This is an intermediate level course. After completing this
course, mental health professionals will be able to:
The materials in this course are based on the most accurate
information available to the author at the time of writing. The literature on
the effects of online engagement on adolescents and young adults grows daily,
and new information will likely emerge that may supersede certain aspects of
these course materials. The present course material will equip clinicians with
a basic understanding of how to work with adolescents and young adults to
create balance between their online and real-life experience. This course is
adapted from the following book: From Real Life to Cyberspace (and Back Again): Helping Our Young Clients Develop a Strong Inner Selfie, by Tobi Goldfus, ( Zeig, Tucker and
Theisen, Publishers, 2017).
The
purpose of this course is to present a selection of road-tested techniques and
perspectives focused on working with adolescents and young adults. The course
acknowledges technology as a central aspect of human development and
relationship, and it explores a host of realistic ways both to use it in
therapy and to approach it as a topic for therapy. As an author, I take my role
as a teacher seriously, thus I have tried to offer content in an interesting
way. The case excerpts identify certain client characteristics and
circumstances, and the segments that follow them illustrate practical ways to
attune to young clients and help them establish and strengthen the core self –
the “inner selfie.” There is content in the course that will withstand the test
of time and some that will need to be updated as technology continues to expand
its reach into our private lives and social media increasingly becomes the
platform through which people explore identity and developmental questions.
Further, the studies coming out of brain research are clarifying the intricate
connections between these threads every day.
The
information and approaches that I have been exploring, developing, and teaching
about integrating psychotherapy interventions with cyberspace experience are
offered here. The framework includes views that I believe are essential as we
attempt to understand and be with our young clients.
Digital
life is a fact of life and it is here to stay. Many of our young clients have
little idea of what came before or even that there was a “before.” What on
earth did people do? How did they possibly manage? I almost don’t remember
myself. So, our young clients are plugged in without question; it is now an
“organic,” natural and, often, central aspect of their environment, education,
socialization, exploration, communication – their normal daily life. Their
parents are often as plugged in as they are and many of us are hearing a lot of
complaints about that. Although cyberspace is a free space to go anywhere, the
generation gap can be found in cyberspace too, with older adults going to
digital neighborhoods or looking for things younger visitors don’t care about.
We therapists are plugged in too: we are both therapy-anchored and digitally
aware. The degree of our awareness depends on many factors, including age, tech
savvy, comfort, and interest.
So
if digital life is a fact of life, it must also be a factor in therapy. I want
the digital realities of your younger client to be an integral part of your
therapy, no matter what therapeutic blueprint or treatment modality/school of
thought you use. We must recognize this digital online plugged-in life as part
of who our clients are, as part of our therapy, from beginning to end. Without
this view, we are worlds apart from our young clients and add to their feelings
of isolation and not being understood.
This
course focuses on how to integrate these worlds in our therapy. I have included
both the adolescent and the young adult because this is life as they know it.
Some of you might even fit that young adult profile.
The
positives of the digital age are phenomenal; but there are also concerns and
caveats. This course considers both in terms of their impact on the developing
young person. We know that the brain continues to develop until around the age
of 30. We know that being socially connected online can both reduce isolation
and stimulate curiosity and learning. We also know that too much of anything
can cause all kinds of problems. Internet compulsivity and addictions, and even
other addictions that can be fueled online, are often a central aspect of the
problem. The course also addresses and identifies healthy use, compulsive use,
and addictive use; as well as how anxiety, depression, and other psychological
problems can be impacted both positively or negatively.
Boundaries
and confidentiality, and other old conceptual pillars with clear definitions,
have given way to new ones. Some of these mirror what our clients are dealing
with. What you would never do IRL (in real life) is a whole different ballgame
online.
We
also explore how our young clients are practicing and mastering developmental
tasks online as well as offline. Because online engagement is so externally
focused, a very interesting and creative question for me is how my clients’
digital interactions might be channeled more toward emotional and psychological
growth.
Over
the years, I have developed several ways to enlist the aid of electronic
devices to help clients access and improve self-confidence and build strong
internal states as they confront their many challenges. I refer to this as
building their Inner Selfie. Trancework or hypnotherapy, both direct and
indirect, and “parts” work or ego-state work, as well as other approaches that
I have integrated over the years, are the focus of the treatment choices
outlined here. They make sense and come alive with young people.
I
describe the Inner Selfie as an immediate down-regulation tool. This image
promotes the reflective, the contemplative, that inner pause. Inner Selfie
awareness promotes self-confidence and strengthens inner resources. Here I
describe how using ego-state or “parts” work begins to increase internal
responsiveness and how combining trancework or mindfulness techniques with this
will add to transformative emotional impact for change and Inner Selfie
building. I show you how to use your client’s mobile devices to access a part
of their Inner Selfie and provide a short trance for anchoring and strengthening
their maturing resources.
Not
bringing the digital world into therapy risks missing a large part of who younger
clients are and what is defining them at any given moment. I have developed the
Social Media Assessment Form (SMA), a tool for navigating and “seeing” their
digital landscape, which will serve as a valuable resource from the beginning of
therapy to the end. It moves seamlessly into the therapy hour, increasing the
understanding of your client exponentially. This establishes an openness around
both sometimes-tough questions about clients’ digital explorations and what
digital experiences and interchanges they are having that impact them.
You
will also learn about the Seven Stages of Smartphone Attachment, which you can
use to determine where your clients are with theirs (as well as observing where
you are yourself). This tool identifies the pulse and strength of attachment
and can help you to target treatment goals.
Over
time, I have studied the comparison of hypnotic phenomena that is happening
when one is in digital time with that of therapeutic trance. These parallels
are contrasted and discussed with a focus on utilizing these phenomena in
therapeutic trance in the service of improving inner strengths and real-life
relationships with others and with oneself.
Another
tool I offer is how to pepper your dialogue with technology-friendly words in natural
ways. I encourage and discuss the benefits of the “trancette” (a brief trance)
designed specifically to appeal to the adolescent/young adult client,
acknowledging his or her attention capacity while creating positive emotional
impact.
Being
connected and active online is essential in today’s world but we need to go
“unplugged” at times. If offline time can be intentional, no matter how long or
short it is, our clients will come to welcome it, as they experience lower
anxiety and a surge of authenticity with themselves and others. This is where
living in real community can flourish. It is a visceral, kinetic, warm sense
and is felt deep within, perhaps touching into that Inner Selfie. We also look
into when to unplug and when not to.
By
the end of this course, you will have no question as to the importance of
including the digital persona of your younger clients in every phase of your
treatment and relationship with them. And you will have the tools to do it!
The
terms below are used by the author in this text and are not necessarily used in
common parlance.
We
know that what isn’t discussed becomes the elephant in the room. If ignored or
just given a nod to, the digital life of your client is one of the biggest
elephants you will ever miss. The welcome mat is out when you acknowledge and
get to know their online profiles and activities as a natural part of who they
are.
Constructs
of ego states or internal state systems in therapy focus on all parts of a
person, both internal and external. If the digital personas and experiences are
not treated with equal respect, you may be encouraging the
compartmentalization, fragmentation, and dissociation that young people so
often describe in therapy today. We must address all parts of our younger
clients, and that includes what they experience and act out online. When we do
this, we demonstrate a level of respect for the total self of the client, which
translates into the client feeling really seen.
When
I was in social work graduate studies more than a few years ago, seeing the
“whole” person was already a part of our training: familial, social, emotional,
physical, spiritual, and systemic. Today, what constitutes the “whole” person
has expanded. We accept that our clients will likely Google us and that their
smartphones often actively join us in session (texts, pictures, YouTube). The
therapeutic relationship between “us” and “them” now includes this “other.” This
third entity is an alive and active part of our client’s whole being – part of
their vital presence.
If your approach can embrace the electronic persona of the
adolescent/young adult, you will find that your work together will be enriched
and more effective.
Clearly,
the digital world has become part of who we are. Almost all of us use our
smartphones, iPads, and PCs as adaptive extensions of our physical selves,
interacting with them most of the time. We have changed how we see ourselves,
how we communicate, and how we spend much of our time. It’s all so automatic
that we hardly pause to think about these changes, but our lifestyles are fully
wired (or wireless) and it affects almost every aspect of interaction.
Automaticity
has two sides: One is our growing adeptness in navigating the electronic social
media world. It is like learning to drive a car or ride a bicycle – we get
better and better and don’t think about each little skill that it involves. The
other side is more akin to eating a bag of potato chips in front of the TV – two
hours go by and the bag is empty and we don’t even know how it got that way.
And sometimes when we do things mindlessly, absorbed in something else, the
cost can be huge – far more than a few hundred calories.
As
therapists, we are not immune to the call of the digital world. We parallel our
clients’ digital engagement to a great extent. The fact is we should
neither ignore the force and influence of cyber technology nor demonize it; we
need to incorporate it. Our clients spend many hours of every day absorbed
online and on social media sites. More and more studies are looking at
increases in adolescent and young adult reports of anxiety, depression, and
general malaise that seem to have a connection to time spent online. Physical
impacts of prolonged use are reported to be on the rise too. I have a client
whose teenage son has been diagnosed with “adolescent round back” from spending
too much time hunched over his video games. I have read about “text neck” and
“iposture.” Sleep problems among young people are also on the rise, as many
simply can’t turn their minds off at night, their digital night-lights
constantly calling out to them. They can’t turn off and they can’t tune out.
We
can use psychotherapy as a “search engine” to help our clients who are engaged
in cyberspace. I will introduce ways to effectively adjust and expand your
therapy strategy to fit with the client’s digitized world. You will
significantly improve your interventions for bolstering ego strengths and a
solid inner locus of control.
You
will learn about the Social Media Assessment form (SMA), a central tool that
can help you find the common digital ground between you and your client. The
SMA allows the client to share his or her online digital reality, or at least
open the front door, in a straightforward way. The information provided will
quickly form a cornerstone of your shared information gathering that invites
clients’ digital experience into therapy, and will foster further exploration
in all aspects of your treatment.
The
SMA marks the beginning of the journey to help clients move more easily back
and forth between online and real time (IRL). The goal is to match their
technical savvy with richer, deeper possibilities for connection and a growing
sense of self in a present, mindful way.
We
need to redefine our view of what it means to see the whole person to include
all aspects of the digital self. Updating our understanding will deepen our
attunement to these wonderful young people who are often telling us they are
lost, anxious, confused, and overwhelmed. Our ability to move with some grace
through the digital landscape with them will help us refine and better tailor
our therapy with them.
The
digital galaxy is as vast as the real universe. With every second that passes,
it becomes more complex as it is experienced, explored, and exploited by
billions of people. It is the connector for most of the world’s population, no
matter how remote. It has changed our lives profoundly and forever.
The Internet is
its own wild kingdom. When people head their digital off-road vehicle deep into
the electronic jungle, there are no passports, no vaccines, no antibiotics to
take if they get sick or infected, and no licensing boards or speed limits. There
are no danger signs, no U-turns, and sometimes there is a digitally fueled
reconfiguring to a place that is even more unknown than anticipated. GPS is for
physical spaces, not for cyberspace travel. Safety nets and controls are
limited. Remember maps? They offer a picture of where we are going, an estimate
of the distance between points, and an image of where we are setting out from. They
provide a clear reference, a sense of spatiality. Using maps, we can find
detours and choose alternate routes should something unexpected arise. We have
time to consider our options and perhaps even decide not to go. But online,
there are almost no objective indicators, nothing to tell you whether you are
heading into an isolated back road of disaster, a vortex of shame, or a
mountain of material that might be way beyond what you can handle.
Our
maturing adolescents or young adults may be masters at traversing the digital
landscape, but they could use our help in developing reliable maps that keep
them true to their internal compass. By understanding more about what
“territories” they frequent and what their visible digital profiles look like,
we can begin to be that guide who is in the unique position to show them ways
to strengthen their Inner Selfie and fine-tune that compass.
