Taking An Interest


This week I was at the dentist, and the appointment probably took twice as long as it was supposed to.  This was because as I was waiting in the dentist chair, I was playing Denki Blocks on my iPhone when the assstant came in.  She found the game interesting, and confessed to me that she didn’t know how to download games on her new iPhone.  And as I was explaining how to do that, the dentist came in and he talked about how his children weren’t allowed to play games on the iPhone because they discouraged socializing.  So then of course I explained that there was research that suggested very differently.  He listened quietly and I said, “maybe I shouldn’t be arguing with someone who is about to put a drill in my mouth.”

“No, no,” he said.  “It’s just that I’m thinking about what you said, and I haven’t thought about it that way before.”  All three of us had an ongoing conversation between all the stages of filling a cavitiy, about smartphones, digital literacy, gaming.  And at the end of it I noted how clearly this is a topic for our times if all of us can be talking and listening intently about it for such a long period of time.

In college, one of my creative writing teachers once said, “What interests you is interesting.”  I think there is a lot of truth in this in general, and specifically when it comes to psychotherapy and running a business.  I feel extremely fortunate to be in a portfolio career that allows me to pursue my interests and take an interest in the psyche and society.  Not everybody has an easy or clear path to this in our society.  Some self-help gurus make it sound like all you need is a burning interest to become the happy and successful, which is absolutely not true.  There are millions of talented people out there that start off with less privilege and opportunity, and more stressors due to race, gender, poverty, or living in an ableist culture.  But what I do think my professor was on to was the idea that often what interests you can be a strong motivator to yourself and exciting to others.

A supervisee and I recently were discussing the possible meanings and messages that could be conveyed in leaving a voicemail for a patient.  After discussing this for 30 minutes, I interjected by saying, “Can I just take a step back and point out what a weird profession we’re in that we can spend so much time talking about this?”  We both laughed at this, and it was true, but the time had gone by so fast because we were mutually interested in the subject.

Enthusiasm, in its original meaning, was taken from the Greek enthousiasmos, which came from enthousiazein, to be possessed from within by a spirit or god.  That sense of a powerful force from within that can fill one with energy and ideas and lose track of time is at work in all of the stories above.  It is not the only ingredient to having a successful business, but I believe it is an essential one.  We need to be able to geek out about what we do, to go on at length about it.  Hopefully we can do so in an engaging way, but we need to be able to lose a bit of self-consciousness to be able to focus properly on our patients, our work, and our business.

Frequently I consult with therapists who come to me because they want to grow their practice.  A few of them say that, but what they really mean is that they want to make more money and work less.  That is not in itself a bad thing, but for some it is an attempt at compromise.  For they have grown tired or disinterested in what they are doing.  They feel trapped in their work, not interested in it.  They are afraid that they are too old to change, or don’t have anything else they can do.  Some dream about a time they’ll retire and write a novel.  But for now they are consigned to sit silently and voicelessly in their office.  They grow bored and resentful of their patients, who if they are lucky, escape.  This vicious cycle can go on for years.

The same holds for supervision.  I have heard from a lot of supervisees about supervisions where it’s all about the paperwork, or the liability, or the billable hours.  I’ve heard supervisors lament how they don’t have time to focus on talking about the dynamics of therapies, as if that was “extra” stuff!  My experience is that these comments are voiced midway or at the end of a progression towards burnout.  First the supervisor feels overwhelmed by the “musts” of paperwork and filing 51As, and then the supervision shifts to only being about those.  Next, the supervision gets defined as merely being about that, so that the supervisee sees the supervisor rushing down the hall or on the phone, pausing to ask, “Anything we need to talk about?”  If there is no crisis the student feels pressured and becomes trained to say no, there isn’t.  And now that supervision is only about crises and paperwork, it becomes something everyone wants to avoid because it is boring, lifeless.  There is no enthusiasm.

I would suggest this is ultimately a setup for malpractice.  Supervisees trust supervisors who seem interested in them.  Over and over I have heard that supervisees have a hard time connecting or trusting supervisors who are “just business,” or cheerleaders.  Yes, supervisees don’t want a supervisor who lets them talk for an hour and then says, “sounds like you handled that well.”  This bears saying, because sometimes we unconsciously or consciously try to substitute affirmation for engagement and interest.  If you’re a supervisor, don’t do it, because your supervisees can smell it a mile away.  If you’re vacant, they know it.  If you are filled with the spirit of interest, they know that as well.

