold a session via Skype across state lines. (This is an increasingly important issue, considering the growing number of startups that want to offer online chat therapy.) As Rutledge puts it: “The regulations that are put in place by the APA and the government are all things for another world.”

Considering the transformative technological changes that society has experienced within a short decade, APA’s most recent code of ethics, adopted in 2002, does seem otherworldly. For one thing, the document is devoid of the words “social media.” Six years ago, APA ethics director Stephen Behnke offered an informal addendum to the code, admitting that people’s online lives were “something that we haven’t gotten into the habit of thinking about.” His interim update simply advised practitioners to protect themselves when using Google, Facebook, or Twitter. “Educate yourself about privacy settings and how you can make your page as private as you want it to be,” he wrote.

The ACA is only slightly more up to date. In 2014, it addressed social media for the first time with a new code of ethics, but its recommendations were similarly privacy-oriented. “In cases where counselors wish to maintain a professional and personal presence for social media use, separate professional and personal web pages and profiles are created to clearly distinguish between the two kinds of virtual presence,” the section addressing online platforms reads.

Though the issue of a therapist who overshares online is not unheard of, such strict guidelines can persuade others to tip-toe around the topic of online personas altogether. In the view of Laura Lansrud-López, a clinical mental health counselor and art therapist in New Mexico, the recommendations are clearly outdated.

“Things can really open up once you start looking at your client’s online behaviors,” she said. “As clinicians, how do we engage, or do we engage with our clients online? For what purpose, and how is that supported by a theoretical rationale? All of those questions are not being asked by the people who draft and publish the code of ethics for our profession.”

A self-proclaimed “Generation Xer” who has been practicing for close to 12 years, Lansrud-López was not always so enthusiastic about understanding her clients’ online lives. Around 2008, as social media took root in society, she began treating a young woman who was experimenting with her sexuality by sending nude photos to people online. There is no lack of alarmist literature on the potential dangers that girls face in what seems like a hypersexualized landscape of social apps, and Lansrud-López’s first instinct was fear. She found herself bringing an agenda to their sessions in an attempt to protect and educate her patient. But it was only after some introspection that she realized that her fear came from a lack of understanding about the culture that shaped her patient.

“I started to back off on all of my value judgments that this was dangerous behavior, and asked: ‘How is it helping you develop?’” she said. “What I found was that it was actually safer for her to play with these things online and not with her immediate peer relationships. For her to have someone to talk to about it who wasn’t going to judge her, she was ultimately supported in coming to better decisions around her safety while also exploring something that, in her group, was normative.”

Lansrud-López’s revelation of how to better serve what she calls the “hybrid identity” of patients changed how she approaches her practice, but that doesn’t mean her approach is common among mental health professionals or that that’s what a patient always wants. One journalist I spoke to said she actually finds it refreshing when her therapist doesn’t understand the internet. “When I’m explaining something dumb that happened on Twitter, it makes me realize just how dumb it really is,” she told me. “[I] obviously don’t want to, like, undercut the validity of my feelings, but I’ve found it to be a helpful perspective shift.”

Lauren Hazzouri, a Pennsylvania-based psychologist who specializes in media psychology, says that, while therapists are familiar with the latest social networks, they don’t necessarily need to see how a person presents themselves on those platforms to be effective. “Most of the time, the goal is to get away from the persona, so understanding it in depth is a waste of precious therapy time,” she wrote in an email. “Our goal is to help you close the gap between persona and true self. In the past, it wasn’t necessary for clinicians to witness patients interacting with their friends to see the nuances of the face they presented in public. The same holds true today.”

In her view, being unfamiliar with an individual’s personal experience can sometimes be an advantage to approaching treatment.

“Clinicians don’t have to have the same experiences as their patients in order to have a depth of understanding in various aspects of the human condition,” she said. “There are a multitude of experiences and symptoms that many of us have never experienced personally, yet we’re fully competent to pace with someone and lead him or her from problem to solution. At times, [a clinician’s] personal experiences can be a detriment to treatment in that the objectivity needed to see patient experiences clearly can be compromised.”

Even if a person has an active online life, Rutledge advises patients to choose a therapist who is best suited to address the most important issues at hand.

“If I’m suffering from depression, I would want to go to someone who was skilled at handling depression,” she said. “At the end of the day, what we’re really talking about is human behavior. So, the fact that you know more about Facebook than the therapist isn’t necessarily the problem.”

Nevertheless, some therapists are challenging the institutions that have discouraged practitioners from getting more in touch with their clients’ online lives. Carmichael said she’d like to see more graduate-level courses that explore the presence of technology in therapy. Lansrud-López holds workshops on the topic, and continues to confront what she describes as a personal bias of “older generational clinicians” who are known for posting “No Cell Phone” signs outside their offices. She advocates for more voices on decision-making committees that don’t just represent different races or sexual orientations, but a spectrum of technological skill too.

“One could make a case that digital natives form their own culture,” Lansrud-López says. “That it’s not generational. It’s not something they’re going to age out of.”