Dixie,
from the vignette above, had been navigating the electronic world without being
able to chart where she was for a long time. She was not alert or particularly
conscious to its seductive danger potential, and she was unschooled in how to
withdraw from it anyway. As she moved into her 20s, what would be pretty
intimidating for most people was feeling pretty normal to her, and her appetite
and curiosity for more had her traveling deeper and deeper into the underworld.
I could sense her suffering because I entered that world with her and she took
me along.
A
couple of years ago, I visited South Africa where I was presenting at a
hypnotherapy congress on the subject of this course. The plane landed in the
middle of the night to refuel in Dakar, Senegal. As I stared out into the
darkness, I saw very little light. The uniformed men who came on board to
search our luggage and then bizarrely spray us with an anti-yellow fever agent
made me feel unworldly, lost, and out of control. For a moment this was my own “uncharted
frontier.”
Two
colleagues and I stayed a couple of days at a gorgeous inn close to Kruger
National Park. We had to land and orient ourselves to that beautiful foreign
country I knew nothing about. Our driver, Mandela, became our guide and “GPS”
as we took in a couple of safaris and forays into the mountains. Mandela, a
warm friendly father of three daughters, owned a Nokia and a Blackberry. His
family still carried water from the river to their home. He was saving for a
small water tank. His wife’s dowry at marriage was 12 cows that he was still
paying off and he had already calculated how many cows his daughters’ dowries
would be.
Simultaneously,
he was a member of the global digital world, emailing and texting. I wondered
where this would take his daughters as they grew into adolescence and young
adulthood. Would there be the equivalent of a “digital” cow, as these ancient
cultural systems intersected with contemporary digital operating systems?
I
kept thinking about the striking contrast between young people all over the
world who live with so much less economically than many of us in highly
industrialized countries. Cyberspace becomes then the grand master of equality.
Age, gender, country of origin, economics, social strata, you name it, in the
digital universe there is no differentiation. Navigating skills may vary
greatly, but your presence is made known immediately – and you are on your own.
You connect with others in that universe, but you travel alone.
Even
the wild animals I observed on safari, who roamed with no visible boundaries,
have primitive biological survival skills. The young learn from the mature
about danger and about where and how to find food, how to survive. They are
guided and have an innate loyalty to their tribe, which gives them that
reference point and sense of membership and belonging.
Social
networks are the closest thing to that belonging in the vast digital landscape.
Online memberships permeate the digital world, but joining them usually only
takes a click or a quick fee. Loyalty is also only as thick as the click.
Thus,
therapy with young people navigating this great frontier has to rise to the
occasion. Our own internal compasses may be intact, or still evolving, but it
is our responsibility as therapists to redefine therapeutic attunement for
today’s all-inclusive online, IRL, and internal landscape. For the sake of our
developing young clients, who are still finding their way toward healthy ego
maturation, we must join them in their world. As their world becomes ever more
focused online, including large and always active social networks, their life
offline is often getting shortchanged. There’s no precedent for it.
The
title of Robert A. Heinlein’s classic 1961 sci-fi novel, Stranger in a
Strange Land, can help describe each of our entries into the land of
cyberspace as we begin to assimilate, with our digital backpacks becoming
lighter as the landscape becomes more familiar. And yet there lurks many still
unknown and strange lands where we will likely feel alone. When Heinlein’s
alien characters landed on earth they used the now well-known term “grok” to
describe being understood and having felt empathy from earthlings with whom
they felt attunement. As therapists, we have to increase our “attunement;” we
have to grok our younger clients, be part of the mother country and real-life
presence that helps them acclimate to their true selves.
Our
younger clients often describe being more comfortable online than off, or
wanting to get back on when real-life interactions or being alone raises
anxiety. They also love a good adventure, practicing cyberspace skills, and
having their own space. So many online interactions take place simultaneously:
never “alone” there.
Most
of these young people also describe strong longings to have that comfort within
themselves and with others in real time: often “alone” there.
I know that most of you have accepted your client’s
smartphone and mobile devices as a real presence in your therapy sessions. Whether
you have embraced this change slowly or quickly, I will assume you have made
some kind of peace with it. Perhaps you are already taking clinical notes on
your computer or iPad during session. Truthfully, I still find this idea
difficult. I don’t even like my own doctors doing it. Something
feels as though it is missing in the relationship and their attentiveness. I
choose at this point to still make handwritten notes during session. For me, I
can be fully present and attentive this way. The use of the computer or other
device would demand too much given my current technical skill level. You may
find that it doesn’t interfere with your ability to be
present at all, and as long as it’s okay with your client,
it will work. It is our job to be present, of course. Anything that interferes
with that needs to be cleared out from that space between you and the client.
When it comes to the smartphones and other mobile devices that
come into the office with your young client, relax! You are going to be
inclusive. These devices will be recognized and welcomed. You don’t
ignore anything else about your client, so it doesn’t make
sense to ignore or banish what is a central aspect of life for most adolescent/young
adult clients. Now you can see this device as a gateway of knowledge to
different parts and experiences of them. The SMA has also given you a big leg
up insofar as being able to glimpse inside their digital world.
The give-and-take that now happens with our clients and their
smartphones is like the old “show-and-tell.” We get to see their “selfies” (how
they present themselves), pictures of their friends and family (both those who
are known IRL and those cyber-only interactions), videos from YouTube they want
to share, music they like, and text after text they may read out loud or show
us (how they interact socially). They may show you their Tumblr site (journal
entries or postings of interest) or share a poem or written work on a fan
fiction site. The fact is, now that you have invited them to share this digital
part of their lives, you are in this world with them.
Being accessible and transparent in terms of your own digital
electronics is important too. This might include looking something up on your
computer that is relevant to the session. Your young client may use your
computer to show you something poignant. I’ve been asked
to share a picture from a trip I’ve been on, which seemed
to add to our bonding in a certain context. “Easy flow, easy go” makes for a more
natural interchange.
Many of you already record trances and guided imagery for your
client in different ways. I prefer to record them directly onto clients’ smartphones so they are accessible at any time. If I think a
trance is one I want to save for any reason, like they want me to have a copy
they particularly resonate with and don’t want to lose it,
I have them send it to me via email. This method has worked well for me.
I use their mobile device for the Inner Selfie technique (or
ego-strengthening resource technique). You will learn how this technique
utilizes trance work, ego-state therapy, and integration of self. In short, I
film my clients talking into the device from the perspective of their Inner
Selfie strengths to other parts that are struggling or need a pep talk. This
technique of using the mobile device to access one’s inner
strengths is bit contradictory to the idea of “unplugging,” but it works in a paradoxical
way. It is an integration technique for digging deep into core beliefs for
support of the wavering parts (requiring the “pause,” the reflection, the juice
of self-understanding that gives that organic push) – all using the mobile
device as a vehicle. And our younger clients are listening and watching
themselves, which is a hypnotic hook for them.
Randee, our conscientious high-achieving athlete, found that
listening to herself support her inner strengths was like giving herself a
cheer. At times, her anxiety around disappointing her family or wondering about
her self-worth ambushed her. If she took a few breaths and watched and listened
to her Inner Selfie speaking to her from her smartphone, she was able to return
to her more confident and relaxed self.
Over
time, I found myself asking more and more questions about my adolescent/young
adult clients’ online life. As social media sites have become an extension of
our lives and the place where so many of our young people engage for hours
every day, I knew I needed to have much better information. I had to expand
those office intake forms and my blueprint in the initial assessment to include
this central aspect of clients as a natural and normal way of information
gathering. So I developed the Social Media Assessment form (SMA). It can be
used for all clients, but it is the young online-immersed clients I am
specifically focusing on in this course.
All
new clients 14 to 29 years of age, as well as current clients in the same age
range, are invited to fill it out. It’s a gold mine. It seems so simple and yet
the SMA has accomplished several things at once. It tells me immediately what
social media sites are being used the most, how much time is being spent on
them each day, how much time is devoted to role-playing or gaming sites, and
which ones have my clients’ attention. The SMA also lets me know of clients’
general satisfaction/dissatisfaction with their digital engagement and what
they like or don’t like. Direct, no big explanation. Wow!
The
SMA is shared here to help you focus on the growing impact that the digital
world has on your young client’s world and experience of self. This form will,
of course, change as new sites and other techno realities emerge. And our
clients will always answer it in a current up-to-date way. Yes! We don’t have
to be tech whizzes for this. If you are old school, you may still have a flip-top
phone; on the other hand, you may be ahead of or on par with your clients. It
doesn’t matter. The SMA will help you keep current with their digital
realities.
Every
single young person to whom I have given the SMA has been cooperative and open
about their digital realities. In one easy step, I now have information that
helps me from the beginning of therapy to the end of treatment. I can explore
the complexities of their online/offline relationships and move with them
between their virtual and their IRL experiences with ease.
I
find that my clients are actually very appreciative, always cooperative,
usually relieved, and that they seem to be more open about their digitized
experience. I feel a unique attunement with them that starts at their
smartphone. We are less far apart, less divided in our understanding; no longer
do they have to keep hidden such a big part of their lives. They can still have
their secrets, part of healthy individuation, but they are much more likely to
share them in the context of acceptance and acknowledgment. Resistance will
most likely be lower.
I
have learned to ask more digital-specific questions too, which adds to greater
mutual comfort. By joining them in this way, the connection is strengthened,
and with it my therapeutic effectiveness! For example, “When you tweeted that
to your online friends, what kind of response did you get?”
The
SMA offers a key to their digital world. Then when you begin your intake, your
understanding is more contextually filled in as you learn to ask about how
interactions are taking place: Was the argument IRL or via text or post? You
can easily find out more about clients’ digital profiles as they show you their
“selfies” or their “likes” and “friends.” They will read you relational
texts and tell you about their characters (or avatars). All you have to do is
ask as if it is the most natural thing in the world. It is.
Another
thing the SMA provides is a rich arena for developing your clients’ awareness
of different parts of themselves or ego states. Those of us who have worked
with parts/ego states/hypnotherapy know how creating awareness of all parts of
a person can lower defensiveness and open the way to more self-reflection. Welcome,
digital “states”!
The
SMA is also a key to increasing the experiential moment and emotional impact
for change. Adding cyber-friendly and familiar language to your interventions,
perhaps through indirect or direct inductions, or a “trancette” that you
sprinkle with digital spice, or a therapeutic anchor you give for a
future-paced directive, helps the “yes set” (orienting toward sense of openness
to change) begin to percolate.
With
the SMA to allow you access to the digital galaxy of your client, you can be
confident that you are listening better, and hearing what is really being said.
As a result, you will have what you need to tailor your therapeutic
interventions to the client’s uniqueness.
I
will show you how using the “Inner Selfie” approach can lead to
common therapeutic goals with young people for improving down-regulation,
contemplation, resiliency and self-awareness.
SOCIAL MEDIA ASSESSMENT FORM |
| Name ___________________________________ |
Age _______ |
Date ____/____/____ |
| Please check which social media sites/methods you use and which ones you use most frequently: |
| |
USE |
MOST FREQUENTLY |
| Facebook |
|
|
| Twitter |
|
|
| Instagram |
|
|
| Snapchat |
|
|
| Tumblr |
|
|
| Email |
|
|
| Texting |
|
|
| Other: ___________ |
|
|
| What times of the day or night, if ever, do you turn off access to social media sites? __________________________________________ |
| What do you like the most about social media sites? ___________________________________________________________________ |
| |
YES |
NO |
| Are you satisfied with the amount of time you spend on social media sites? |
|
|
| Or, would you like to spend more time? |
|
|
| Or, would you like to spend less time? |
|
|
| If you are a gamer, what games do you play online? ____________________________________________________________________ |
| About how many hours daily? < 1____ 1-3____ 4-6____ 7 or more____ |
| Tobi B. Goldfus, LCSW-C, BCD. tobigoldfus@gmail.com. Copyright © 2019 by Tobi Goldfus |
The Phantom Appendage We Can’t Live Without
Opening Scene: His smartphone, earplugs, and computer are lying on the love seat across from
me. He walked into the room five minutes earlier, moving to some music, and he
didn’t hear me say hello. He opens his computer, moves his fingers at breakneck
speed, a couple of quick clicks, and then pulls off his earphones, and there it
is … a great smile and a hello!
