New Models of Mental Health Care

Where Making Money and Making a Difference Come Together

This week Anderson Cooper of CNN is doing an expose on cyber bullying. As mental health professionals we need to pay attention.

Your clients, whether adult or child, are plugged in. They have relationships, positive or negative, online.

You don’t need to be plugged in just for business/marketing/networking reasons, you need to be plugged in to be an ethical, effective clinician. Today Michael Langlois, LICSW brings that to our attention, too.

Cyber relationships affect everyone. People make friends, fall in love and hurt each other online. They act out fantasies, explore new identities, and keep secrets online. The next generation of kids aged 8-18 don’t know a world without cell phones, Facebook and online chat. Our brains are being rewired to scan, quickly shift our attention and multitask.

A child who is cyber bullied will look depressed, anxious, even paranoid. An adult who is engaging in an online affair will be unavailable to his spouse, kids and possibly appear secretive and obsessive about their computer/cell phone.

Do you ask about online activities or internet access as part of your intake? Do you allow clients to bring in their cell phone or lap top and show you their online social life?

It is striking to me that many of the young people who have committed suicide in the last year over cyber bullying were suffering without adults even being aware of what was going on. Some even had seen therapists of pediatricians for changes in their behavior. But still, adults had no idea until it was too late.

Why didn’t anyone over the age of 21 know about their pain?

Because they didn’t know to ask.

But that can’t be our excuse any more. You know by reading this blog and being online yourself that you need to ask, you MUST ask how your clients are using the internet in their daily lives.

We need to go further than that, especially if you work with young people. You need to let anyone over the age of 8 bring their technology in the therapy room with them. We’re so conditioned to tell our clients to turn their cell phone off at the door, that we forget that the key to understanding their social relationships is right there in their pocket.

Have you ever asked a teen to see their texts? I have and I can tell you it was fascinating. It made real all of their struggles that they communicated to me in the room. I’ve done the same with their online videos, audios and downloaded ipod songs. One teen recorded a friend’s mom yelling at him as they drove together in the car. A girl showed me what she and her friends were up to at the mall. Through sharing tunes on the ipod I learned of one boy’s fascination with death.

These technologies are intimately intertwined with people’s existence. To not discuss them or bring them into the room is like never asking about friendship, relationships with family members or taking an adequate psycho-social history.

Without the information about people’s engagement with technology we are the practitioner using outmoded treatment.

Yet, how many CE courses do we see offered on bringing the internet and technology into our clinical work? I’ve looked around and I see none. NONE! That is pathetic. Maybe you know of one or two, but are these focused on treatment or marketing, or liability?

Keeping it in perspective

Our culture has turned a curve. The online world isn’t something “those people” do. It’s what EVERYONE does. Therapists do it less than most people and that is a problem.

Quick side story…a few weeks ago I flew to Baltimore to talk to social workers about “clinical practice plugged in.” Ironically, at that conference I saw very few iphone, Blackberries or laptops. However, at the airport every single person waiting for my full plane back to Boston had an electronic device of some type: smart phone, laptop, ipod. People were scrounging around to find plugs (and the airport provides charging stations, and internet portals). I paid attention to who wasn’t plugged in…maybe a few parents who had young children to attend to, the rest of us were surfing the ‘net furiously.

Folks, as a profession we are way, WAY behind. It’s not something to be proud of. We can stand apart and dismiss this revolution as “unhealthy” or “undermining real relationships,” but we can’t turn back the clock on an evolution of a culture. We don’t know better than the 500,000,000 people that are on Facebook. We need to treat real people with their problems of today, not some idealized concept of how things “should” be.

And this is what I want you to keep in perspective – if you are working with a client and don’t explore their life on the internet and that person goes out and harms themselves or someone else in some direct or indirect way related to their internet relationships are you liable for malpractice? Can we be sued if we don’t ask? Or if we conceptualize a client’s desire to discuss their online world as “avoidant,” write that in our notes and then later find out that all of their pathology was being expressed in that online world, are we open to suit? I don’t know, but it’s something to think about – deeply.

Important devil’s advocate message here

You will hear many, many “experts” telling you to be careful and to avoid of online technology from a liability, privacy, fear of the boogyman perspective. Take it all with a grain of salt. Because unless you live under a rock, you know that real mental health issues are played out online. And if you’re hiding behind a construct that therapists don’t “do” online relationship work, you’re not only completely irrelevant to over 75% of our population, you may be verging on the edge of incompetence.

I know that sounds harsh, but it’s something we need to explore – quickly – because no more kids need to die because the adults responsible for caring for them and treating their pain “don’t get it.”

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