I’ve had colleagues tell me how clever I am to have found the niche I have, which drives me crazy frankly.  I didn’t choose to focus on technology, gaming and social media in therapy because I saw a vacuum.  I was just lucky that there was one.  I chose these areas of specialty because I am a total geek about them.  I could play or talk about video games for hours.  I can’t talk about Twitter or Google+ without getting animated.  I see their influence everywhere, read vociferously about them on my “free” time.  I wrote a book about it which I charge $2.99 for.  When asked to teach a class on clinical practice I declined, and said, “No, but I’ll write a syllabus and teach a class for social work and technology.”  Any of you who have taught at the graduate level know that teaching from a pre-existing syllabus is easier and less time-consuming than writing and proposing a pilot course.  But I was enthusiastic about the topic, which fueled my work ethic.  And this has set up a virtuous cycle, where I get more recommendations for reading or TED Talks than I can handle, and referrals to work with those patients.

I’d be lying if I said I didn’t hope someday to become famous or rich, but it is more likely that I will make a decent living and have a modest reputation.  Because as I said there are thousands, no millions of people out there who have talents and interests to share with the world.  I’m just grateful I got lucky enough to be one of the ones who got the chance to do it.

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How to Get Taken Seriously as a Mental Health Professional

Many therapists looking to start or grow their private practice often wonder the same question when they are starting out:  How do I get referrals?  If you can tolerate a mild rant, I may have one answer for you.

Let’s look at this concern through a tried and true mental health paradigm.  First, we take a symptom, and then we look at the underlying conflict that the symptom represents.

So what’s the symptom?  That’s easy, head on over to LinkedIn and take a look at several profile pictures of colleagues.  Go ahead, I’ll wait.  What did you see?  When I looked I saw some professional headshots, but more of the following:

  • blank photos
  • top of head/ chin cut off
  • people in front of a car
  • waterfalls
  • tank tops
  • the “I’m holding my phone camera at arm’s length” shot
  • at a party
  • graduation gown
  • flower
  • too dark to see
  • wearing sunglasses
  • skiing


If you want to generate referrals, this may be a problem. Some colleagues may have a different opinion or be too diplomatic to say this, but let me not mince words.  If you don’t have a professional headshot it is doubtful I will refer to you.  I don’t send people to waterfalls for psychotherapy.  I suspect people wearing shades of paranoia or vampirism.  I envy people who can ski much too much to ever want to help them grow their business.  Cars in photos are either nicer than mine or too shabby, triggering too much judgment either way.  And party-goers scare me.  😉

My experience as a consultant has been that these headshots are symptomatic of one of two scenarios:

1.  You don’t take social media seriously.  In this day and age, our potential patients want to see us before they see us.  They often do their research by checking out our online presence.  If you go on LinkedIn for example, you may find that several people viewed your profile this week.  A picture is worth a thousand words.  I have seen great head shots in black and white, or even avatars for online therapists, so it doesn’t have to be a standard color shot.  But the way technology works now, whatever picture you choose will most likely attach to your emails, tweets, blog comments, posts, and feeds of all kinds. There are exceptions to this, like my colleague Social Jerk, who needs to maintain a tight hold on her anonymity to allow for her to create such creative and satiric posts about social work.  But if you are not trying to be a satirist, but rather grow a therapy practice, this will not work for you.  And if you’re on Twitter, please don’t be an egg.  When I need to jettison followers to follow additional people, the eggs are often the first to go.  Accept that social media is the point of professional first contact with your colleagues and customers.  Take it seriously.

2.  You don’t take yourself as a therapist and businessperson seriously.  Anyone that has read this blog or chatted with me at a workshop can probably tell you that I am neither dour nor constantly serious.  I certainly think there is a lot of room in our profession for humanity, play and creativity.

That said, we are in the business of providing treatment for serious concerns, working with people who have a range of predicaments.  We assess for suicidality, psychosis and trauma.  Your patients come to you with vulnerability and hope that you will help them create profound change, recovery and healing in their lives, maybe even help them stay alive.  If you think that therapy is just two people in a room chatting, then by all means keep the beach picture.