Flashback: “Hey, I’m your
shrink, not an app!” This might be my first thought as I follow him into the
office. I wait for that smile and greeting. Then we begin to talk about his
week in school, how he did his homework but didn’t turn it in, yada yada yada. We
are both a little bored. His legs are moving up and down; his t-shirt is
wrinkled, his Pumas scuffed and worn. He wants to tell me about what happened
last night on his role-playing game. He looks tired. I ask what time he went to
bed. He tells me at about 3 am because he was trying to reach a certain level. He
is a junior in high school. His cell phone pings. He responds. “Patience, girl,”
I tell myself.
Today: In the waiting
room, his earphones are on. I smile and offer a thumbs up. He follows me into
the office, his computer and smartphone humming. We spend an easy five minutes
talking about his favorite iTunes, the last character development and
interactions on his role-play. When he checks his computer, he shows me a funny
YouTube clip. It is funny! Mentally, I am gathering metaphors, inductions, and
trances for the upcoming therapy. Humor and interest in his digital world
unites us. Whether it will be direct or indirect hypnotherapy today, there is
cooperation and open collaboration. The SMA told me early on that this kid is
online 10-12 hours a day and that this may include school days. He needs help
putting some digital brakes on.
In
her book Alone Together (2011), Sherrie Turkle writes about how our
smartphones and devices have become an extension of ourselves. If we are
honest, many of us know exactly what this means. Our smartphones are like an
extra part of the body that really feels physically missing when it is not with
us.
As
I mentioned in the introduction, I was a late-comer to smartphones. My
20-something son taught me the basics and continues to clean up and lead me
home when I’ve lost my way. I admit that at first I didn’t get the obsession
with this device that the world seemed so taken by. A personal experience led
me to humility.
I
was at a Master Class in Ericksonian Hypnotherapy in NYC. I had owned my
smartphone for only six months. Some minutes into the class, I realized that I
had left it in the hotel room. To my surprise, and with some disappointment in
myself, I felt as though a part of me was missing. I felt a little anxious. Two
colleagues offered to let me use theirs that day, but all I could focus on was
getting my own phone back. At the first break, I fled, flagged a cab, and
grabbed that little sucker off the bedside table where it was peacefully
recharging. When I got back, I was relieved and “whole” again. Whew! I barely
looked at it for the rest of the day but knowing it was accessible provided
that relief.
It
was a humbling experience. I now understood my younger clients’ connection to
their own phones or computers in a complex visceral and physical way. It was a
valuable field trip into their attachment to it. It is a relationship!
Epiphany! But in order for my clients to unplug, or for any of us to, for that
matter, it has to be intentional and time-oriented. This was a new order of
empathy – one that recognized that relationship.
In
my workshops, I often open with a joke. “Can you please tape your smartphone to
your forehead so I can at least pretend that you are looking at me?” I don’t
know where I heard it, but it always gets a chuckle. Everyone knows and can
relate.
If
it is a relationship, then our attachment to it is like any relationship – it
has stages. As you read the following stages of smartphone attachment, ask
yourself two questions: What stage is my young client in right now? What stage
am I in right now?
Keep
in mind that we move back and forth between these stages, just like we do in
our other relationships. Knowing where they are, and where you are, at any
given time will help you in your assessment and treatment planning. For
example, if a client is considering upgrading to a new smartphone, he or she is
likely to be back in the attraction stage.
Seven Stages of Smartphone Attachment
1. Attraction Stage
I’ve been eyeing you for a time, yeah! There are
others, sure, but something about your style, looks, appeal, and skills
separates you from the rest of the crowd. There’s some chemistry here.
2. Honeymoon Stage
Love at first thumb press. Wow! This is fantastic! You are a wonder, over the
top, and the surprises just keep on coming! I want to learn everything about
you. I can’t wait to get to know you even better. Show me more. Yes! You can do
that too? Awesome. I am totally into you.
3. In Love Stage
I am not myself if you are not with me – in my bag, in my pocket, turned on and
charged up. Those cute little dings, the adorable ring tones, all those sweet sounds
that make me feel so good and attended to. I can’t imagine you not being around
or accessible. I want to wake up with you, eat with you, hang out with you, go
to bed with you. We were meant for each other. Yes, there are just a few
things, very little though, that bug me about you. Sometimes you don’t answer
back fast enough or you freeze up on me. What’s that about, anyway? Okay, you
can get a little demanding. But life is so much better with you than without
you. Nothing we can’t get through.
4. Co-Dependence
and Addiction Stage
I think about you 24/7. You are on and with me 24/7. The more you give me, the
more I want. I would rather be with you than not. If I have to be with someone
in “real time,” I cheat and look at you without a thought or at least caress
you with my thumbs in response to your messages. People get annoyed with me and
I don’t care. Just leave me alone. Don’t they understand? I want to be with you
as much as is humanly possible.
5. Disillusionment Stage
I’ve had enough. I’m done. You are so getting on my nerves. Every time I turn
around or try to breathe, you’re dinging away, texting, trying to FaceTime,
whatever. What used to attract me to you is now bugging the s*** out of me. I
feel out of sorts. Where is everyone? Oh yeah, they’re with someone like you,
so I can’t even get their attention for more than a glance or a grunt. I have a
headache, my neck and shoulders hurt, I feel nervous. I feel far away from
everyone in “real time” because I have spent all of my time with you. And you
know what? I’m sick of you. That’s the truth. I think we need to take a break.
6. Time Off Stage
I turned you off. I didn’t charge you. I turned my back. I went for a walk. It
felt weird, like something was missing. It seemed so quiet. Almost too quiet. I
liked it for a while. But everywhere I went, and I mean everywhere, everyone
had a you. I tried to reach out but sooner or later they all went back to that
you of theirs. I was lonely. I began to wonder what was happening with all the
social media connections we had made together and all the places you had taken
me to. I began to feel isolated and not myself. I missed you. A lot.
7. Rapprochement and Acceptance Stage
I decided to give you another chance. I knew you would take me back without
question. I charged you up, turned you on, and we were off, like nothing had
ever happened. It kind of felt like when we just met, going everywhere and
connecting with everyone online again. Responding to and being responded to. Felt
so good. Except this time, I knew you weren’t perfect and I wasn’t either. You
are what you are and I am me, and time away does not have to mean we are
finished, it’s just some time off. And time off is good. If I plan it right. I
have learned to feel alive, relaxed, and creative. I can feel connected to both
myself and others in those chosen times off. My Inner Selfie is feeling strong
and secure. I am grateful for that. I know I can stand on my own without you
when I choose to. But having you there, always ready to connect with me and
take me where I want to go, means the world! This “we” is interdependent, not
our old co-dependent.
How to Use the Stages in Therapy
This
is easy. After you determine what stage your client is in, you will know how to
estimate how high the resistance will be to shifting to a more balanced use of
devices. Apply this to what stage you are in, too! When you think about these
stages of smartphone attachment you will be able to add this “relationship” to
an expanded picture of digital living. Knowing your stage of attachment will
also help you understand your own responses to where clients are with theirs.
For
example, when I was in the pink cloud with my own smartphone, discovering for
myself the love affair so many others were having, I wondered what messages
were coming in to me when my clients were checking theirs. In a flash of
insight, I was more understanding and tolerant.
If
your client is in the co-dependent and addiction stage, you will want to tailor
your approach to acknowledge that stage, intervening to encourage less time but
in a tolerable way. The client who had taken so long to be present in my office
though physically sitting on the couch for several minutes, definitely needed
some electronic detox.
You
get the picture. The smartphone, and our relationship with it, are here to
stay. The body just feels something missing when we are not in relationship to
it. But this relationship doesn’t have to haunt us like a phantom appendage
once we make it a conscious visible part of our environs. Awareness helps us to
take control of this relationship rather than it controlling us!
Therapeutic App: Accept that you and your young client
both have close relationships with your mobile devices. The quality of the relationship
differs depending on the stage of attachment and the level of empowerment we
feel with regard to our use of these devices. How is that relationship
interfering or contributing to your therapeutic goals?
The Digital Self and the Real-Time Self: Developmental Tasks
Mastering Developmental Tasks
As we look at the mastery of developmental tasks that our
adolescents and young adults need to move through, Erik Erikson’s
(1950, 1968) classic components of these tasks have held up over time. The shape
may shift gradually, but the form and elements still remain. These tasks help
us evaluate where our client is. We can then consider the ways in which
cyberspace has become the place where these developmental stages are
simultaneously being practiced.
- Adolescent Developmental Tasks: Identity vs. Role
Confusion
- Who am I and where am I going?
- Sexual maturation: the time to
experiment and explore.
- Forging past influences and beliefs with
future expectations.
- Loyalties to persons and groups (social,
family, politics, spiritual).
- Fluid and complex forces often at odds.
- Young Adult Developmental Tasks:
Intimacy vs. Isolation
- Finding and practicing with partners.
- Changing roles and attitudes toward
marriage and gender identity.
- Feeling alone and “everyone else” is
perceived as different or not
available.
Adolescent and young adult maturation often blend together as mastery of developmental
tasks today may not be completed until the late 20s or even the early 30s. In
the United States, the 20s are often looked at as extended adolescence,
sometimes called the Odyssey years or Floating generation, before embracing all
of the responsibilities of the maturing adult. This is partly our changing US
culture (40%-plus of adults in their 20s now move in and out of their parents’ home, whereas young people left home permanently at a much
younger age in previous decades). The economy in the United States has an
influence, as college graduates are having more difficulty finding jobs and
their parents are working until much later in life than in the past. American
parents can now keep their adult children on their medical plans until they are
26 years old since without a job or one that offers benefits, a young person
will likely be without medical coverage. These and other trends in the US
contribute to an extended period of adolescence and a slower pace of mastery
for many young adults.
Tara, age 24, with an MA in psychology and a first job in an
inpatient hospital for adolescents, doesn’t look much
older than her clients. Although she does not live at her parents’ house, she continues to binge drink with friends on weekends, to use
drugs to enhance concert experiences, and has random hook-ups. She knows she
has to clean up her act and wants a more stable intimate relationship. She says
she is careful online and posting, and really believes she keeps her private
life and professional life separate, no conflict. Although she realizes the
risks to both herself and the ethics of her profession, she insists (her
rebellious adolescent side) that she is too young to give up her lifestyle.
This
is a fairly common example of a 20-something adult who is in the process of
still mastering significant developmental skills. In Tara’s
case, the search for and practicing for an intimate relationship still mirrors
almost an adolescent level of maturity – and the gulf between her professional
and personal life is wide.
Rites of Passage and Developmental Tasks in the Digital World
Since most young people from their teens through young adulthood
report spending many hours per day online and on social media sites, we should
assume that these developmental tasks are being practiced, experimented with,
and perhaps being formed at the same time as real-life developmental tasks and
internal states.
When Erik Erikson talked about the young developing persons’ need for “time out” or “free space” to
experiment without consequence, he was foreshadowing cyberspace as the dream
playground! “Time out” and “free space” have become more
unrestricted and for longer periods than Erikson could have ever imagined. And
talk about no visible consequences! The young person’s
perceived sense of “nothing will happen to me” and “no one has to know” is
unchecked in the digital space. The young person is left to his or her own
devices when it comes to monitoring behavior, meaning having to rely on
internal controls that are still maturing or are easily ignored via a “who
cares, no harm done” attitude.
The SMA has given you the “wheres and whens” of clients’ online travel in brief form. You will observe significant
parts of the client’s developmental tasks as well as which
ego states are being practiced and activated there.
