Technology, Social Media, and Psychotherapy: getting with the programme

Bleeding all over by Jano De Cesare

The art of being curious

Aaron Balick, PhD

In many ways the practice of psychotherapy can hardly be described as “modern.” If we take it back to the turn of the last century, its practice has hardly changed at all since Freud. Sure, since then we’ve had massive developments in theory and an explosion of modalities but when evaluating the differences between a psychotherapist’s consultation room from 1900 (when Freud published Interpretation of Dreams) to one of today, you’d find a lot more similarities than differences. Imagine making the same comparison with a GP’s consulting room, or that of a surgeon’s operating theatre – they would be so different as to be nearly unrecognisable to each other. While I wouldn’t want to underestimate the shifts in the nature of the research underpinning modern psychotherapy (including outcome and longitudinal studies, observational studies, attachment research, neuroscience and neuro-psychoanalysis, and over a century of collective experience) the technology of it remains mostly the same: for the most part, it’s still two people talking to each other in a room.

From Megabyte to Exabyte
In contrast, our daily contemporary lives are thoroughly in the grips of ubiquitous techno-culture. While the buzz space exploration that began with Sputnik may have taken a backseat since the grounding of the space shuttle, today we nonetheless have more than a thousand satellites orbiting the globe, the vast majority of which look inward rather than outward; they are more engaged in beaming reality television into living rooms and globally connecting us to each other through our smartphones and computers than they are looking outwards into deep space. At the same time they are making every inch of the world’s dry surfaces known through Google Maps, and in relation to cloud servers (which, ironically, are on the ground) they are processing and collecting every single bit of communication happening all around the world – every telephone call, every text message, every word document – it is mind boggling; today we don’t measure in megabytes and gigabytes, but in terabytes and exabytes. Don’t worry, you won’t need to understand any of this jargon to understand Eric Schmidt of Google who said: “There were five exabytes of information created between the dawn of civilisation through 2003, but that much information is now created every two days, and the pace is increasing” (Kirkpatrick, 2010). This is dizzying stuff!

Today’s technology is about connecting the world by way of the Internet, and on top of that, the familiar online social networks that sit atop it. Facebook alone has more than 1.32 billion active users (Facebook, 2014), accounting for about 12% of the world’s population. If Facebook were a country, it would be the third largest in the world. Mobile technology is more pervasive than electricity and clean water, more people having mobile phone than access to a toilet (UN News Centre, 2013) – a fact that ensures we revisit Maslow’s hierarchy of needs to re-evaluate that bottom level. While it may be surprising that even today only about 40% of the world’s population is actively online, in the developing world this is growing at an astonishing pace (a growth of more than 5000% in Africa since the millennium) (Internet World Stats, 2014). When looking at developed countries, the numbers of those online hover between 70 and 85 percent, and we can safely say that most people who are online are doing some form of social networking – more than 70% of online adults and more than 90% of teens (Duggan and Smith, 2013). Being online and social networking are quickly becoming intertwined and as software and smart devices develop even further by becoming smaller and wearable, this intertwining will tighten.

For many, the development of these technologies can be frightening – as if they were emanating from an external powerful non-human source bent on our destruction. Contrarily, technology is produced by humans, developed between humans, and human feedback shapes it, iteration after iteration through social shaping (Baym, 2010); in this sense, technology is thoroughly human and therefore available to understanding by way of the human sciences like psychology. With regard to personal computing, we have been utilising, rejecting, and ultimately adapting technology to suit us. Before 1984 you needed to speak a different language to communicate with an ugly box glowing with a scary alien green light to make it do anything; today we pinch and swipe without a thought on a device that is so intuitive that toddlers use it with ease. To track the development of technology and understand it, we need to look at the people who engage with it. We need to look at ourselves. Technology is simply an extension of human consciousness into the world – so while there are things we should be wary of, we also need to keep in mind that the skills of psychotherapy are not anathema to the understanding of technology, but absolutely essential to it if we are to get our heads around creating a relationship with it that’s more human and containing.

Technology 1

Threats to the therapeutic frame
As psychotherapists we need to think both about how technology impacts the clinical situation, as well as applying our thinking more widely to society as a whole (Balick, 2014). Therapists, however, are scared. We find that the therapeutic frame is threatened from a thousand different angles – Google searches, increased accessibility through text messages and emails between sessions, mobile phones vibrating in pockets, and overlapping online social networks to mention just a few. The risk of exposure can feel overwhelming. However, our profession has historically specialised in meeting anxiety within a theoretical frame so we can tolerate it, get inside it, and come to understand it better. Why not adopt this frame to better understand our relationship with developing world of ubiquitous technology? After all, humans extend themselves into the world by way of their tools, and technology is simply a highly sophisticated tool with which we do this. It is the way that tools are deployed that matters most. The whole Internet, at base, is simply a tool that transports information of almost any kind from point A to B (Naughton, 2012). It’s like a virtual freight train. A train is neither good nor bad, but it can transport grain or arms. Online social media, like Facebook, Twitter, and Instagram transmit extensions of ourselves in an effort to relate to others (Balick 2014; 2013). Like the freight train, these technologies are limited in the way that they do this, but this is ultimately what they do.