To get a professional head shot requires investment of your time and money.  It is a business expense.  If you are unwilling to invest in a professional image to represent your business concern I suspect you are not ready to own and run a business.  If you are unwilling to invest the time to look through your existing photographs and select one (if you have it) that presents a professional demeanor online then I suspect you are not ready to own and run a business.

Now I know that the term “professional” photo is vague and subjective.  I am not saying that you need to be in a suit and tie.  You can be a play therapist and have affect like my colleague Charlotte Reznik.  But slapping up a blurry photo of you near a palm tree sends the message that you can’t be bothered to represent yourself or your brand.  And in business we need to be concerned about our brands, even as therapists.

Look, I’m not saying these things to hurt your feelings.  I really want you to succeed, and I know that there are a lot of people out there who need your help.  That’s why I suggest that the photo is the symptom of an underlying issue, which is the difficulty to take either technology or your business seriously.  If you have taken time and consulted with trusted colleagues and have come to the conclusion that “I want potential patients to see me as someone blurry whom they could go skiing with” is your brand, and that the head shot is a conscious and intentional image to brand yourself online than you have my blessing.

If not, get thee to a photographer.


If you are interested in participating in a small group supervision experience, you may want to check out the Supervision Package I’ll be offering this fall.  You can find out more about it here.

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When Wallflowers Attack

Back in graduate school, my group therapy professor once said to me, “early risk-takers are often scapegoated by the group.”  This comment came on the heels of yours truly taking a risk in the group, a group of psychotherapists in training.  I learned two things in that group class on that day.  The first was that early risk-takers are often scapegoated.  The second was that we therapists can be just as cruel with our comments as anyone else.

This is something that many of my supervisees encounter when they start to put themselves out there, especially on the interwebs.  They are stunned when the blog post they write elicits comments that are sometimes shocking in their nastiness.  They are confused as to why this happens, and what to do about it.  If you are beginning to use social media to build your psychotherapy practice, write newsletters, prepare a public speaking campaign or just write a blog, this post is for you.

The internet has made it easier to be both impulsive and anonymous, and emboldened some people to hurl invectives.  I call these people the wallflowers.  These are the people in any given group who are afraid to take risks or stand out, and resent those who are brave enough to do so.  They are quietly resentful, and more often than not envious of people who are not quiet.  I’m not talking about introverts here, but rather a particular group who stand on the sidelines seething.

These are the people who send you a nasty email at 2:00 AM criticizing your post for a spelling error, or the folks who text really ugly comments to you after you post something on a listserv they don’t like.  They’re the people who make personal attacks on your workshop evaluation in the guise of constructive criticism, or bait you in discussion groups by deliberately misconstruing your words.  Yes, I’m not making this stuff up, all of these things and worse have come at me by email, Twitter, Facebook, blog comment, and text message.  The majority of the time it will be behind the scenes of whatever arena you’re in, so that you can see it and the larger group can’t.  Consciously or unconsciously, wallflowers are counting on you not passing these barbs on to the larger group.  Nobody likes a tattletale.

So what do you do about them?

First, take a second and calm down, and note that the intensity of your response is probably an indicator that this is out of the ordinary.  Next, try to find a trusted friend or family member that you feel comfortable sharing it with, and ask them what they make of it.  Supervisors are often really helpful here.  Often they will react more strongly then you did, which gives you another clue its a wallflower attack.  Your inclination may be to try to learn something from the comment.  I’m going to say something that may go against the therapist grain here–Dismiss the comment and the wallflower.  Don’t bother trying to make this into a growth opportunity, there are plenty of other growth opportunities out there for you.  Don’t give this your energy.

In my experience this is very hard to do, because therapist wallflowers have a lot of skills to hook you.  They bring their therapeutic arsenal and try to come at you as a therapist, by analyzing or interpreting you.  Don’t fall for it.  Just because you both speak the same language doesn’t mean you have to have a conversation with them.  Therapy is a specialized and voluntary form of conversation, and anyone who tries to inflict this on you unasked is using their Jedi therapy powers for ill.

This is your reminder.

This is the price you will have to pay for being an innovator and a risk taker.  Early risk takers are often scapegoated.  You didn’t do anything wrong, you were just putting yourself out there.  And every time you do that, you will run the risk of a wallflower attack.  Don’t overprocess it, move on.  And definitely don’t let it stop you.  Remind yourself that the reason they had anything to attack you about is because you’re doing something they wish they could, creating.  Anyone can ping off a blog post, or fire off a Tweet in reaction, but it will only be a reaction, not a standalone.