In her book Alone Together (2011), Sherrie Turkle
describes how the digital world can help in these rites of passage – including
navigating friendship stages; exploring religious, political, and other
ideologies; participating in interactions that are outside of parents’ purview; having a parallel sense of independence and the
ability to make contact with parents at any time; having long-term (forever)
“friendships,” as online connection does not necessarily shift with changes in IRL.
Turkle points out the positives of young people exploring these
multiple online identities, developing social communities, and serious play
practice outside of “real life,” and reiterates cyberspace’s golden offering where one can always be de-marginalized
through virtual groups. No one knows I am fat ... or shy ... or transgender ...
or gay. I can be part of this group. I can be accepted here.
So far, so good. These parts being played out daily for hours
can create “alter egos” that can feed internal ego states or confuse them. When
individuals create a profile on a social media site or an avatar on a
role-playing game site, they can create and then edit who they want to be. They
can act and experiment with parts of themselves. They can also express their
dark sides, such as anger, shame, aggressiveness, and sexual compulsions that
may hinder healthy ego development.
Is this different from IRL? In cyberspace, there is more freedom
and one can take more risks without consequence, at least on the surface. Any
of us who has ever had a young client read texts that are being exchanged with
someone they are in conflict with may agree that what is said online is often
dramatically less restrained than what would have been said in person; most
clients tell me they would never say IRL what they communicate in their texts.
Welcome to a whole new meaning of free speech! The experimentation and
exploration of sexual development, gender identity, and forming views that
differ from family upbringing in belief, religion, and politics can be private
and unchallenged. We must also be aware of hidden online ego states that can
hold spaces of shame, despair, and hopelessness. Not so easily revealed, we can
never assume the absence of this just because it is not discussed. There are
telltale signs, though, such as stated self-disgust or low self-esteem, and
these observations can open the door to specific and gentle discussion of how
these ego states may show up online.
Practicing developmental tasks online can foster independence
and self-esteem – or it can hinder it. Frequent texting to a parent, multiple
“friends,” or feedback from unknown people might encourage a dependency and
avoidance of self-regulation of mood and anxiety. The emotional charge of being
an online “friend” is high, but expectations of
others have been lowered, sometimes to where they become “objects” who are
useful and comforting (Turkle, 2011). Because the relationships are so easily
discarded, our younger clients can still feel isolated and lonely. Thus, young
people (especially) may search for more and more response (always instant) and
can end up feeling even more alone. I have also observed this “short friend
life” to be repeated IRL. One of my high school clients changed her core group
of friends at school over a semester at least five times, as was reflected in
her contacts online. And I see my clients in their 20s struggle with finding
good relationships that stick or practicing them IRL. They often have their
“discussions” or “fights” via text when they could just as easily use the phone
or be together in person. What a difference between the ease and editing of
texting (being in control) and the more challenging and less secure
characteristics of face-to-face encounters or even FaceTime or phone
interactions and relationship negotiations.
Practicing developmental tasks IRL and practicing them in
cyberspace are not the same thing. The quality, full-dimensional learning that
comes with working out differences, thinking and reflecting, building trust,
and creating attachments that last IRL far surpasses what is easily discarded,
deleted, and forgotten. Although the digital emotional charge that we feel in
connection and relationship to others is a felt reality, “cybersincerity” (how
honest and authentic this self is online) can be circumspect. Never judge an
online profile by its cover. But recognize it as a real part of your practicing
client toward maturation.
Cybersincerity feels real when plugged in and may match the
person’s sincerity IRL, but it may not. See it for what it
is: a spin on truth and authenticity – and the stakes can be high.
Today, as the “genuine self” of our maturing young client is in
the cooker; we look for a more “fluid” self over the more classical “stable”
self (Lifton, 1993). Peering through this developmental lens matches our own
requirement of fluidity and flexibility in meeting clients where they actually
are, as we help them move from cyberspace realities to embracing themselves and
others IRL.
I invite you to see the reality of your clients practicing these
developmental tasks online and to discern where they are with mastering them – both
online/offline. Ask yourself if what you are hearing from your client is
promoting maturation or where they might be stuck or lost.
The Growing Brain: A Time of Independence, Desire for Knowledge, and
Exploration
Most experts in the science of the brain agree that the
adolescent and young adult brain doesn’t fully develop until the mid-20s or
even later. Girls are often around two years ahead of their male peers. Let’s review a few simple facts about our client moving into
adulthood.
- From the growing ability to self-regulate such responses as
fear, anger, and aggressiveness (the ancient primal amygdala reigning); to
range of emotions and decision making (frontal cortex areas); to planning,
thinking before acting, and reasoning (prefrontal cortex); to mental tasks (the
cerebellum); the brain continues to mature alongside the development of
discrimination and down-regulation skills.
- Signs that the brain is still maturing include our clients’ problems interpreting social situations (PISS),
impulsivity, being accident prone, fighting (verbal and other), engaging in
risky or dangerous behavior, addictive behaviors, self-harming, and making poor
decisions.
- The brain’s reward and arousal systems
(neurons firing up) that get triggered and stimulated during these years often
allow for the domination of peer pressure. What others think can often supplant
the young person’s own judgment.
Digital Impact on the Developing Brain
If someone is plugged in 24/7, higher levels of arousal can be
triggered, which can increase emotional responsiveness. It may be that
irritability, sadness, moodiness, or anger set in or that euphoria, giddiness,
and positive feelings reign. Dopamine, a neurotransmitter associated with
pleasure (also associated with addictive behaviors), also gets fired up with
unexpected and/or frequent responses in texting, gaming, and social media
activity. “Hey, that ding that signals someone has responded or has sent me a
text makes me feel good!” The lure of responsiveness and the subsequent
dopamine rush create a compelling invitation to return to cyberspace, no pause,
no question.
Being plugged in so often and for so long, and interacting on
multiple sites with multiple people (group messages, threads, blogs, tweets),
can decrease our clients’ comfort in being alone IRL. And we know that it is
the time alone, when one is still with and within oneself, that is required for
developing the reliable sense of self, the Inner Selfie.
Creativity needs ideas and reflection to incubate below the
awareness level and then to be developed. If online input and information never
stops, the natural talents and creativity of our clients may be underserved.
This APP generation (Gardner & Davis, 2013) especially needs encouragement
for this creativity and reflection in their identity formation. Online, people
can either create or borrow from other sources to fill in the blanks. A type of
laziness can seep into an imagination that only uses mix-and-match methods
(Gardner & Davis, 2013).
This necessary space for developing intimacy skills can be
practiced in online relationships and communications. They can also be
superficial and non-binding, which gives that connection in online time and
place the illusion of being within one’s control. Of course, hours of texting
are often taking the place of IRL conversation where relationships can be
negotiated, built up, or torn down and where long arguments can occur. This
one-dimensional communication pathway leaves what happens in face-to-face
contact out, such as visual, physical, and tonal cues, and it leaves a lot of
room for misinterpretation. And these limits in understanding and perceiving
online are also still maturing in our young person’s
brain. Apology and conflict resolution online takes less work – much less since
one can edit and control messages and responses. The closing of the digital
door requires no exertion, little introspection. In IRL negotiations, the
conversation cannot just be turned off, at least not so easily; working things
out is more natural. So much can be muted or avoided online. One cannot plan or
anticipate outcomes when relating in real space. One has to put in an effort
and take the risk, something the young client may not relish, whether because
of discomfort, lack of skill, or not finding the other person willing to be in
that real space too.
When it comes to imagination, we can be lazy online, just mixing
and remixing. Gardner and Davis (2013) give us another helpful assessment tool:
observing whether clients’ apps or sites are “app
enabling” (where they are constructing and challenging themselves to create) or
“app dependent” (where the work is being done for them).
With too much information overload, the part of the brain
responsible for decision making and control of emotions shuts down. Frustration
and anxiety may soar. This is when bad choices and mistakes increase and the
self-regulators in the developing brain act according to where the client is. The
constant input of information encourages them to make immediate decisions, when
more thought would be warranted; overload makes discrimination skills – which
are still being developed – difficult (Newsweek, 2012).
The Impact of Cyberspace on Anxiety and Depression
We hear it every day, how our excessive digital engagement is
negatively impacting our well-being. The champions of human interaction
research and neuroscience help us keep current with ongoing updates on new
discoveries about digital influences. Scholars and researchers such as Dan
Siegel, who has written and studied the precious interactions among
relationship, attachment, and the brain, bolster our resolve to help our younger
clients find their Inner Selfie and stay connected in real-time relationships. We
know today how vital our human connection is in helping our brain make new
synapses and release good chemicals (such as oxytocin, which gets released when
people connect with each other) and neurotransmitters related to attachment and
sharing with other human beings. The ongoing discoveries about neuroplasticity
– our brain’s capacity to make new connections in learning
and behavior– provide us with an energized sense of hope and efficacy-based
certainty as we begin to understand how change continues over time. We can
teach our clients – no matter how old they are – to transform and grow, no
matter how stuck or hopeless they may feel in a given situation or stage.
Thirty-eight hours a week online is now a low norm for all
adults (Newsweek, 2012). Multiple studies show that anxiety and depression in
young people are on the rise and link the pervasive or excessive time spent and
pressure from social media sites to this trend (Michigan State University,
2012). On the other hand, internet use can lessen loneliness and depression in
youth as they engage with others online in many positive ways.
In the past, admiration for technological expertise may have
trumped concerns about use. Now the effects of being constantly plugged in are
being reported almost weekly on radio, TV, and internet. This accentuates how
important it is for us to enter our clients’ world fully in order to help them
learn to navigate their travels back and forth between cyberspace and full and
present living IRL. The magnetic draw of cyberspace is that the rewards are
instant and easily attained, whereas the rewards in real life are more elusive.
Research (Turkle, 2011) shows that although hanging out online doesn’t necessarily make one feel any better, real-life interactions
may be experienced as so awkward that the younger client returns to cyberspace
anyway.
The “empty” feeling, irritability, and constricted behaviors
described by many clients following hours of looking at a screen tell us a lot
about the problem and its circular nature. We need to be alert to the
distinctions among what is healthy, what is compulsive, and what is addictive
use of the Internet.
Prolonged use, where one goes, what happens there, and what
relationships and connections exist IRL all influence the anxiety and
depressive symptoms in our clients. The vicious cycle of getting offline,
coming up empty or dissatisfied, and then returning to the online dopamine theme park often interferes with the ability to fully engage in life.
Therapeutic App: Your clients are practicing the
developmental tasks that need to be mastered online as well as in real life. These
rites of passage are carried out unchecked in cyberspace. As the brain develops
into the mid-20s and beyond, the influences of cyberspace can lead to increased
anxiety and despair. On the positive side, there is the common experience of
affirmative social interaction and practice, from sharing secrets to exchanging
ideas, emerging beliefs, and values. Your goal is to help clients find balance
and authenticity in relationship to themselves and to others so that the Inner
Selfie has the space and support it needs to grow.
Developing a Strong Inner Selfie
Opening Scene: “I’m so confused. I have no idea what I want to be or who I am. Am I totally
f***d, or what?” Hannah, age 18, looks at me, her shoulders bent forward. Heading
for college in a few months and with her anxiety mounting, Hannah would
describe herself as uptight, driven, and full of fun. She is one of the fastest
texters I had ever seen and she has many friends online and off.
She
is a confidant to scads of these friends and she gives great advice. She also
dislikes herself and how she looks. She feels like a “nobody” despite the
positive feedback from her high digital profile and her popularity in school.
Flashback: Hannah was very
likable and open in our sessions. She was not shy about sharing the details of
her life. I watched myself chase her dialogue as I tried to figure out which of
her interactions were IRL and which were online. We counted 30-plus texts in an
early session. She agreed to put her smartphone under a pillow after the fifth
session. I was relieved, but could sense how uncomfortable this made her feel. Did
it really help our sessions?
