I received a great question from a fantastic therapist friend,Lesli Doares. She asks, “how does a therapist keep up with all the information available to their clients on line?”
I’d like to say I have a thorough answer at the moment. Instead of delaying, I will attempt to answer. In fact, the original pitch to Rich Simon at the Networker was on the idea of “cultural competency” as it relates to this brand new, unabridged look into humanity via the web. Therapists do not get the entire picture from clients, who hide as much as they wish from their therapist. For the first time ever therapists have access to fascinating information, without filters, AND with the cultural responses to anyone’s particular issue. In other words, the most raw form of your clients are online and you can see the most raw responses they get from society at large. Anonymity can be brutal but insanely fascinating from a mental health perspective.
Rather than be bogged down by every possible nook and cranny a client hangs out at, it’s more important to figure out if and how they’re engaging their online space. For many people the most community they have is online. In person may be going to work and then coming home. I credit the web message boards for dramatically improving my engagement wedding planning experience (I am NOT a girl who dreamed of her wedding her whole life and had literally only been to three before planning my own.) I also found the message board world very educational, empowering, and uplifting during the pre-pregnancy, pregnancy, and new baby experience. I was also heavily on a message board for a very dramatic surgery and credit the site for hugely calming my fears and helping me get a window into a wild world (plastic surgery… I’ll write more on that in the future including a great potential niche market I may try to enter when I get my license.)
So let’s say you have an intake form today that asks something like, “what are your support systems?” It’s important to get the lay of the land, right? What if you tweaked your intact form to normalize the fact that many of your clients may be ONLINE. Perhaps you can simply ask, “do you seek blogs, message boards, Facebook, Twitter, or other online mediums for guidance and support?” It’s not asking them which ones (they may be a little weirded out about you invading their personal online space.) As you go about your normal intake session you can ask more about that in person. You’d want to simply allow THAT world to enter therapy, whether it’s a great source of comfort and community for them, or it’s a source of facts and information (aka psychoeducation), or whether it’s impacted their relationships (positive OR negative.)
I say for your current clients, it wouldn’t hurt to say something like, “so I just read a therapy magazine article about the online world and I am just wondering if you hang out online and find it a place for support for [insert presenting issue.]” If they say “no”, then that’s fine. But if they say yes, then you can engage them! Ask what they get out of it, if and how it has helped them, and whether they think you’d benefit from checking out the website they visit. Let them be your teacher! They’ll love it.
The online world can be horribly toxic. One of the last, what they call “national boards”, I visited included a post that made me so angry I was shaking. This is an example of NEGATIVELY being impacted by the online world. This woman was posting because she was finishing up law school, her husband was unemployed, having been fired from his job, staying home with their baby in the meantime, and struggling with depression while resistant to therapy. Her question was simply whether she should take a job offer to relocate and start earning income, though it was not where she/they wanted wanted to live. A valid question, right? You know what happened to this poor woman? She was attacked. Her husband was attacked. Her marriage was attacked. It came down to him being a Supreme A-hole for not working and not being able to “suck it up and be a man” and it included the fact that she ought to just ditch him and move on with her life. Absolutely no acknowledgment was made that she LOVED her husband, that she had NO marital challenges requiring separation or divorce, and that she did not feel he was less of a man for not working or for having depression. Her original issues were ignored as people went on a rampage, with full ignorance and male-hatred. (This is a female message board.)
I’ve been online for 15 years now, back when it was mostly white super geeky guys in their 20’s. Things have dramatically changed and now anyone, anywhere, can get online and ask a sincere question. The response may be brutal, soul-crushing, and send a person in a tailspin of insecurity, depression, self-doubt, or in extreme cases, often made national, can lead to suicide. The online world was responsible for a whopper of a fight with my parents because I threw out a wedding idea that triggered emotions on all sides…resulting in an argument that would NOT have happened if I wasn’t online getting ideas from other brides.
It’s important that therapists realize these worlds exist and to help their clients manage those worlds as they would help a client deal with a challenging mother or difficult child. And since mental health still has a stigma, the online world is the safest place anyone can go to. For better and worse.