Remind yourself that your ideas are precious.  I’m not trying to sound New Agey here.  What I mean is that the fact that you had something to put out there is not to be taken for granted or underestimated.  You could have not had the inspiration for that workshop or podcast, but you had it.  All over the world there are people who have not given awareness to ideas, throughout history millions of good ideas have never been expressed or seen the light of day.  Not you.  You did it!  And if you stop taking risks the wallflowers win, and the prize is one less idea in the world.  Yippee.

I know this can be hard to do, trust me.  And the technology we have today has made it even easier for wallflowers to attack.  It’s sort of like that sense of invincibility drivers get when they are encased in the protection of their cars.  Shake it off.  Share it with someone you trust for perspective.  Dismiss it.  Stay focused.  You can take time to smell the roses, but don’t get distracted by the wallflowers.


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Harriet At Forty-Eight

If you never read the novel Harriet the Spy, I hope you will ASAP.    My hope is that most children, parents and therapists have had a chance to read it already, because it has a lot to teach us about digital citizenship.  You can get it on Amazon here.

Harriet spends a lot of time writing down things in her notebook.  Truthful things.  Unflattering things.  And one day the notebook falls into the hands of her classmates, who read these things, and respond to her with anger.  What I find interesting is the way Harriet’s friends, teachers, and parents respond.  Their initial response is to take, or try to take, Harriet’s notebook.  Of course Harriet gets another one.  That’s not the problem.

Harriet the Spy was published in 1964.  According to Wikipedia, at least one variation of the technology of the notebook had been around since 1888, and there are examples of its common usage in the early 1900s.  This technology was prevalent long before the 1960s.  No one says to Harriet that she has a “notebook addiction,” although her usage of it becomes problematic.  In fact, her redemption in the book also comes from the same technology of the written word.

One of my favorite moments in Harriet the Spy comes in Chapter 14, when Harriet has her initial appointment with a psychiatrist.  As they settle down to play a game, the psychiatrist takes out his analytic pad:

Harriet stared at the notebook.  “What’s that?”

“A notebook.”

“I KNOW that,” she shouted.

I just take a few notes now and then.  You don’t mind, do you?”

“Depends on what they are.”

“What do you mean?”

“Are they mean, nasty notes, or just ordinary notes?”


“Well, I just thought I’d warn you.  Nasty ones are pretty hard to get by these days.”

“Oh I see what you mean.  Thank you for the advice.  No, they’re quite ordinary notes.”

“Nobody ever takes it away from you, I bet, do they?”


This vignette illustrates how the clinician is not above or apart from technology.  Harriet’s psychiatrist uses it himself.  And his response to her struggle and worry about using technology is an approach I’ve come to see as key:  He doesn’t try to restrict her from using the technology, he engages her around its use and thinking about its use.  He actually gives her a notebook, and then respects her usage of it when he lets her leave the office without taking it back or asking to see it.

He then recommends that her parents talk to the school about allowing her to use technology to amplify her thoughts and expression there, via the school newspaper.  He also suggests that they use technology in the form of a letter written by Harriet’s old nanny to give her some advice and connection.  Many will say that Ole Golly’s letter is the pivot point for Harriet in the story, but I’d suggest that the pivotal moment comes when the mental health practitioner doesn’t demonize technology (the notebook) or pathologize its usage, but rather leans on technology as an avenue into the patient’s forward edge transference.

Technology, as Howard Rheingold reminds us, is a mind amplifier.  It can be used to amplify our memory in the form of notes, for example.  It can also be a voice amplifier, for better or for worse.

If Harriet was around today, I imagine she would be on LiveJournal, perhaps with her settings on private, but on LiveJournal nevertheless.  In fact, her LiveJournal notebook would probably be more secure than a notebook carried around on her person without encryption.  But maybe she’d also be on Facebook, Twitter, and Tumblr.  And unless she had parents or teachers who talked to her about digital literacy, she might not know or care about privacy settings or mindful use of technology.

Every day, on Facebook or Twitter or other social media, people young and old post, and “drop their notebook” to be read by hundreds or thousands of people, who can amplify the notebook even further by liking, pasting, sharing or tweeting it.  By comparison, Harriet’s class of 10-15 students seems paltry.  When an adolescent complains about her ADHD medication on her status, or when a parent tweets how proud he is of his Asperger’s child, these nuggets of information, of expression, of identity formation are sent out into the world and amplified.  Our work as therapists needs to be to help our patients understand the significance of what they are about to do to themselves and others when that happens.  And to do that we need to understand the technology ourselves.