Today: A year after
first meeting with Hannah, I give her the SMA. Her social media sites are vast,
including Tumblr, an online journal where she vents her deepest and darkest
thoughts. She has 200 followers on this site alone. She meets boyfriends,
girlfriends, and older men (though she insists she has stopped this) on various
sites and she admits to sexting for “fun.” She is swinging back and forth
between newly minted self-confidence and old self-doubt.
Hannah
likes the short “trancette,” and we spend the summer before she heads off to
school processing her internal ego states, external states, and online parts in
dialogue, in a psychodrama in different chairs, and during trances. I have
introduced the Inner Selfie as her beautiful, strong and resourceful inner
self. We use her mobile device to give her quick access to this ego
strengthening whenever she needs it.
What Is the Inner Selfie?
The
Inner Selfie is the internal sense of self, our core, our “inner strength,” our
“inner wisdom,” our unblemished and pure self. It is the healthy ego, the
strengths and resources that we have and that we rely on when our deficits,
insecurities, anxieties, and self-destructiveness get in our way. It is the
sacred part of who we are. It is the part of our client that is sometimes
unfamiliar and unexplored, vague, and definitely in the process of developing.
“Selfies”
are the universal cyberspace fingerprint. Documenting and/or preening, they are
the digital mirror, the reflecting pool of Narcissus. Who hasn’t taken a
selfie? Selfies are fun; they tell stories about us. We are sharing in a vast
collective archive. Adolescents/young adults have grown up crafting images of
themselves, as they endlessly create and edit online personas. What or whom
should they look like? How do they want to see themselves reflected online? The
Inner Selfie is a term they respond to; it represents a thread between their
external experience and their inner strengths and resources.
Inner
Selfie resonates; everyone seems to know what it means. My younger clients
immediately get it and even if they have no solid relationship with that Inner
Selfie, it is a place to start. Offline, it is a deeply internal ecosphere. It
is within. This is a place many young people are not used to spending much
time. It is a place that is easy to ignore or avoid, a place to fill up with
all kinds of distractions. You are most likely not accessing your Inner Selfie
when deeply engaged on social media sites.
There
are many and diverse approaches for building strong ego states and internal
strengths. The “inner sage” or “true self” has a prolific place in literature,
education, theology, and therapy. The Inner Selfie can lead your client there.
It will help your client down-regulate. It can guide them to inhabit their body
and teach them self-reflection. Being still, knowing your own voice, being
comfortable with it – these are usually foreign concepts to our young “cyberspaced-out”
clients! “Huh?” they respond.
“To
thine own self be true,” Socrates wrote. “Huh?” a developing self may
wonder. “True to what?” One of our tasks as therapists is to help guide the
journey to self-discovery, ask the necessary questions, and hear the depth of
the answers however they come to us. The Inner Selfie gives clients a clue, a
glimpse into a part of them that invites more exploration. We hope that this is
a place they will want to return to again and again, like returning to a spring
of fresh water.
Five Ways to Introduce the Inner Selfie to Young People
Teach
them the relaxation response.
You may have a way that works well for
you. I teach all of my clients a version of the way I learned years ago when
training at the Mind-Body Institute of the Harvard Medical School (Herbert
Bensen, MD, director and founder, who actually coined the term, “relaxation
response,” in the l960s).
“On your in-breath, fill your stomach up
slowly like a balloon, slowly counting mentally 5… 4…; deflate slowly on your out-breath, slowly counting mentally 3… 2… 1… Bring your thoughts back
to the counting when they drift off – and they will.”
It doesn’t matter whether the breath is
through the nose or the mouth, whatever is the most comfortable for the client.
Work with them, even for as little as five minutes, with their eyes closed. Check
in on their experience, how it is for them being in their body, what it feels
like, what sensations and images they have. For many, this is not a familiar
place!
Normalize any sense of dizziness as good
oxygen to the brain. I talk with my clients about how when we are anxious or
occupied we are usually using shallow breath through the chest. So their brain
is absorbing this healthier dose of oxygen as their body and mind slow down
with abdominal breathing and focused mind. I reiterate the importance of the
mind taking a break along with the body. If our mind is still racing, our body
has difficulty really relaxing.
This simple relaxation piece gives your
client a super-easy tool to practice after their first session. Most report
that they use it with good results. Most describe a sense of relief, a feeling
of calmness. Pick up on that. Talk about what that is like. You have already
provided a beginning sense of mastery in this easy way to learn to
down-regulate.
- Discuss positive resources you have observed in your client, both online and
off.
Give examples. In Hannah’s case, I can point to the great advice and help
she offers online and with her IRL friends as a wonderful part of her, a part
of her Inner Selfie, an essential part of who she is. This is a way to start
building up that inner core.
- Begin to introduce short trances (what I call “trancettes”) that will give
clients the experience of being totally unplugged, in a down-regulated place.
This provides an early induction that allows for listening and observing
healthier ego states. I find that shorter trances are enjoyed by my younger
clients. They live in accelerated time. With the time distortion that can
happen in trance (as part of hypnotic phenomena), a 10-minute trance is often
experienced as longer and is well tolerated. A lot of bang for your buck.
Hannah
liked to talk and update for a bit, then do a “trancette” that focused on a
goal and a strength. As a result, she was calmer, more present, and reflective
for the rest of the session. The Inner Selfie was stirring.
- Do you always have to be relaxed to access your Inner Selfie?
Fortunately, the
answer is no. You can show your clients how to take a “pause,” to opt for that
“left-hand turn.” Yes, it can be as easy as reminding them that taking a breath
or two is the bridge between the mind and the body, as the popular Buddhist
teacher and writer Thich Nhat Hanh has often pointed out. One or two or five
breaths can offer a significant pause. Invite clients to ask themselves in this
pause, “What would the stronger, more confident part of me say or do?”
Encourage listening to that part until they can “hear” it (this might require a
few more slow and easy breaths). Have this part convince the other parts to
take their Inner Selfie’s advice or at least to temper a behavior they may jump
into impulsively and later regret. You will be teaching your clients how to
improve self-regulation and sharpen an observer self, rather than seeking
immediate feedback online from wherever or whomever they can get it.
- Fine-tune your therapeutic approaches.
I primarily employ hypnotherapy,
ego-state and parts work, and cognitive behavioral therapy as my mainframe for
strategic interventions.
Use what you know well and tailor it to your client. Use
the SMA to understand and to explore their digital experience and the profiles
that you will be integrating to help them build the Inner Selfie. Learn their
cyberspace language to enhance and open up your therapeutic work.
In
one of my inductions with Hannah, she resonated with taking an Instagram of her
loving heart, one she could look at in her mind’s eye at any time. Here I first
used the metaphor of a selfie – her inner self as the part of her that is
loving – and then seeded the therapy to come, as well as giving a post-hypnotic
suggestion.
Therapeutic App: Think of the Inner Selfie as the image
for loving one’s self, thinking for one’s self, trusting one’s self, listening
to one’s self, and being able to be in authentic relationship with one’s self. Being
able to embrace this position allows for true connection with others.
Redefining Boundaries and Confidentiality
Opening Scene: Megan was in her late 20s. A confessed “borderline,” she was determined to find
out everything she could about me – and she did. She looked up where I lived, how
much I paid for my house, and the age of our son. She even found a poem I had
written and read at my mother’s funeral (many years before), which had been
published. She drove past my house and knew exactly where I parked during the
work day.
Flashback: I believed my
boundaries had been violated and I felt exposed. Where was my privacy? We
discussed it in session and worked it through, although it took a while. We
found a good place, one that respected boundaries and privacy. I have always
guarded my private life, keeping my online presence very low key. It didn’t
seem totally wrong, just brazen; a part of me was impressed with her research
skills and I could recognize this resource in her.
Today: I expect that
Megan will find this personal information and more. Par for the course. Based
on her SMA, I know she finds many sites that feed her feelings of emptiness and
her abandonment issues. It just seems to me now that she is simply trying to
connect with me in an anonymous online way. But she has told me about it. This
pseudo boundary-crossing feels more fluid and not really so intrusive. My work
with Megan is to help her create a world that keeps her safe from herself and
energized toward discovering a more solid sense of self. The trolling of dating
sites, and the profiles she sends out, versus how she really feels about
herself, add to her sense of depression. She has vented on the electronic
“wailing wall” to total strangers about her intimate thoughts and feelings. She
receives both encouragement and horrible negative responses. But at least she
gets something.
From “No Boundaries” to “Know Boundaries”
The
Webster Dictionary defines a boundary as “that which indicates or fixes a limit
or extent or marks a bound, as of a territory, bounding or separating line, a
real or imaginary limit.”
In
cyberspace, that boundary line is usually constructed by the user. We freely go
to any site. Sites recognize us and store all kinds of information about us. We
pick familiar places and move carefully through new ones. Or we don’t. We tend
to dissociate from all that is out there about us. Dissociation then has
developed and become a new boundary of protection.
If
adolescents and young adults are still maturing, still developing their
personal boundaries, how do they learn how to create good boundaries online and
on social media sites? Yes, they are practicing, through trial and error, just
as they do IRL. But the real world has social restraints, acceptable ways of
being, and checks and balances. Parents begin by teaching and modeling
boundaries to their children. Boundaries are also drawn and reinforced by laws,
religion, teachers, and mentors. These parameters are built into any society. The
experimentation that begins in the teens and continues through the 20s is a
natural part of development. Limits are stretched in real time, but the limits
are there. In cyberspace, limits are few, and thus the ability to safeguard
oneself is tenuous at best; learning to protect oneself becomes paramount.
External
boundaries are delineated by those in authority to protect people from the
consequences of certain behaviors. This is rarely the case online. Thus,
internal boundaries are essential in the open space of the digital world; they
arise from being able to listen to a strong Inner Selfie, that part of the self
that has a sense of knowing when something is good, productive, and nurturing.
Healthy internal boundaries equate with self-care. Patrick Carnes (2001)
describes the presence of internal boundaries as reflecting a relationship to
oneself (pp. 141-143, 153).
As
therapists, we need to help our clients develop internal boundaries that are
both firm and flexible. This is a central paradox in our work with them. First,
they are creating their own space and they are practicing their developmental
tasks for mastery as mature adults, separate from their parents and other
adults in the world. And second, these internal boundaries are just beginning
to take shape and are highly vulnerable and easily influenced. Young clients by
nature are also at an “anything goes” stage and are reluctant to judge
something or turn away from it just because it is off the beaten path. They are
also often suggestible. We have to help our clients to come into themselves and
to self-regulate, especially as they interact in the digital world.
Further,
the feeling of unreality that goes with keeping a digital presence can blur
boundaries. The digital possibilities for being bullied or for bullying, for
being manipulated or controlled in some way, are rampant. Uncensored verbal
attacks on others that would never happen in real time, or deeply personal
confessions that would not be made face to face, occur a thousand times a
minute in cyberspace. Being online highlights every kind of boundary issue and
whatever challenges there are in being able to self-regulate. Online
relationships can exacerbate unhealthy real-time ones and can cause great
dissonance for our clients’ internal states.
Good
boundaries are more about paying attention to one’s conscience, and that
willingness and ability to learn from and listen to the Inner Selfie. Pausing,
breathing, making contact with the self – these are essential to beginning to
establish internal boundaries.
Megan,
the client whom you met at the start of this section, eventually chose to block
self-destructive sites and stop a digital interaction if it didn’t make her
feel good. She learned to ask herself if what was happening online was hurting
or helping how she felt about herself.
I
tell my clients who are struggling with how to decide where to go and with whom
to interact that there are no rules to turn to, but that if they learn to
listen to themselves and take the pause to ask the right questions, they will
stay on a good track.
Besides
boundaries regarding online behavior and where one travels, there is another
important boundary to consider: how much time to spend plugged in. When I bring
up with young clients that they can be in charge of their time online, they
seemed surprised. Many of them have indicated on their SMA that they want to be
on social media sites less but that they don’t know how.
