What Google+ Could Mean For Therapy

Every technology reveals the hand that shaped it.  The technology of the 21st Century is no exception:  Social Media has proliferated because human beings are inherently social creatures, even when that sociability takes on different forms.  And the explosion of access to information was detonated by our own curiosity.

For better or for worse (usually worse) our ability to engineer and zeal to use technology usually outstrips our ability to behave well with it, and in a large part I believe that this is what spurs on our refinement of it.  Listservs are a great example:  They allowed amazing access to online community through emails and postings, and they elevated the concept of “flame war” in comments to a new level.  Eventually, email and bulletin boards were insufficient to allow us to be sociable, and Web 2.0, with its emphasis on interactivity and real-time community was born.

And then Facebook, MySpace, Friendster and other social network platforms quickly outstripped the listserv and bulletin board.  The emphasis became on finding and connecting with old friends, acquiring new ones, and maintaining a steady if sometimes awkward flow of real-time announcements, status updates and feedback to them.  The online world expanded exponentially, and in fact that interactivity and information became overwhleming.

Which brings us to Google+.

For those of you who have not had the pleasure, Google+ is a new social networking platform (and in many ways much more than that) which has brought a new level of functionality to online social media.  Although it is still in beta, the number of people participating in the largest usability test in the history of the world is growing by leaps and bounds.  If your patients have not mentioned it, it is only a matter of time before they do, and that alone should be a good reason to learn to use it.  But in fact, Google+ has already begun to show me how valuable it may be in actual treatment.

So today I want to introduce you to two of the core concepts of Google+, Streams and Circles, and show you how each of these may present you and your patients with an arena to talk about psychological concerns and skills in therapy.


The Google+ system of circles is as powerful as it is flexible.  Whereas on Facebook you really had only one big group of people called your Friends, Google allows you to create and label various circles, such as “Friends,” “Colleagues,” and “Family.”



The interface let’s you drag the name and image of different people located on the top to one or more of the circles below.  When you mouse over the circle it expands to give you an idea of who you have put in it.  And if you drag a person to the grey and white circle on the far left, you can create a new circle, one which you label yourself.  For example, I have a circle for “Minions.”  I’ve always wanted minions.

This graphic representation of the way we can and often do categorize people in our life may allow our patients to visualize the decisions and boundaries they struggle with in real life.  This can be especially useful with patients on the autistic spectrum.  We can begin by empathizing with them when we upload our 1000 email contacts, and discover that we now have an overwhelming 1,000 individuals to make sense of.  Who goes where?  Is everyone a friend?  Can we put people in more than one circle?  Decide to take them out of one and into another, like say out of “acquaintance” and into “friend”?  What sort of circles might we want to create that Google+ didn’t give us?

People with Aspergers often have exceptional spatial reasoning, and can find mapping out relationships very helpful.  Now they have a dynamic way to do this, and a visual representation of how unruly and confusing social relationships can be.  Even though we can use this only as a powerful metaphor and coneptual tool, we could go even further.  Inviting a patient to bring in their laptop and taking a look at Google+ could be a helpful intervention.  We could help them explore and decide how to set up their own personal boundaries and affectional investment.

Or imagine for a second you are working on emotional regulation issues with a patient.  You can encourage them to create circles like “love them,” “Push my buttons,” “scary,” “feel sad,” and help them take a snapshot of their life at any given time to see who they want to put in each circle.  Do some people go in more than one circle of affect?  Do they notice that they are taking people in and out of circles frequently, or never?

Or imagine working with social phobia, and trying to help the patient brainstorm what activities they might want to try to invite someone to.  They can create circles like “Go to movies,” “Have dinner,” “Learn more about them,” and other options for various levels and types of engagement, and then they can sort people into those.  And all of a sudden they also have a visual list of who they can call when they are trying to socialize.

Last example, working with trauma and/or substance abuse.  Circles can be created for “Triggers me,” “Can call when I want a drink,” “My supports,” “self-care partners,” etc.  Then populate each with the people in their life, so they have a ready-made resource for when they are in crisis.  It also can be very illuminating to share and explore this in therapy, allowing you to make comments like, “what do you make of the fact that most of the people in your family circle are also in your triggers one, but not in the support one?  What do you think you could do about that?”

So these are just a few quick examples of how you can use the Circle concept of Google+ to understand your patients better, help them understand themselves better, and use social media to intervene in a variety of situations.