Few of us would consider giving Harriet a notebook as “feeding her addiction,” or giving her a hair of the dog that bit her.  Yet, we level such technophobic claims on the social media and technology of our time, trying to focus on technology as an addictive substance rather than as a tool, and pathologizing its use far too quickly and easily.  And we often join technophobia with adultism, when we try to intrude or control the use of technology by children and adolescents (note that I said “often,” not “always”)

When you look at some of the stories Harriet prints in the school newspaper, you have to marvel at the bravery of the educators in that school!  How many of school administrators would allow entries like “JACK PETERS (LAURA PETER’S FATHER) WAS STONED OUT OF HIS MIND AT THE PETERS’ PARTY LAST SATURDAY NIGHT.  MILLY ANDREWS (CARRIE ANDREWS’ MOTHER) JUST SMILED AT HIM LIKE AN IDIOT.”  Can you imagine the parental phone calls, even though the parents were both the behavioral and quoted source for this story?  Can you imagine kids being allowed to experience communication and learning with this minimal form of adult curation?  But also, can you imagine parents saying that the problem is allowing access to the technology of writing a newspaper, and that the idea of a school paper should be abolished?

When you think about it, we live in an amazing era of the amplification of human thought and expression.  Our children will need to learn how to manage that amplification in a way we still struggle to understand ourselves.  I remember one notebook I dropped, when I was managing a staff of guidance counselors.  I was very frustrated with the response of one of them to something, and wanted to share that with my supervisor.  I thought it would be important to share my emotional response to this with someone I understood to have the role of helping me sort this stuff out, and I was being impulsive and cranky.  I ended up sending the email to the staff instead.  Boy, did that torpedo those relationships.  But I did learn a lot about how to pay more attention to the power of technology, and that part of being a good digital citizen requires thoughtful use of ampliying your words and ideas!

Most of us probably have a notebook-we-dropped story we’d rather forget, but we need to remember them and share those stories with the up and coming generations as cautionary tales, and examples of good and poor digital citizenship.  Ole Golly tells us, “Remember that writing is to put love in the world, not to use against your friends.”  Writing, a technology we have come to understand a bit better since Gutenberg, can be used for good or ill; but we don’t ban it.  Now we are all learning, albeit uncomfortably at times, how to handle the newer technologies of social media, digital communication, and video games.  It may be a bit utopian to suggest that texting/tweeting/gaming/Facebook/blogging is to put love in the world.  But the alternative seems to be that while some of us ignore, avoid or fear it, other people, governments and corporations will learn how to use it against our friends.

Embedded in Harriet the Spy is a quote from Lewis Carroll, which aptly describes where we find ourselves in the 21st century of social media: “‘The time has come,’ the Walrus said,/’To talk of many things:”  Indeed, the chatter can be deafening, impulsive, hurtful and confusing.  But the solution is to choose our words carefully, not to stop talking altogether.

Like this post? If you are interested in joining my upcoming online supervision group for therapists, please email me.  There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.

But Not Your Thoughts: Social Media & Children


Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.


Therapist Websites Are Not Enough

Last March a friend and former graduate student I supervised was visiting me from out of town. He was telling me about a call he got that went something like this: “Hi Bob, great website! Would you like to do a workshop on creating a online presence for our chapter of NASW? You won’t be paid for this, but you’ll get exposure, what do you think?”

This sort of exchange contains every element you need to have to teach a lesson on how not to do things as a Web 2.0 therapist. Let’s break this down:

1. What you are doing is so valuable we’d rather not pay you for it. Anything that you would go to a workshop to learn is something you should be willing to pay for. Even if it was only $20, a small amount or honorarium is something you should offer when you recruit someone to help you. Offering a rationalization is not the same thing; if my former student needed exposure the last place to look for it would be from this cheapo crowd! I know we have had a longstanding tradition in the psychotherapy disciplines to expect that we will present papers or talks at big yearly conferences for free, and that kind of thing seems a little different in my mind, because they are national conferences or Symposia and have many presenters. But to recruit someone specific for a specific workshop and not pay them any honorarium seems both cheap and arrogant to me.