I
ask them about their beliefs and values. They usually don’t offer up this
information on their own, but their responses give me the keys to tap into their
conscience and ways they might be guided to own a sense of responsibility both
online and off. I know, for example, that one young client values trust but is
“cheating on her boyfriend” with online meetup encounters. I talk with her
about where she is drawing her “boundary” line. At first, she says that they
feel like two different worlds (which they are) and that one doesn’t affect the
other. When she was in high school, talking to lots of guys online and dating
in real time didn’t cause her too much stress. Now she says she is serious with
her boyfriend. As we talk, she begins to realize that maybe she has crossed a
boundary of trust with him within the parameters of her own value system. She
says she definitely wouldn’t want it the other way around. Boundary-building in
the making!
“Flaming,”
as Sherrie Turkle describes in Alone Together, is a way of uncensored
ranting toward someone online, whether you know the person in real life or not.
I hear these rants quite often in my office as some of my clients read them to
me off their smartphones. There is a bravado and self-righteousness in their
tone. Sometimes, young clients (and others) feel their anger as a way of
“drawing a line.” But this is a false boundary. It is not the “working things out”
kind of process so crucial to navigating the world. Cyberspace is an open forum
that gives us all a voice, but it can mute the conscience and dull the
discernment naturally guided by it. We are here to help our clients develop
their own moral yardstick. We invite them to reach deep down and get to know
that Inner Selfie.
Impulsive Acts
Who
is your adolescent or young adult client? Untethered, curious, both delighting
in and at the mercy of a developing brain, acting at times without thinking, and
“living” on social networks, while having what has often been the young
person’s nemesis – PISS: Problems Interpreting Social Situations!
Imagine
the misinterpretations that happen hundreds of times online for our
adolescent/young adult clients every day as they edit, project, absorb, and
distort. How can they tell what is “real”? Even FaceTime lacks real eye
contact. In cyberspace you can’t touch or read emotions. Yet most young people
are choosing to text or email rather than talk on the phone or hang out in
person. So much goes missing. And the margin of error for projection,
misinterpretation, and emotional distress goes way up as human contact goes
down.
Growing
up connected to the digital world is like driving without brakes for many young
clients. Those in their 20s may report that they were “addicted” when they were
younger and went places and did things on the internet that they would never
let their children do. It’s a mixed message though, as they also admit
continuing to do things and go places they feel some question about, even if a
bit “wiser” now. Why do they do it? Well, many of them simply find it difficult
to stop. Others don’t really even think about it. It is what they have done ever
since their fingers discovered the keyboard.
Spontaneity
Distinct
from impulsivity, spontaneity is understood as “proceeding from natural
feeling, temperament or disposition, or from a native internal proneness,
readiness or tendency, without constraint as, a spontaneous gift or
proposition” (Webster).
I
like to talk with my clients about the difference between impulsivity and
spontaneity, providing them with examples to help them differentiate. Spontaneity
may look like a flash mob where everyone converges to dance or sing, or sending
a friend a text that is loving and kind, or posting a funny picture and getting
a thumbs up. No harm done. I encourage these clients to think of a time when
they have been spontaneous or to imagine something in the future that could be.
And I ask them to think about how that spontaneous action may differ from
something they have done impulsively or could see themselves doing. Most of
them have not really thought about the difference before.
The
“native internal proneness” that is part of the definition of spontaneity
...yes, it’s that Inner Selfie!
The New Confidentiality
A
lot has been written about the changing face of confidentiality in recent
years. What is personal and private today can look unrecognizable from when
some of us were young. What I find interesting is that my clients often share
their “private and secret” selves on sites with people they don’t know IRL. There
in that digital space are places and people they can vent to, get support from,
or rant with. “Sharing” with online-only associations is often described as
less risky than confiding in their friends or family IRL. Journals online come
in many forms today, and most private journals have followers reading them and
posting responses. These responses can be kind or cruel, which can tip a client’s
mood toward despair or euphoria. Take the example of 15-year-old Shari, whose
school friend “accidentally” caught a confidential feed sent to her many
online-only “friends” about an upset at school. Her school friend sent it to
others and Shari was soon very distraught as messages started coming in
criticizing what she had shared, which had been meant only for those online. Her
response outwardly was angry bravado but she admitted that her inside part was
hurt and that she had cried in her room for hours.
If
you have a personal profile and threads to it, you have an outed self. The more
of your information that is out there, the more you are out there. Even
some of my younger clients who are developing therapists have posted more than others
of us would ever dream of sharing on Facebook and other sites. This new
“confidentiality” is perfectly normal to them.
Ask
yourself how you view confidentiality today compared with a few years ago. Does
it affect how you practice or how you view your client’s sense of privacy and
what it means to honor it?
Four Steps Toward Helping Your Clients with Online Boundaries
Step
One: Start with easy external boundary decisions tailored to the client’s circumstance.
(A couple of examples: “I will play X game online before 11pm and then put
my device in a place I can’t reach or see when I am going to bed.“ Or, “I will
not send any more sexting or compromising pictures of myself.”) Have clients only
carry out one or two decisions at a time. Invite them to make an intentional
statement in your office, directing it to themselves. Encourage clients to say
it out loud when needed (their own verbal anchor) and to visualize doing it as
they state it. You might do a “trancette” to give it emotional impact and
weight. This will help them keep to their resolve. Ask them “how” they feel on
certain sites? How does being there help them have a positive sense of being? If
it doesn’t, and being somewhere that is perhaps secret, makes them feel a sense
of shame or discomfort, discuss how this could be a boundary crossing that is
contributing to the depression or anxiety they may be experiencing. Discuss how
feelings of shame can be telling them it may be a place to stay clear of.
These
ideas mark the foundation of building Inner Selfie awareness, the consolidation
of inner strength, and the forming of an internal boundary.
Step
Two: Encourage your clients to practice the relaxation response (stop, deeply inhale
and exhale slowly, maintaining other focus, i.e., counting down slowing from 5
to 1) and to visualize changing their course online when something negative
about it bubbles up for them. Picturing what they want to do is part of
indirect post-hypnotic suggestion and encourages the success of one’s
intention. Invite them to listen to where that feeling resides in their body. Remind
them that a decision, one they have made, just takes a simple click and that it
could free them up in such a positive way. Follow up in future sessions and
chart their progress. Give lots of support as they experience both successes
and difficulties. The discussion alone gets them thinking. Aha! Some offline
reflection!
Step
Three: Do a “trancette” using metaphors of boundaries and allow these images to deepen
with post-hypnotic suggestion. For example, I remind young Shari: “.. just like
you enjoy closing the door to your room, YOUR room, when you are ready to be
away from your brother and all the noise downstairs, you can shut the door on a
post … knowing that in a day or two … you won’t care as much and that by taking
that break, just a short one, like being in your room alone for a while with
your door closed, you will ride the tide and the next wave will be much smoother
...” (This is a bit of tailoring based on Shari’s enjoyment of surfing.)
Step
Four: Talk about maps and travel guides that they can develop for their online life. For
example, the young client who has decided to stay off of meetup sites with
other guys now that she is in a serious relationship, puts a stop sign in her
head and takes a “route” to a social media site where she has plenty of
“friends.” Discuss how and why making decisions like these represents a
positive internal shift. The inner resources that you are nurturing in clients
will help build their resiliency and resolve.
Therapeutic App: You have joined your client by witnessing the changing definitions of
boundaries and confidentiality in the digital world with them. You are
spearheading the trek to help them tune into their internal self, the Inner
Selfie, and to develop digital resiliency, which includes the ability to
recognize unhealthy triggers and to willfully change course!
Application
Using Trance, Mindfulness, Somatic Experiencing, and Ego
State/Parts Work for Effective Integration of Digital Life with Real Life in Your
Clients
Hypnotherapy Can Be Your Lens
The masters and great teachers of hypnotherapy have provided us
with an incredible way to look through the digital keyhole. The chorus of those
who stand behind me – which includes Jeffrey Zeig, Ph.D and Michael Yapko,
Ph.D., both brilliant sages of the wise pioneer Milton H. Erickson and both
profound contributors to the field – has given me my own wings and flight
mapping. Very briefly, Ericksonian approaches are based in and evolved from the
work of Dr. Milton H. Erickson. They encompass a tailored, individualized,
strategic yet nonlinear focus, which can include both direct and indirect
trance and interventions for optimal emotional impact.
You, the clinician, have your own chorus of voices behind you
and I encourage you to keep using and growing from what you know. I will lay
out some basic ideas from hypnotherapy that you can apply in helping you work
with the social-media-filled life of your clients. Whether you are a novice, an
experienced, or a seasoned hypnotherapist, using the hypnotherapy lens
encourages the therapeutic goals of being fully present, flexible, and moving
from being stuck in old patterns to creating more positive new ones that access
inner resources and allow for more effective resolutions.
When you go into trance in a natural way, you are focused on
something (like looking at a gorgeous landscape) or absorbed in an experience
(like floating on your back in water feeling the sun above and the water around
you) that is elsewhere. You are absorbed here, not there. Or there, not here.
Watching a good movie, reading a compelling novel, driving to work while
thinking about what you are going make for a friend’s dinner party tonight,
waiting in line at the grocery store completely lost in thought – these are all
examples of being in indirect trance. Part of you is dissociated by the very
nature of your dual experience.
Being in the digital wonderland is the mother lode of a natural
trance. You are absorbed by whatever you are looking at or communicating with
in that little box. Your body is somewhere else, perhaps on your couch, in the
car, on your bed, while you’re walking, and so on. You may
be aware of the TV in the background, people chatting, people talking to you,
music playing, the sounds of traffic, and even silence. You are dissociated.
You are in a trance.
And when you are online, you are probably on more than one site,
perhaps many simultaneously. There is information; there are dialogues,
pictures, sounds, and more that you are negotiating in a competent and seamless
way. Can someone be “cyberpresent” on ten sites at once? I think so.
Cyberpresence
Being “cyberpresent,” which is my word for
being online in a totally absorbed way, means responding and resonating with
whatever is happening to you online. You are there. You react and respond
simultaneously. Upon receiving a communication, you react (whether it is a cognitive,
emotional, or even physical reaction) almost immediately. So even though you
are not present in your body IRL, your body releases dopamine (the chemical
associated with both pleasure and addiction) each time you hear the ping of
someone responding to you. So you feel good about the response and then you
filter your response depending on the perceived tone and content of the
message. Your body’s muscular system is responding both to
the physical constrictions of your prolonged online use and to what you may be
experiencing online. You are dissociated from IRL, but completely cyberpresent.
So, if our teens and young adults have been cyberpresent for
huge chunks of their days, months, and years, they are going to be dissociated
from experiencing IRL. They are dissociated from being IRL-present, from what’s
in the moment, in the body, from deep breath, reflection, and the ability to
meditate, create offline, and connect with themselves and others. And when they
are offline, they are often hyper-focused, ready to bounce back to their
digital world when the first ping comes in. Immediately.
Pay attention to the bodily behaviors you observe in your clients,
and make connections, for example if they are holding their breath or breathing
in a shallow way. This can be as simple as knowing that they sit for long hours
(info from the SMA and self-report) and move very little while being
cyberpresent.
Moving from “Cyberpresence” to “Being Present”
Cyberpresence has some interesting parallels to hypnotic
phenomena experienced in a direct or indirect trance in hypnotherapy. Here the
hypnotherapy lens assists us in our work when we take in the digital personas
and experiences of our young client. Being mindful of themselves and others,
being present and in the “now,” and being in the body, are therapeutic goals no
matter what the issues being brought into therapy are. Look at some components
of hypnotic phenomena that echo the online experience.