In Google+ circles go hand in hand with your Stream or Streams.  A stream is a stream of comments, updates, links to information, invitations, photos, video and other media, posted by people in your circles.  It is probably important to note here that similar to Twitter, you can invite people into your circle without their permission, but that doesn’t mean they will invite you back.  And you can set each circle to have different levels of access to your posts.  In other words, circles and streams together allow you to learn and set boundaries.  Here’s what a Stream can look like:

This is only the fraction of the incoming Stream, which gives you a sense of how multimedia, interactive, and possibly uninteresting some of it could be sometimes.  Much like Twitter, or like life.  If we had to pay attention to everyone all the time in the same way, we would become very fatigued.  Like our patients with ADHD, we would be overwhelmed despite our best attempts to understand at times.  Again, we can use this technology that our patients may be familiar with to begin to deepen our empathic attunement with them.  But it gets even more interesting.

If you look at the upper left-hand corner under Stream, you will see a list of your circles, in this case family, friends, acquaintances, etc.  Now if you click on any of those circles, the Stream changes.  Specifically, it changes to list only the posts from the people in any given circle clicked.  This synergy between circles and streams highlights not only the importance of privacy, but that focussing our attention is inherently a social as well as cognitive function.

Imagine working with an adolescent and reviewing their streams together.  What sorts of media, comments, and concerns are streaming through their lives at any given moment?  And what is the consequence of having 500 “friends” in their friend circle?  Do they feel intimate or able to attend to all of these friends?  Or are there some times that they may be more interested in attending to some friends than others?  If so, why?  Might it be time to start to rethink what it means to be a friend?  Is it ok to select who they attend to at certain times?  Do they really find the content they get from A interesting?  And if it is consistently uninteresting, does that say anything about their relationship?  Sorting through Streams to make sense of their world quickly becomes a talk about sorting through their values and their relationships.

For a second example, let’s return to the patient with ADHD.  Perhaps they could create circles for “School,” “Fun,” “Work,” “Family,” and sort people that way.  That way when they are doing work for school they can focus only on the Stream for the School Circle, which may contain links to papers, classmate comments, or lecture recordings from their professor.  If that stream starts to have too many other types of posts, maybe that is an indicator that someone is in the wrong circle, or that they need to only be in the “Fun” one until that paper is done.  Remember the circles are easily adjusted back and forth, so this is neither difficult or permanent to do.  But these types of decisions and focussing techniques may be crucial to staying on task.  (For those of you who might be ready to suggest that they not need to follow any Streams when they are studying, I encourage you to take a look with them at how much academic content and collaborative learning is done online before you rush to judgment.  It’s not always just “playing on the computer” now.)

Other ways that you can use Streams to help your patients therapeutically may come to mind if you reflect on the names of their circles.  Do they really want to follow the Stream of posts from their “Pushes My Buttons Circle?”  Maybe they’d rather tune into a steady Stream from their “Supports” circle instead?  And what might happen if they created a circle for “Intimates” that only contained people that touched them in deeply meaningful ways?  Could they still enjoy their “Friends” Stream, but switch to a “Skeleton Crew” one when they are needing to simplify their social life?

We make these decisions all the time, we just aren’t always conscious or overt about it.  And if we don’t make those decisions, we often suffer for it by overextending or stressing ourselves.  We need to have boundaries and filters.  We need to be able to focus and set limits and values.  These needs have begun to be more clearly revealed by the technology of Google+.  Knowing about that technology may improve our ability to treat our patients.


  1. Hi Mike,

    Great article, and I agree with many of your points, though I’ve considered G+ from a different view point/skill set thus far.. 🙂

    Like you, I’ve been playing around with G+. I found it most excellent for being able to target things at different audiences.. psych articles to psych contacts, drawing work in progress to artist contacts. The collaboration tools are excellent.

    However, I have now deleted my G+ account. The only reason for this is that Google are currently deleting all accounts that do not use “real names” (and are deleting the associated gmail accounts as well). My own reasons for wanting anonymity are not so important, but I wonder about the types of examples you gave – things like circles for “who to contact when in crisis”. I know that we have pretty much given up all our privacy etc to companies like Google, but if I were in that type of situation, I would be very concerned about having my real name associated with those kinds of “need” groups and conversations.