Online modes of expression
These platforms are based in our most basic psychological object-seeking drives like the motivation to reach out and connect to others, to recognise and be recognised, to attach and to know, to be discovered and to discover, to seek out the subjectivity of the other and to be known by others; all of these motivations are activated in a variety of ways on social networking sites (ibid). The psychological activity of discovering ourselves in the eyes of the other simply continues online. However, because complexity is limited across any online social network (for example communicating by text and by picture rather than the more complex interaction of voice, eye contact, and body language) the nature of the interaction is different from our face-to-face interactions. Furthermore, since online social networks operate in a virtual extension of a public space, they also readily invite expressions of the ego in lieu of what we might call “the whole person”. (ibid) Because of this limited mode of expression, online social networks may also increase transference and projection. By better understanding the consequences of this, the better we can not only engage with it, but also influence the development of such networks to enable them to be more productively human, emotional, and psychologically attuned.

We can begin to ask not only how psychodynamic insights can contribute to the development of these networks towards enabling the expression of a more whole self, but also to see how we might utilise technology to enable greater access to psychological insight for individuals using it, either through social networks, apps, or other technological/psychological interventions. After all, not everyone will be able to experience the benefits of a depth psychotherapy, but we can make psychotherapeutic insight more readily available across technologies that are plainly becoming ubiquitous. The delivery of psychological services across technology is not new – but the results of it frequently give people pause.

Ellie the friendly-faced avatar
One example, is Ellie the virtual psychologist who will speak to you from a screen while scrutinising you through webcams. Also known as “SimSensei” her “multi-sense programming” observes:

‘automatic human behaviour [that] identify indicators of psychological distress – she automatically tracks and analyses in real-time, facial expressions, body posture, acoustic features, linguistic patterns and higher level behaviour scriptors like attention and fidgeting ‘(Rizzo and Morency, 2014).

Technology 2While the sophistication of her hypersensitive software deployed in the name of human observation may make her patients nervous, they are cloaked in a rather friendly-faced avatar with a warm and inviting voice. Additionally, in order to build rapport, she asks her patients where they are from (“Ah,” she says to one patient, “I’m from Southern California too!”) and she pauses, nods, and has over 200 ways to say ‘uh huh’” (White, 2014). No doubt this idea of a virtual human, offering virtual rapport may make you feel uncomfortable – it is the very definition of Freud’s uncanny. In this case it’s even more distressing to hear that Ellie was developed by an arm of the US military Department of Advanced Research Projects Agency (DARPA) that specialises in “creating and preventing strategic surprise” (DARPA, 2014). When we step back, however, we see something we may not have thought about. Ellie was in fact developed not as an extension of our tools of war, but out of a recognition that those who participate at the front lines of our wars tend to be young men – and these young men, who are coming home with a fair proportion of PTSD are the least likely to seek help and talk to someone about it. These men, think the military, may be more likely to speak to Ellie. While we may recoil at the thought of psychological services being developed by the military and deployed by artificially intelligent robots, we must at the same time admire the solution that is offered here to increase accessibility and reach a demographic that has long been reluctant to seek psychological services.

Virtual safe spaces
Outside the military we find similar demographics of individuals who are less likely to get help in traditional ways. Again we find that it’s young men and boys who are the least likely to talk about their problems; additionally we have individuals who live far away from mental health services, and others who, due to their sexuality or gender, religious or cultural background, cannot seek such services locally. In the UK we find swathes of localities devoid of necessary mental health services – and find that through the telephone or the Internet, traditional charities like Childline and The Samaritans get much greater penetration, making themselves available to people who otherwise would not be able to access a listening ear. More recently, services like YouthNet’s online mental health support network “The Site” and “The Big White Wall” in partnership with local NHS mental health services are able to reach out to whole new demographics as well. As psychotherapists, we not only have the frame and experience to improve these services to offer dynamic insights, but also to consult and contribute to the development of mainstream social networking sites like Facebook, Twitter, and others to enable safer spaces where individuals can reach out to each other more honestly and more fully.