Comparing Components of Hypnotic Phenomena with the Experience of
“Cyberpresence”
Dissociation
In therapeutic trance and induction, we
bring our client back into the body. Through ratifying (or underlining their
physical experience and awareness while going into trance), we help them land
softly into themselves. Just a quick example for folks who aren’t
familiar with trance: “… and you can notice how warm the sun through the
window feels on your head and shoulders, how comfortable it makes you feel, how
you might be aware of your body beginning to unwind and slow down ...you can
notice how the cool air of the air conditioner compares to the warmth of the
sun, you may feel a growing lack of tension from your head … to your shoulders …
down your back … from your thighs down to your feet … as you enter this experience
of being totally focused and alert in your mind’s eye
while your body’s emerging comfort settles in …”
It is then (now that they are dissociated from your office and
more present in their body and internally oriented) that we can help them
deepen this absorption and move in the direction and toward the goal you are
collaborating with them on reaching. They are now dissociated from the therapy
room and from online distractions even though they are aware of those
dimensions and others, like the sound of your voice. They have left the
familiar place where they are usually immersed. So it is similar on one level,
but they are organically connected to their body and going inward as compared
to being online, dissociated from their body and focused in cyberspace.
Time Distortion
In therapeutic trance, one experiences
time distortion (that is, time often seems shorter than it actually is). My
young clients often experience a trance that is 5-10 minutes as being longer.
They are not used to slowing down and being present IRL for long periods of
time without checking in online. I find that the briefer time in trance seems
to be tolerated well and will often become something they look forward to in
their therapy. Online time distortion happens to all of us constantly. Time
goes by without our noticing. Teens and young adults spend countless hours
online and often report being surprised by how much time has passed. You can
point this out as well as how long periods of unconscious time can create the
opposite effect of therapeutic trance or time spent relaxing offline, including
muscle tightness, feelings of sluggishness, or of being wired, etc.
Automatic Behavior
When therapeutic induction flows into
deepening trance, automatic behaviors such as swallowing, readjusting one’s position, or scratching an itch, are done with a
semi-awareness while focus goes inward. Just as when your client is online
while sipping a soda, or hears a parent calling and answers absent-mindedly, or
drives while texting (yikes!), automatic behaviors come from habit or
self-absorption somewhere else.
Positive or Negative Hallucinations
As we use metaphors
or create possibilities in trance, our clients will “hallucinate” them in their
own imagination. This is a part of giving your client the gift of creating,
experiencing, and foreshadowing where they may like to go with their goals. Our
younger clients do this multiple times daily in digital space; they fill in or
project what is not fully available to them. Think texting. You don’t see the emotion or hear the tone; you make calculated guesses
as to meaning. A message may feel more challenging or caring than it is meant
to be. Since this guessing game and projection happens among all human beings
to some extent, especially when someone is not forthcoming about a feeling or
position, it is not hard to imagine how this occurs at a greatly accelerated
pace online. Lots of room for error and misunderstanding. And we see this up
front and personal with our clients frequently. For example, they may be very
excited when they feel that someone is expressing interest in them, or they may
be very hurt by a message they interpret as a rejection.
In therapeutic trance, positive or negative hallucinations
(something one wants to add or subtract from one’s experience) are your young
client’s own creations, which are being “seeded”
by you.
Age Regression or Age Progression
In trance work, we may
go back in time to access a client’s memory for positive
recall and resource-strengthening or go forward in time to suggest the
possibility of what can be. These processes are used as a kind of time travel
for growth and responsiveness. Age regression can also be used for reparation
and healing to lower the emotional charge and reactiveness with trauma.
Many examples of age regression and age progression can be found
being practiced online. Role-playing games, for instance, have characters of
all ages, and your clients’ characters may reflect their
developmental stage and parameters of imagination as well as different parts of
their ego states; what traits they would like to have, what they hate in
themselves, or emotions that are easier put into characters. (Released in 2015,
the movie Inside Out is a terrific film that portrays the rich inner
world of ego states. I recommend it highly to clients as well as to clinicians.)
You will want to know about such characters and digital personas for your
trance work and interventions. A client may project a different age than his or
her own biological one or may be interacting with others who are far younger or
a great deal older. Of course, since others online may also be projecting a
created self, age differentiation and how it is perceived can become almost
psychedelic. Who knows what is what and who is who!
In your trance work with your clients, the experience of age
regression or age progression is one that serves to promote health and
well-being.
Amnesia
In trance work, a therapist may work in tandem
with a client to forget about something when cued. This happens in different
ways and for different reasons. Many people who go into therapeutic trance don’t remember parts of the trance experience and some people
recall very little, even though while they are in trance they are aware of
being in trance, of what is being said, and of the clinician’s
voice. This is more automatic and unconscious. The advanced hypnotherapist can
use amnesia to minimize a traumatic event. For example, when working with a
28-year-old client who couldn’t stop thinking about or
being flooded by a traumatic event – a severe bullying incident that had
happened to her when she was 7 years old – we talked about how she was much
more than that event as a child. Then we had her put the event in a balloon
that she could let go of – from time to time she could look at the sky and
wonder where that balloon had gone. This work freed her from remembering it
constantly. In fact, the details began to fade. Amnesia, even as part of an
induction to encourage a client to “forget about it” with a metaphor to forget
a letter of the alphabet or the first lines to a favorite song, can encourage
clients to be creative in filling in the blanks.
Online, the hypnotic phenomenon of amnesia occurs often. When
one is cyberpresent, memory loss for behaviors or experiences IRL while online
happen frequently. An adolescent client may literally tell her mother three or
four times that she will start her homework in the next half-hour but when
confronted about it, have no recollection of the promise. Appointments and
commitments can be “forgotten” until well past the time they were to take
place. Amnesia can happen as part of the dissociative process such as when your
client has behaved or experienced something online in a way she would rather
not remember and so quickly moves on, erasing the evidence as much as possible
both online and in her mind. When a teenager in my practice had been outed by
so-called “friends” for her behavior at a party, she unfriended them (not a bad
idea in this instance) and a year later was so immersed with her new social
life online and off that she barely “remembered” the incident.
Catalepsy and Ideomotor Behavior States
I choose these
two states to mention here because in trance work, catalepsy (the restriction
of movement) and ideomotor behavior (semi-conscious physical movement) hypnotic
phenomena are often present. If you ask your client to signal to you with a
finger, your client may remember raising a finger in a vague way later. The
client may describe the sensation of being glued to the seat, but in a relaxed,
comfortable way. Simultaneously, internally the client is alert and awake,
absorbed, and focused.
When people are deeply absorbed online, we know their physical
movements are often constricted and slowed down, even for hours at a time. And
they may dimly remember some ideomotor behavior. Kyle, a 27-year-old married
client with a young son, is quite positive that as he is role-playing for hours,
he reaches out and pats the little guy’s head and murmurs
something, but it is very foggy since he is absorbed in the drama of his role
play. (He is not proud of the amount of time he spends there, although it is
one way he is able to relax after a long day at work at his … yes, computer
tech job!) Our trance work is brief, whereas cyberpresence is often extended
for long periods.
Post-Hypnotic Suggestion
One of the gifts both direct
and indirect hypnotherapy gives us is the possibility and hope for change in
the future. Whether it is when the client leaves our office or it happens in
different ways in the next weeks, months, or years, we seed that idea for
future change from the very beginning of our interaction to the end of
treatment. In the Ericksonian world, every step of your interventions and
interactions is a seed for change, and moves in the post-hypnotic suggestion
direction.
Online, suggestions given to and made by our clients can be
either supportive or negative. We know these “post-hypnotic” suggestions have
weight because clients bring the stories to us. Sometimes they get locked into
the scripts they are hearing online or are contributing to. If Megan, our
“confessed” borderline, has poured out her negative self-talk on a post, we
hope she gets the “cheer up, mate, you’re
beautiful inside and out” talk, but she could get the “you are a piece of
s***t, you always will be” tirade. We need to know what feedback our clients
are getting and giving. These messages have so much power, especially when
people are young and impressionable. If the negative response appears to
underline their own poor self-image, they buy into believing the prophecy given
them, a dangerous post-hypnotic belief. Being aware of these negative
self-messages built up from online interactions, therapists can help shift
clients to more self-affirming beliefs with post-hypnotic suggestions that move
into a positive sense of self, the healthy Inner Selfie.
Thus, with the lens of hypnotherapy you can provide a reliable
map and the real-life CPR that is sometimes necessary for clients who are
caught in the maze of cyberspace and are unsteady in the here-and-now.
Hypnotherapy can help them navigate back and forth in a healthy way, using
therapeutic hypnotic phenomena for building positive experiences and growth.
Looking for Responsiveness with the Hypnotherapy Lens
Positive responsiveness or emotional impact, that defining
moment of change, begins at the hypnotherapy door. The information imparted to
you in the SMA is key to creating responsiveness, as your interest and
awareness allow you to walk into your client’s
cyberpresence. Whether you use direct or indirect inductions and trance work,
guided imagery, the relaxation response, a meditation, whatever your style and
intervention approach, you have opened responsiveness, the “yes-set,” the
receptive floodgates. Your own style of magic and artistry with your young
clients will resonate with them.
You can now recognize how hypnotic phenomena are alive and well
in cyberpresence and how a therapeutic hypnotherapy lens can capture and
harness that reality and bring it into the therapy hour for the IRL presence
that will help build and maintain those strong Inner Selfies.
Now let’s look at how parts work and ego-state
work can add to this alchemy of success with your teens and young adult
clients.
Parts Work and Ego-State Therapy as the Home Page
If hypnotherapy is our lens, integrating the different parts of
your client can be an effective “home page” – one you can return to, is easy to
find, and is comfortable to access.
So many extraordinary people contribute to my home page: there’s Virginia Satir, Murray Bowen, as well as a most brilliant
graduate school teacher, who introduced me to the work of John G. Howells. There’s Maggie Phillips and Claire Frederick, pioneers of ego-state
therapy, and other contemporary contributors such as Gordon Emmerson. I count
my training blessings. Martha Stark’s unique sensitivity training for really “getting” clients with organic empathy is an essential addition
to the mix as is Dan Short’s work on transformational
relationships. Psychodrama, psychodynamic, CBT therapy and gestalt chair work
give parts work flair and movement in expression.
Whatever background you bring to your therapy, attention to your
client’s developing parts and ego states will lower
resistance, open up sharing, and allow for the “observer” self to begin to
stir.
All of us essentially have multiple personalities; we all have
different sides that either blend together in harmony or do not blend easily
and can be dissonant from each other. Some parts of us are dissociated from
other parts. Other parts are close friends, great playmates. We have internal
voices from our past: parent, child, adult, caretaker. Are these voices
supportive, punitive, loving, or withholding? We have the critical voice, the
funny part, the shameful self, the executive mode, the creative self, the quiet
reflective side, the strong and bold part, the sexual self, the intelligent
self, the dumbed-down self, the talented self, and the list goes on.
A wonderful aspect of ego-state and parts therapy is the
implicit acceptance that these are just parts of us. It is like sitting in an
AA meeting, listening to “everyone” (all of one’s ego
states and parts) with curiosity, respect, and acknowledgment. No judgment.
Introducing parts is easy because the SMA is already in place.
You are aware of the digital places and personas your clients express as well
as their parts IRL; cognizant of their internal landscape as well as sides of
them that they play and feel on a daily basis.
You will find how this segues to a willingness to reveal
themselves early in your treatment with little hesitancy and resistance. When
you are looking at this new whole person constellation, one that includes all
the parts that are operating and expressing in digital space, clients feel more
comfortable sharing these parts of themselves with openness and transparency. You
have given them permission and invited those digital parts into the therapy
room as well.
Once these digital parts are in the room, along with their other
ego states, they can be explored in the context of the canvas that showcases
every color and hue of your client’s individual
uniqueness. The process of integration of self becomes more viable and
supported.