    Just a thought I’m putting out there 🙂

    Thanks for the time you’ve put into this article.



    • Mike Langlois, LICSW says

      WG, you raise an excellent point. It’s important to keep in mind that we’re still in the early adoption phase of this technology. And although our patients are not constrained by confidentiality in the way therapists are, having a circle called say, “My AA Group” could violate that groups rules and/or traditions. That said, I think there are a lot of groups or ways to categorize our social circles which don’t put our own or others privacy at risk inordinately.

      Lastly, I think your reasons for wanting anonymity may not be any of our business, but ultimately they are important because they tell you something about your limits and their origins.

      • Hi Mike,

        Thanks for the response. Just something as a heads up to the therapeutic community – you should expect your clients to put absolutely anything (including the most personal details of their therapy) on the internet, often publicly available. Unfortunately (?), it’s only therapists who are required to adhere to confidentiality standards.

        Client education might be one of my (several) soapboxes.. 😉



        ps.. re: personal limits.. I think you’re “shrinking” me.. or perhaps I’m projecting 😉

      • Mike, I too am protesting G+. It looks like a great service, except for the part where they’re policing identities in ways which are bad for everyone, but fall especially hard on women, people with disabilities, whistleblowers, ethnic minorities, and, presumably most especially dear to our hearts, people with mental illnesses.

        I would ask you to read these three posts:
        and reconsider your advocacy of the use of any “bare name” service, such as G+, FB, or LinkedIn for therapeutic purposes.

        There are many more illustrative posts out there in that vein.

        You comment above to WG, “I think your reasons for wanting anonymity may not be any of our business, but ultimately they are important because they tell you something about your limits and their origins.” Limits? Or boundaries?

        Part of our jobs as therapists is to help people who sometimes were not allowed to have boundaries as children to learn how to do so healthily. Let me give you an example. I know a young woman who became increasingly inhibited and anxious about posting on her social networking page. She revealed to me — and initially in her mind, there was no connection — that her (abusive) parents had found and were now following that account, because it was under her name. I pointed out to her that it was her right, at the age of 24, not to have to share things with her parents that she didn’t feel comfortable doing so. This was a revelation to her. Though she had privacy controls available to her at that account, the fact that they were watching should she slip up and miss-flag a post lead her to conclude the solution was to create a new account, under a pseudonym, and notify her trusted friends. This allowed her to resume her creative writing and her reaching out to the community of supporters helping her to heal.

        Another part of our jobs is to be scrupulous with our client’s confidential information — often more scrupulous than they are. For instance, as per now standard ethics, I warn my clients about the limits of confidentiality in email. My clients may be blasé about it, but it’s my job not to be. Similarly, I think we should think twice about encouraging self-disclosure on a bare names service. Even if we therapists aren’t the ones communicating with our patients online, we do them a disservice if we lead them to believe a bare names site is an appropriate and safe place to, for instance, ask for support from friends or divulge any medical diagnosis.

        Instead we should be talking to our patients about boundaries and the tools that let them have boundaries, from pseudonyms to circles.

        • I too have real problems with this move towards “real names and real names only” attitudes. One of the fantastic things about the Internet has always been the ability to reach out and gain support from people all around the world without compromising your own privacy, location, or identity. Imagine a thriving, vibrant message board designed to offer support to those dealing with depression (or any other mental health issue). Now imagine they change their policy so that everyone must use their real names and could potentially be found by their employer, family members, casual friends. I predict crickets and deleted years-old posts within a day.

          I received a G+ invite from a Twitter friend, signed up, and was immediately annoyed that the account was linked to a Gmail account that I almost never use and whose handle I’ve never really liked. The only reason I had that Gmail account was because my Android phone insisted I have one, and it took me a good while to figure out how to stop G+ emailing me notifications, which were making my Droid go off at all hours of the night (because no matter how many times you “kill” the Gmail app, it restarts itself!). And then, not only was my G+ account now linked to an email account I don’t use, there was no way to change the email associated with G+ or even add an alternative email.

          I kept G+ for a few weeks, but couldn’t seem to “get” it. To me, it’s an uncomfortable mishmash of Facebook and Twitter, and not in a good way. Circles aren’t really anything new; Facebook has for ages had the ability to group people and use those groups to control who can see what (granted, Circles *may be* easier to maintain; FB has a fantastic habit of burying settings in odd places). I was also made uncomfortable (for lack of a better word) by the large number of complete strangers who were adding me to their Circles (like, as you say, on Twitter); it felt “wrong”, somehow.