2. Online Presence=Having a web site. Wrong! A website is just one small (important, but small) part of having an online presence. Having a website is something you should have prior to trying to launch your online presence. Now opinions vary on how to get one. I have some colleagues who know this space who believe that Therapists need to hire someone to build a website for them, and I can see the merit of this. My own opinion is that WordPress and our current technology have made it possible to have a very professional website for a fraction of that price if you are willing to spend some time and a little extra money to get a framework like Genesis. That is the one I use, and this site is one that I was able to design and launch pretty quickly. I have an older site that is still out there, but doesn’t get anywhere near as many hits now. That being said, I do think that whether you build one or have a professional do that, you definitely ought to have a professional critique it. My colleague Juliet Austin has a expertise doing this, and having been in the market for a while, she has a great eye for dos and don’ts.

But having a website is not an online presence in 2011, it is a colorful classified ad. Yes it is necessary now that potential patients want to see and meet you before they see and meet you, but now that there are thousands of Therapists with websites it will not distinguish you much more than a Psychology Today profile. Having an online presence requires you have a vibrant combination of interactive dialogue, recommendations that establish your “brand” as a therapist, multiple forms of media to see, hear and read you, and some amount of change over time.

I’m not trying to discourage any of you from getting started online with a website, I just want to make sure you see it is only one component of having an successful online presence.

3. Professional Organizations need to become more professional when it comes to business and social media. Asking your constituents to take the lead without compensating them is just lame. But even more concerning are the attitudes I see many organization taking towards social media. One example recently was a workshop NASW was promoting on HIPAA and Social Media. The flyer began with the bold red words “Protect Yourself!” The workshop like many others I have seen approaches the Internet and Web 2.0 from the point of view of fear-mongering, if the advertisement is accurate. Be scared of social media. Don’t learn how to use it for marketing your business, let alone your clinical work. This is not the message we need from our leadership. Include a component on social media in a general ethics course, sure. But please stop fostering the association of technology with ethical risk, social media with liability.

Our professional organizations also need to put the same thought and care in finding expertise when it comes to Web 2.0 as they would other workshop topics. Would we ever email a colleague and say, “Hey, want to do a workshop for NASW on EMDR?” based on information as limited as a website? I doubt it. As leaders of our profession, our professional organizations need to treat the topic of social media and health care with the same care as other topics. Their endorsement gives an imprimatur. If they say, the only thing you need to know about social media is to avoid it or you’ll be sued, we learn nothing but fear. If they say, social media requires no expertise or experience, we underestimate the skills we all need to learn to use it.

Bob is a great guy and an excellent clinician, but his having a website doesn’t make one an expert. Being on Facebook or Twitter doesn’t make one an expert. Having 5-15 years of experience working in the space of Web 2.0 like Juliet, Susan Giurleo, or myself does. These are peer-vetted experts, experts vetted by peers in both the clinical and Internet fields. I used to be hesitant to say this, because even though I teach people how to self-promote as part of their business I still feel uncomfortable with it myself. But I feel it is important to make a distinction between people who have spent years and thousands of dollars learning how to integrate clinical practice and Web 2.0, and your colleague who has a nice website.

Look, we need to start taking social media seriously, 97% of our patients and other human beings use it. I applaud our professional organizations for trying to offer something. But the above approach reminds me of having your grandson hook up your DVD player when he comes home from college. It is shortsighted and underestimates the complexity of the matters at hand. At some point Therapists need to strike a balance between a healthy respect for the growing importance of social media and avoidant fear. And at some point we’re going to need to invest time, money, and serious thought into how, not if, we use it in our practice.

The Lurker Below

Both video and tabletop gamers know about Lurkers. There are two particularly famous ones. In Dungeons and Dragons, one of the earliest and most beloved monsters was the Lurker Above. Imagine a giant cave-dwelling manta-ray-like thing that clung to the ceiling until some unsuspecting party of adventurers wandered into its lair (lurkers and lairs go hand-in-hand in many cases.) Then it dropped on the adventurers and ate them if it was hungry. It was nearly always hungry.

A more recent favorite lurker is the Lurker Below in Serpentshire Cavern in WoW. This Lurker is the second boss in the instance, and perhaps even more importantly, the catalyst for the achievement “The Lurker Above,” where you fish up the Lurker from the bottom of Serpentshire Cavern.