Psychotherapists no doubt privilege live face-to-face communication and value the nature of building authentic attachments with their clients in the real world. Because of this, our collective response to the tsunami of technological development has in many ways been suspicious and in many ways distant. Ubiquitous technology, however, is here, and particularly for younger people, it is not something that is consciously separated from everyday life it is everyday life. Our digital world is a non-neutral extension of our psychological lives, and we need to deal with it as such. Further, as psychotherapists whose trade is within the complex dynamics of human relating, we have much to offer in humanising the development of such technologies on the larger cultural level.

Technology 3

When it comes to our own practices and our engagement with the world of technology we don’t tend to think about culture at large, but more locally: our practices, our clients, and our relationship with technology. Because psychotherapy is very much a “use of the self”, the very nature of who we are with our clients demands that we think through very carefully how technology can enhance or impinge upon the psychotherapeutic space. Because there is so much to know, and because psychotherapists can rarely be described as “techies”, one’s choices, from how to manage client material by email to whether or not to have a profile on Facebook or LinkedIn, can be challenging and anxiety provoking. For these reasons, many therapists choose to avoid it all together and turn their heads the other way. While this may very well be a sensible choice for some, if it is not an active and informed choice, it is likely to be anything but liberating, and anything but curious. Others may not feel so anxious, but feel they need to stay out of this world for the protection of themselves and their clients; this lies on the model of “psychotherapist as shaman” – a role slightly outside of society – of the world, but not in it. However, many psychotherapists, and among these I include myself, don’t want to be shamans outside of culture. For those like me, staying outside this now dominant form of social expression can mean that they feel they are missing out on something. The personal consequences of this are clear, but there are also consequences for not knowing the world in which most of your clients reside.

Digital natives and digital immigrants
Interestingly, these last few paragraphs constitute a temporal blip in relation to the digital immigrant generation of psychotherapists for whom “whether to or whether not to” engage in social networking is a question that is still alive. The younger generation of therapists coming through trainings now are digital natives (ironically, being trained by digital immigrants who largely continue to run trainings as if technology is not a necessary point of interest). These burgeoning therapists grew up online. They already come fully equipped with a cyber shadow of everything they publically tweeted, blogged or posted, long before they even decided to train as a psychotherapist. The concerns of “whether to or not to,” is pretty much limited to a generational subsection of therapists over the age of thirty who are moving up through the ranks of the profession. The playing field is completely different for the younger generations of therapists in this field as it will be for their clients. It is indeed a Brave New World, and to misquote Shakespeare, we might exclaim, “Oh brave new world, that has such things in it.” These things, however, are not things in themselves, but things through which people express themselves and do their best to connect to others. Things that we, young and old, need to understand under the rubric of psychotherapeutic thinking.

Psychoanalytic psychotherapy as ‘slow food’
In closing let me make my themes here clear. I believe that as a discipline, we owe it to culture to participate vociferously in the continued development of technologies to ensure that the more elusive parts of human relating – most notably the importance of real and authentic person-to-person interaction are preserved and possibly enhanced within a world that is currently leaning more towards personal branding, ego performance, and interpersonal objectification. I believe that psychotherapists have a role to play in this process – from a serious undertaking to understand culture to the more local nature of our clients’ lives, however they choose to express them, and then applying the same open-minded curiosity to the way that we ourselves experience technology and the choices we make in relation to that. Perhaps most importantly, though, is to be clear with you that while I hold potential for the promise that technology can offer, I am not a wide-eyed utopian. My critical gaze continues, and I see the old-fashioned practice of longer-term psychodynamic psychotherapy as a sort of antidote to the fast moving world of technology that can frequently drive us to distraction. In this sense, psychodynamic psychotherapy can be seen in the same light as the slow food movement (Grief, 2011). We can also offer a counter-cultural response to the “here-now-when-you-need-it-results-oriented-culture”.

We may create technologies that are extensions of our human motivations, but this does not mean that we create technologies that are good for us. We need nourishment but produce food that kills us; we need to defend ourselves, but we build weapons that can annihilate the earth. With regard to technology and social media, we need connection, but we may have created a digital manifestation of connection that is more like fast food than a nourishing meal. While I don’t think that our profession excuses us for being luddites, I do believe it does allow us to take a very unique and important perspective on our dominant culture. Freud shocked the world by saying sex was everywhere; only no one was talking about it. What is all around us now that we are not explicitly working through?

Dr. Aaron Balick is an Integrative psychotherapist and supervisor, honorary senior lecturer at the Centre for Psychoanalytic Studies, University of Essex, and chair of The Relational School UK. In addition to his clinical and academic work, Aaron is a cultural theorist and regular communicator of mental health and psychological issues within the media. He is the author of The Psychodynamics of Social Networking: connected-up instantaneous culture and the self.


Balick, Aaron. (2013). The real motivation behind social networking. Tilt Magazine 3:2: pp. 24- 34.

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Image: Bleeding all over by Jano De Cesare


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