What To Do When Your Therapist Turns Into A Kitten


I have been working with patients online for about 6 years, and even now I have some interesting surprises in the work.  Recently I was meeting online with one of my long-term patients for their regular session.  I use my laptop but have a better web camera and monitor hooked up to it.  The bigger monitor allows me to see the patient’s image, but also keep an eye on my image so I can see what the patient is seeing.  The laptop monitor stays dark, and the laptop’s built-in webcam goes unused, at least most of the time.  But this particular day the laptop webcam decided to switch on 15 minutes into the appointment, and hijacked the webcam I was using.  So from what my patient could see, one minute I was there listening empathically, and the next minute I had disappeared.

Those of you who enjoy object relations theory should be enjoying this story by now.  Wait, it gets better.

As I was explaining to my patient why I’d disappeared, I was trying to turn off the laptop’s built-in webcam.  Instead I turned on a special program the laptop has that replaces the screen with the image of a kitten, the one seen above in fact.  Suddenly I was not invisible, but a kitten.  Better yet, the kitten was lip synching and moving its mouth when I spoke.  Fortunately this wasn’t happening at a particularly delicate moment in the therapy, and we both had a good laugh at it.  I apologized to my patient and said, “you know, I studied a lot of things at grad school, but they never taught me what I’m supposed to do if I turn into a kitten when I’m with a patient.”

Many psychotherapists have the sort of relationship with technology that resembles the folks they treat with Borderline Personality Disorder:  They alternately overidealize and devalue tech, often in the same breath.  “Skype” will be the way we salvage our dwindling practices, we’ll be able to reach people all over the planet, make our own hours and go completely self-pay because most insurance doesn’t cover it.  It will be wonderful.  That’s the overidealizing part, the devaluing part is more subtle.

Because I do a growing amount of therapy and supervision online, I often get requests for a consultation session to help therapists who want to do online therapy and “need my help getting on Skype.”  At this point I try to explain that Skype is not HIPAA-compliant, and that there is more to it that getting a webcam, but here’s where the devaluing of technology comes in.  It’s as if some folks think that the only thing one needs to know in order to be an online therapist is how to download a program and turn on the camera.

Most therapists who decide to get Basic EMDR training wouldn’t bat an eye at needing to go through two weekend trainings and a minimum of 20 didactic and 20 hours of supervised practice in order to be certified.  And yet many therapists don’t consider that working online and with emerging technologies requires more than learning how to flick a switch.  It’s sort of the way people often treat the IT guy at the workplace:  With one breath we describe ourselves to him as “clueless” about technology; and yet we really want him to stay in that basement office until we need him to come up and fix our email.

Graduate programs teach us next to nothing about how to use technology in our practice, except perhaps to warn us to avoid it at all costs.  Think about it.  Do you know what to do if you disappear in the middle of talking with a patient?  Do you know what to do if you turn into a talking kitten?  More importantly do you know how to prevent yourself from turning into a talking kitten, or turn yourself back from one if you do?  And perhaps most importantly, do you know how to help patients anticipate the glitches with virtual therapy, process the unique empathic failures that can arise, and create a good-enough holding environment online?

People like my colleagues DeeAnna Merz-Nagel and Kate Anthony founded the Online Therapy Institute for just this reason.  They offer dozens of different 5 hour courses on various technologies, from video conferencing to text chat to conducting therapy in virtual realities like Second Life.  The takeaway here is that there is a lot more to learn about online therapy than downloading Skype.

Look, I am not trying to discourage people from doing online therapy, in fact the opposite.  I know that it can be a very effective treatment modality, and easily accessed by a growing global population.  I’m not even trying to get you to sign up for consultation with OTI or me or anyone in particular.  The point I am trying to make is that it is an additional skill set that needs to be learned and integrated into your clinical repertoire.

Psychotherapists don’t just buy chairs and a couch and start talking.  EMDR isn’t just wiggling your fingers in traumatized people’s eyes. Both take time, case supervision and specialized training.

Online therapy, and integrating social technologies into your therapy practice is no different.


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Radical Transparency

By now you may have read the story of the student in Manchester, NH who was arrested in his school cafeteria by a police officer who lifted him out of his seat, and forced him into a prone position on a table.  Another student captured the video, and you can see it and the story here.  Although the police handling of the situation was clearly disturbing, even more disturbing are the voices of the teachers caught trying to get the student recording to stop, and then attempted to take the phone away from him.  By his report they did make him delete a couple of pictures, but the video went undiscovered until it went viral.

It’s time we get real about transparency in the professional world.  My prediction is that the school administration will address this situation by trying to either enforce a no-cell phone policy or create a policy that prohibits the use of electronics on school grounds to record such incidents.  I hope they don’t, and use this as an opportunity to open some conversations between school staff, parents, students, and officers.  But I will be pleasantly surprised if that happens.

Professionals who work with people “in their care,” be it therapy, education or something else, often cite privacy concerns when it comes to transparency.  I’m convinced that the reality is often that they want to protect their privacy as much as if not more than that of their patients.  What happens behind closed doors is secret.

Remember that phrase “you’re only as sick as your secrets?”