A third and less famous lurker is my cat, Winnicott, pictured above. Winnie can lurk for hours. She is exceptionally good at it. Like the Lurker Above, she prefers high altitudes for the most part, but will opt for deep and semi-concealed places as well.

One of the important and distinguishing characteristics of lurkers is patience. They are always waiting for something, patiently, and still. Another characteristic is that they are observant, sensitive to the environment around them and the non-lurking entities going about their adventuring, fishing or laundry. The final characteristic I would mention is that lurkers don’t pounce until they are good and ready. That’s why we call them Lurkers and not Pouncers. Pouncing is only 2% of the entire lurking activity.

I wanted to talk about lurkers because I have been reading and thinking a lot about social media, Twitter in particular, and therapist’s aversion to it. And I agree with colleagues like Susan Giurleo that one should not use social media before one is ready. But I think a point that often gets overlooked is that you don’t have to actively participate in Twitter to engage with it. If you don’t have anything to say or aren’t ready to put yourself out there, by all means don’t. But don’t avoid social media. Lurk.

Lurking is a time-honored tradition on the internet, and there has been estimates that up to 90% of people on bulletin boards, online sites, Twitter and blogs could be lurking at any given time. That’s a lot of lurking going on, and it is not a bad thing.

One of the powerful ways social media can expand the way we interact is by allowing silent participation without social anxiety. Imagine you are an introvert at a party, only you could people-watch and stay on the perimeter for hours without some well-meaning host noticing you and urging you to mingle. You can relax and take it at your own pace, and in fact over time you might even engage more directly. Nick Yee and the Palo Alto Research Center refer to this as ambient sociability, which Jane McGonigal explores in her new book Reality is Broken. Ambient sociability in MMO games refers to the number of people who enjoy lower intensity and indirect social connection. These are the gamers who run around World of Warcraft by themselves pausing occasionally to help out another player, whisper that they like their character name, wave, or various other social activities that can occur when you are in a virtual world and enjoy being “around” people. Ambient sociability may also be the precursor for introverts to have positive interactions that promote deeper engagement.

Therapists are often introverts, in fact I’d suggest that often our choice to spend our days relating to others is often a counterphobic response! So it makes sense that social media can be intimidating for many of us, the conceptual framework of Twitter or Facebook can be hard to figure out, and we’d prefer to structure of the therapeutic framework. What we may need is to engage in a way that allows for social ambience without plunging us into public engagement at first.

Epic Therapists Lurk.

Epic therapists are not always in the know about all things internet, but they are willing to learn. And they are also willing to learn by lurking, rather than by jumping in with both feet, trying Twitter for a week by tweeting 20 things a day and then just giving up. Epic therapists are not petrified of HIPAA and confidentiality, but they are also willing to spend time learning about social media before subjecting themselves, their patients and their communities to its half-baked use. So let’s review the guiding principles of lurking, and how you can use them to become Epic in social media.

1. Lurking requires patience. Try following a few people or groups on Twitter that interest you. Use the search feature and look around. Pick Tweeters with large followings so you can feel even more anonymous. If it doesn’t make sense at first, just be patient and keep lurking. You can do that, you do it every day with patients. You don’t get up and leave the room 15 minutes into the session if you don’t understand what they are talking about. You pay attention patiently. Try the same with Twitter for 10 minutes here and there between your sessions, and allow yourself some time to feel the unfamiliarity of entering a new framework.

2. Lurking requires good observation. I know you all are experts in that, but we can forget to apply that principle to Web 2.0 You don’t have to respond to anything you’re reading or seeing, just notice things. Just be sensitive to the environment and what the denizens of the Twitterverse are doing. How are people interacting? What do their profiles say about themselves? What sorts of topics trend at certain times of day? Who is following who, and who else is connected to them? What kind of Tweets get the most responses? Who spams, and who sends out thoughtful links? And include yourself in the equation: What Tweets do you notice enjoying? What ones do you dislike? I personally don’t enjoy lots of famous quotations, but that’s just me? Other folks enjoy clicking links to photos, or clicking on the latest news from APA. So since you are giving yourself time to lurk, give yourself the opportunity to notice things and ask yourself questions.