          Long story short: I ended up declaring, “I don’t see how this is an improvement over the two services I already use frequently,” and closing my G+. Perhaps I just don’t have the time/energy right now to be as exploratory as an early adopter needs to be; perhaps I’ll get along with G+ better when it’s a bit older and settled (both FB and Twitter were a few years old before I entered their ‘verses).

          Minder: Like your client, my solution to boundaries on social media as I start down the path of changing careers has been to create “professional” accounts on Gmail, Twitter, and Facebook (and hopefully a new blog soon, if I ever settle on what to call it). Yes, Facebook offers robust privacy settings I could have used to keep one account and ensure grad school classmates/colleagues/future clients only see certain posts. (One of my bosses has his Facebook so locked down that “professional” Friends can only see his Info page.) But while I trust myself to be careful, I don’t trust Facebook not to roll out a new set of “upgrades” that suddenly lays me bare. So I have my old accounts where I can be locked down and fully myself with friends (political, activist, random, bizarre, sometimes angry and ranty), and I have my new accounts where I can be more easy to find (for professional networking) and moderate a bit more the face I project to a certain audience (still random and sometimes bizarre, though).

          I think, going forward, we all have to figure out for ourselves the best ways for us to handle Web 2.0. There’s no one way that’s perfect for everyone. 🙂

          • Mike Langlois, LICSW says

            Hi Rebekah, thanks for elaborating on your thoughts about Google+ and privacy. These are reasonable concerns. The promising thing is that Google has been consistently listening to feedback and modifying things. They recently rolled out the concept of verification badges, to verify that you are who the name in your profile says you are. Hopefully this means that in the future people will have the opportunity to use pseudonyms and forgo the badge for the sake of anonymity.

            I hope they don’t do away with pseudonyms entirely, even though I am a big believer in radical transparency. My motive is this: I want to keep Cthulhu in my circles. 🙂

  2. Wow, how enlightening!
    I am challenged.
    We’ll, see!

  3. Mike, I like your ideas here, but as someone who is not strong in the visual-spatial realm, I feel very overwhelmed with Google+. For me, it has too many options, settings, possibilities. Choice is great until it overwhelms usability. That said, I may not be the optimal user of Google+. Which brings us back to the necessity to choose platforms based on needs, comfort and skill set.

    • Mike Langlois, LICSW says

      Susan, I hear you. But think of the therapeutic value in disclosing that to a kid you work with as a way of illustrating learning difference, not disability. I do agree with you that we can’t and won’t be equally enamored of each platform and need to use the guidelines you mention in terms of skill set.

      That said: If you want to make Google+ look like your Facebook page, there’s an app for that.. 😉


  4. Very, very good article and I applaud focusing on using Google+ in the office as a therapeutic exploration of boundary setting. I’m still learning it, but it seems to have solved the problem of with who and how much I wanted to respond on Facebook. I’m an active blogger and have been bothered by my clients or unknown clients of others wanting to “friend” me, which after listening to Casey Truffo’s series this summer on internet issues for therapists, I’m convinced is never a good idea. The point about learning to focus attention socially and have it be a conscious decision is totally on target. Michael Yapko in the above mentioned series is talking a lot about the younger generation’s mushrooming rates of depression, and its possible connection with a deep passivity and what he calls “continuous partial attention” that gives rise to a superficiality and profound ignorance about relationships, that is born of misuse of the internet and is becoming rampant in the culture. Terrific job, thought-provoking stuff.

  5. This really helped me better understand what I consider to be some excellent opportunites that google plus offers as oppposed to FB. Not the least of it that sociology teaches us that groups can only be so big before they are in effective. The belongingness, boundaries, and tribal aspects of this new technology shows huge promise and potential. I’d like to hear more.
    My first circle is called Licensed Therapists with Attitude…ahhh….but what to do with that…. Open to suggestions.

  6. Great post! How do you bring in the Google+ into the session-do you have a laptop in your office?

    • Mike Langlois, LICSW says

      Lately I have only been bringing in my iPad to the office. I have used Google+ with my consultees, but in sessions I tend to talk through the concepts of circles in terms of boundaries and such.

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