Other professionals want to commute to work so they have a “private life.”  They are outraged with the amount of information available about them online, information that their patients, students, anyone, can access about them.  When I do public speaking about technology and therapy and education, I often find that privacy concerns boil down to this sort of fear and outrage.  Sure, HIPAA is brought up, but that is usually in the context of another fear, getting sued.

I practice and encourage my colleagues to practice what I call “radical transparency.”  I define Radical Transparency as engaging with technology as if it is always in the Public sphere visible to anyone.  To be clear, this does not mean either never using technology to communicate about one’s personal or professional life.  Nor does it mean telling everyone everything all the time.  Rather, radical transparency means that before you “utter” anything via technology, and before any choices you make with technology, you consider what would happen if it one day comes to light.

I’m not saying you have to like radical transparency, I’m just saying that it is time we get clear with our relationship to technology and others with it.  And I’m not saying I am perfect with it, but I try to comport myself with authenticity.  If you search online you will (hopefully) not find my public posts or comments cutting or snide.  If you somehow got hold of my emails over the past few years, what would emerge is an acerbic, funny, tart guy who is prone to arrogance and does not suffer fools gladly.  You’d find a good deal of kindness and wisdom as well, but certainly you’d find frustration, self-righteousness and negativity.  In short, you’d glimpse my human condition.  But there you have it, I am prepared to accept the revelation of any warts that may come along.

Radical transparency, I am suggesting, is not just about what you “put out there” on the internet.  It is not about gussying yourself up so you are acceptable to everyone.

Radical Transparency is about getting clear, clear with yourself.

I have found two spiritual traditions especially helpful with this idea.  The first is Buddhism, which talks about nonattachment and going to the places that scare you.  But in this post I want to focus more on the second tradition which has influenced me, and I think may have some good insights into technology and our place in the world.  That second tradition is Quakerism.

What I have learned from Quakers and my own connection to the Society of Friends, is the importance of gaining clearness, and discernment.  One quote that sums up what I am saying is from an article written by M.L. Morrison in the book Spirituality, religion and peace education.  In it she says:

“Key to a Quaker philosophy of education is the belief that each individual has the capacity for discerning the truth.  The truth does not solely come from the teacher or mentor… The process of getting clear about a particular discernment implies testing it out in a community of fellow seekers.  In this way individuals are accountable to the communities in which they live and learn and the community can support the strength and leadings of its members.” (Italics mine)

What if we started seeing the world, online and off as that sort of community?  Get clear with who you are and what you’re about.  Be authentic.  And after you have achieved a certain amount of clarity have a discerning attitude about what you put out there about yourself, and above all behave as we feel we ought.  Am I saying that we all need to adopt Buddhism or Quakerism?  Of course not.  But we need to start focussing first on who we are in the world, not who shouldn’t be videotaping us.

Technology is not going away folks.  And adolescents are rightly exploring and testing the limits of it, because they will be using it to maintain, more accurately repair, the world we have given them.  September 11th taught these kids that media can be used to bear witness to terrorism and injustice in real-time.  And since then, Youtube has proliferated with videos of the atrocities professionals have perpetrated.  I have seen a juvenile collapse walking around a courtyard of lockup, only to be kicked and ignored by the warden when he was in need of medical attention.  I have seen a college student tasered in a library.  We have seen an Iranian woman shot to death and die before our eyes.

And these images change us, and they go viral.  This is what globalization is, this is our whole planet struggling to get clear.  And there are lots of people, those in power, who want the status quo.  Keep the doors shut so people have to “go through the proper channels.”  But technology is trending towards dialogue and democracy.  You just can’t get away with being cruel unobserved and often unchallenged.  Make fun of a teen who may have Asperger’s and he’ll post a rebuttal on Youtube.

These are the same people as the teachers who try to take away the student’s cellphone, or the administrators that forced Matt Gomez to shut down his class Facebook page.  All the parents had signed off on it, but concerns about privacy were still cited.  And that again, I believe is often a professional rhetoric for “controlling access to information.”

I have worked on the inside of several school districts, and in all of them I saw stellar educators, people who were always taking risks and getting creative.  And I saw lots of lazy, verbally abusive educators there as well.  The way our education, and our mental health, systems are set up there are a lot of disempowered angry people working with even more disempowered angry people.  And many are in the middle, trying to just keep their head low and not make waves.  I know, because I have been all of these at one point or another.

This is not going to be as easy from now on.  If you swear at a student, someone’s going to record it on their phone and have it posted on Youtube before you can blink.  If you gripe about a patient on your Facebook page they’ll find it and call you on it.  And those of you who are trying to just keep out of it all, we’ll see you too.  And more importantly, you’ll see you, and when the kid you ignored being bullied because you didn’t want to deal with it that day kills himself, you’ll have to live with the guilt that thousands of people he never knew reach out to assure those like him that it gets better, while you, the person who saw him every day or week just sat there and did nothing.

Talking about patients online, getting rough with a student, shooting a woman–Yes, these are all very different events.  But they all connect around the idea of an ethics of radical transparency.  Or as Rainer Maria Rilke put it in “Archaic Torso of Apollo:”
for here there is no place
that does not see you. You must change your life.

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