3. Don’t pounce until you are good and ready! It is ok to lurk silently for as long as you want, and if you don’t feel sure about Tweeting, don’t tweet. My experience with social media both personally and as a consultant has been that when you’re ready, it will come organically. Maybe someone will post a link on Japan Earthquake Animal Rescue and you’ll want to retweet it (Note the clever insertion of a link that can take you to an amazing cause to donate to 🙂 ) Or maybe someone will ask a question that you can answer, and you’ll want to. Maybe there will be a conversation going on about healthcare social media and you’ll want to add your two cents worth. Don’t be afraid to open an account and begin lurking because you imagine you’ll be obligated to chime in at some point. Remember pouncing is only 2% of the game.

I forgot to mention one other thing about lurking: It can be fun! One of the keys to engaging with social media is enjoyment, and lurking can provide you with hours of quiet enjoyment with no responsibility to say anything. And if you like that, I know a good laundry basket you can hide in.

No Time To Lose

Photo by Matt Metts, on Makezine.com

In the past year we have seen the power of technology to impact human lives in sad and brutal ways. More cases of cyberbullying, live camera feeds in dorm rooms, Facebook page harassment. We have seen young people take their lives, go to jail, shun their peers. We have read about a grown woman setting up a MySpace account,  pretend to be a teen’s peer and persecute her. Every day people experience emotional assault, risk of job loss, conflict, infidelity, insult and cruelty online, ingame, via email and social media.

And still my colleagues often talk about how they can’t possibly learn to use Facebook. Or lack the skills to go on Second Life or WoW; or have never heard of blogging; or think “Tweeting is for the birds.”

I’ve said it to you before, and I’m saying it again: You cannot afford to remain ignorant of these things. I’ll say it more strongly: It is hurting your patients. It is driving referrals from your waiting room–People who need to talk with you desperately about how their life struggles and hurt play out in the virtual and digital environment. I’m not even talking about the business you are losing, I am telling you as clearly and as forcefully as I can, that you are practicing suboptimal treatment.

The days in which the laptop was the exception rather than the rule have ended. The majority of people now use technology on a daily basis. And they use it for psychological reasons, emotional reasons, personal reasons. In the above tragic stories, technology was not the problem; it was the arena the problem played out in, maybe even the weapon used. But the problem is the emotional distress and violence.  The people using technology as a weapon and expression of hatred are people. We are STILL talking about human relationships here.

It’s high time we stopped confusing technology with pathology and tools with abusers. And it’s high time we stop being complicit in the problem. Every therapist I know has a continuing education requirement each year, yet how many of us fulfill part of that requirement by taking a webinar on social networking, or a workshop on online therapy, or listen to podcasts on gaming? Very few, if the patients I have heard from over the past 10 years are to be believed. I’ve heard tales of colleagues judging their patients about how much time they spend on the computer, without having the least understanding about what their patients may be doing there. I’ve seen how people have been “trained” by prior therapies about what they are allowed to talk about, and Web 2.0 is not on the allowed list. This is what we call in the business an “empathic failure.”

You may think by the above tirade that I am exempting myself from this, but I am not. I still catch myself shying away from talking about online gaming because I worry we won’t talk about the “serious stuff.” I still struggle to refrain from interpreting that conversation about blogging as avoidance. I still send dozens of nonverbal cues that shape the expectations about what can and cannot be considered important in the therapy room. I do it too, and this is a work in progress.

You may also think that I’d be happy as a businessman to have found a niche that few of my colleagues are tapping into.

I’m not.

I used to be, but now my practice is mostly full, and when I have a request to take on a patient who wants a gamer-affirmative therapist, or a therapist who does not view blogging as social phobia, or a therapist who takes virtual affairs in Second Life seriously, I don’t know who to refer them to. I have many names to offer for EMDR, IFS, CBT, DBT, psychoanalysis.  I have many trusted colleagues who have years of dealing with mood disorders, anxiety, trauma and bereavement. But I have only a handful of peers who I can refer to and trust that technology talk will not be taboo or overlooked.

I need your help, and I need you to care enough to learn. People are dying, or living alone in pain, because not enough of us are staying in learning mode. People are flunking out of school, losing jobs, ending good relationships and beginning bad ones, and they don’t have time to explain to you and I what Twitter is on their dime. Please begin to push yourself. Download a new iPhone App for the DSM IV ($.99,) , or surf over to Technorati (free) and read a few blogs, or create a free character in Second Life.

This is continuing your professional education:  This is important.