Somatic Deepening
The goal is for the client to move from their daily digitized
dissociation to a felt experience that resonates in a deep organic way. This
felt experience, which can be elicited through different mind-body techniques,
such as hypnotherapy, somatic experiencing, and mindfulness and meditation
training, emphasizes the intense internal changes that occur when someone goes
into his or her body and becomes aware of sensations and feelings. The observer
self is able to take the front row seat in a more neutral non-judging,
non-critical way. And from an ego-state therapy or parts work perspective, the
awareness of which part is being triggered, and where it is in the body, along
with what emotion or thought, creates a synthesis that can be a defining moment
for change.
As an example: Kyle, our 27-year-old father whose excessive
online role playing illustrated ideomotor, or constricted movement as part of
online hypnotic phenomena, can begin to label his “parts” – father, provider,
husband, gamer, lazy part, angry part, guilty part, loving part, responsible
part, compulsive part, among others – and then be willing to sit with each
part. We go into a short indirect trance with each part as he feels its
location in his body and he speaks the “voice” of that part. Angry part: “I
just want to be left alone, I love him (son) so much but he won’t
let me alone and all I want to do is relax and get into my game” (feels it in
his stomach). Guilty part: “I should want to be with him and not my game”
(feels it in his chest). Responsible part: “I have to figure out how to do both
and not short-change him” (feels it in his neck). As we move toward recognizing
all the parts that are triggered as legitimate, and elicit their help in new
ways, Kyle is less self-punishing and seems relieved. The “chill”
part can inform him of where to relax in a kinetic way. Being more physically
active helps Kyle stay with his resolve to find more balance. Even though it
may seem insignificant, taking 5-10 minutes to walk, play a physical game with
his son, or go up and down the stairs a few times, refreshes his circulation
and interrupts his compulsion machine.
Harmony: Working in Trance and with Ego States in Full Color
Whether you use direct or indirect trance, your hypnotherapy
lens now recognizes those parts of your client expressed and experienced in
their digital landscape. You are now including them in the therapy hour.
You can deepen these parts for integration with your client’s other issues and parts through trance as well as with
physical and vocal parts work. I often find that moving a client to another
chair or standing up and taking the posture of the part that is working
something out with another part can have a deep emotional impact, just as it
did with Kyle.
These techniques are used in many schools of training, including
gestalt therapy, family systems work, psychodrama, transactional analysis, and
others. This psychodrama allows you to focus on how a given part of the client
looks, how it sounds, and, most important, how the experience feels in the
client’s body. Remember that this allows clients to view these parts of
themselves with less judgment, more acceptance, and less defensiveness.
Tom, a 27-year-old man with severe OCD,
learning disabilities, and no meaningful or sustained work, could only tolerate
short evocative trances. He had developed avatars online that had great
superhero powers. He learned to ask for chair work and engaged enthusiastically
after I played out two sides of his conflicted self. He wanted to be able to
turn the volume down on his, “You’re not able to do
anything because you’re a loser”
part and turn up the part that felt too small and undeveloped: “You are kind, a
good friend and want to do something with your life, and you can.” I moved from
one chair to the other and asked for his feedback on voice, volume, expression,
and physical posture. Then he cautiously took one part, his positive side, and
sat across from me as I was representing the “loser” side. I helped
him turn up the volume and sit tall. The loser voice got smaller. Later, he
played both sides himself – with gusto.
Tom could then sit for short “trancettes” that used his
ego-state work in psychodrama, creating images that integrated a more realistic
avatar with deep internal strengths. I knew from his avatars – their
superpowers masking his insecurities through the magical thinking and posturing
that fueled his creativity while playing – that his Inner Selfie needed boosting.
Therapeutic App: From digital to IRL, hypnotherapy points
its lens and invites the celebration and integration of parts and ego states
onto the “home page.” You can utilize hypnotic phenomena experienced online by
transferring to IRL those phenomena in deeply felt and kinesthetic trance work,
both direct and indirect. As you bring your clients from cyberpresent to being
present, you will help them explore all the parts of themselves. Creativity and
self-awareness begin to percolate. The Inner Selfie is supported!
Make the Therapy Fit: The Fine-Tuning of Attunement
Step One: Not a Cookie Cutter Approach
Your younger clients have been galloping over the digital range
for most of their lives. They search, select, edit, and constantly update both
the technology and direction they are taking. They are in constant flux and they
are a fluid force, like the wind moving over the prairie. They are
“cybervigilant” (meaning being alert, aware, and focused on whatever and
wherever their cyber attention is).
If something doesn’t fit or their interests
shift, young people instantly change it with a click and a series of rapid
adjustments to find what they want. Remember those thumbs that speed across the
keyboards in a blur of dexterity.
As therapists, we need to practice this flexibility and movement
to meet their pace. This doesn’t mean we abandon our
professional areas of practice and skill to peddle a mishmash of lightweight
therapy. But we do need to become adept at employing various treatment
modalities when it becomes necessary. With an eagle’s eye
toward your treatment goals, using the myriad tools and skills that you have
will allow you to keep up with and guide your clients.
The SMA helps you individualize your interventions because you
know where clients are and how empty and lonely, or full and vibrant, their
territory is. When they realize your response to the information they initially
share with you is not to pathologize it but rather that you are interested in and
actually understand something of their cyberspace realities, they are much more
likely to help you help them.
Step Two: Be Yourself. Let Your Inner Selfie Shine
A skilled and competent therapist has many strategic
interventions up her or his sleeve. The responsible therapist is always
evolving as a professional, developing more skill and exploring further education;
their wisdom is always expanding. And it shows when the therapist continues to
evolve and grow personally. The self of the therapist shines.
Many leaders in psychology have written about the self of
therapist and attunement. As mentioned, I have been so fortunate to learn from
great presenters on the topic, including Dan Short, Dan Siegel, Martha Stark,
and my Ericksonian mentors, Jeff Zeig and Michael Yapko. The Ericksonian model
shows how the evolving self of the therapist joins the evolving professional
self with the evolving client in order to both be the best and encourage the
best. Whatever your own study and practice, you can integrate this approach to
be the best that you can be. In a million ways, this is your way of letting
your own Inner Selfie come through!
So keep learning about yourself and your own vulnerabilities,
strengths, and areas that can be enriched. Your degree of self-awareness is
integral to allowing a good therapy fit. In other words, if you are feeling
like a “deadbeat” therapist, doing the same thing over and over again in the
very same way every day, you need an Inner Selfie overhaul! Of course, I know,
this does not apply to you! But just in case you find yourself in a slump, be
responsible and find ways to “un-slump.” In his wise book, Oh, the Places
You’ll Go!, Dr. Seuss points out that,
“un-slumping yourself is not easily done” – and so we might need to do some
pruning and revamping.
You will always be checking your own reactions, responses and
any countertransference with your young clients. This clears the space for you
to work at your best.
We have to stay out of our own way. Me to me: “Her clothes are
so provocative.” Reframe: “Uh, lose your critical parent and admire her
sense of freedom.” Me to me: “I feel like a fool; I forgot to check in with him
about that big drama he was in last week, He’ll think I
don’t care.” Reframe: “You remember now, admit it and move
on, get over yourself.” Me to me: “I really want to do a trance with her about
that, but she has switched to a new issue that seems less pressing.” Reframe:
“Hmm, it’s not about what you were set on doing, it’s about her, so jump in and join her there.” And so it
goes with our continuous internal checks and balances – our own parts being
triggered here and there with the mission to heal ourselves and “do
no harm” – we provide the rich uncontaminated soil in which to germinate
a strong Inner Selfie!
You can tune in and attune with your clients only if you are
tuned in and attuned to yourself!
Step Three: Clear the Room of Your Agenda and Listen
Empathy is built upon listening and the taking in of the other
person in a deep and soulful way. You can put yourself in their shoes and
really “feel” what they are describing. If you have
cleared the room of your agenda and gotten out of your own way, you can be
present and listening with your “psychotherapy ear” to the ground. You are
authentic and your young clients will feel your sincerity.
Listening to a young client begins in the waiting room, with how
you interact and what you take in about the person. The SMA offers you another
“waiting room” for listening. Just as observing a client’s manner of dress,
demeanor, and presence before he or she settles in gives you some idea of his
or her way in the real world, the SMA provides glimpses into what and where
your client has been in their digital world. I read a book years ago on the
Aborigines in Australia who were so tuned in to members of their tribe that on
their walkabouts they could put their ear to the ground and “hear” complex and
multi-level messages through the vibrations from many miles away. Now that is
attunement. Our “ear” is multidimensional (including the digital one) and the
more we “listen” the more tuned in we will be. In the walkabout with our clients
we keep adjusting to whatever vibrations are signaled and shared with us.
Listening and staying with the client is a discipline. I
guarantee that when your clients have the deeply felt sense of you “seeing,
hearing, and getting” them, you will have already carved out with them an
important position of caring.
Step Four: The Therapeutic Toolkit
We have the skills and the knowledge. With hypnotherapy and
parts and ego-state work we can help guide our clients from the digital world
to being present IRL. We may pull in a variety of techniques or modalities
toward that end. I might use the Daily Mood Log from the cognitive behavioral
therapy of David Burns (1995) with a bright, anxious, “awfulizing” young client
who can’t talk her way out of the box she is in. I might
use it as a down-regulation tool that we later bring back in trance. Her
negative thoughts might be acted out against her more realistic thoughts to
deepen the experience. This will include somatic experiencing with her parts.
You get the picture – incorporation, tailoring, a weave of trusted skills.
By moving from one modality or technique to another with ease
and flexibility, you confidently stay with the complexity and uniqueness of
your clients. You plant the appropriate seeds, encourage them to take root, and
stay alert and mobile as defining moments of transformation take shape. You
tune into the winds of change, climate, or mood experienced by your clients and
chart the direction that you have set together with them. The clients define
the journey; you help them navigate it.
Your particular expertise and treatments of choice (for me,
Ericksonian hypnotherapy and parts and ego-state work) meted out in accord with
your clients’ receptivity enables the therapy to reach the mutually agreed-upon
destination.
What you use depends on what is in the room with your client. Your
therapeutic toolbox is organized and ready to be utilized to match with your clients’ offering for change.
Therapeutic App: To meet your digitized client in a
heartfelt way, you will dump the “it has to be done this way because it is the
way I work” and embrace “it will be done as you lead me because this is the way
I work.” To attune and tune in, you begin to listen immediately, in the waiting
room and with the SMA, as you quickly become fluent in the client’s language. Your
empathy toward your client increases as you clear the room of your own agenda
and get out of your own way. Your Inner Selfie is shining like the harvest moon
because you are taking care of yourself. This brings you and your client
together, connecting and authentic. You are attuned.
Spotlight on Online Identities and Ego States
Cyberspace Realities
Is there an interpreter in the house?
The answer is yes. Your clients are the interpreters of their
digital identity and digital ego states or parts. Unless they share with you,
you remain in the dark. The SMA contains the initial clues.
Do we need a translator?
The answer to this question is also yes. We need two
translators. Your clients will tell you what some of their digital identity
means to them and what parts of themselves they share online and with whom and
when and how. You will translate back to them what you hear and make sure it is
accurate. The next step is to translate what you have understood into real life
(IRL) treatment goals and strategic interventions.
You are moving back and forth between their online digital
profiles and experience and what they are living in their real life, as well as
their internal experience and states. If you are, say, over 30 years old, you
have a bigger task than in the old days. You are juggling and synthesizing
while you form interventions that you want to weave into a tapestry that
combines all three of these realities – cyberspace, IRL, and internal states.
Who is asking these questions?
The answer to this question is that both of you are asking the
questions. Your clients have implicit questions of you: “Do you really know
what my life is like? My digital life is just as or almost as important as the
rest of my life in many ways. Do you understand any aspect of my experience of
this part of me? Do you have any clue? Are you judging my online life because
you don’t understand it?”
You, the therapist, are asking clients to share this huge part
of their daily life, to teach you what you do not know in order to understand
them better. You are asking that they trust that together you will find the
way. By being alert to this part of their landscape, you offer the message: “I
know some of your language. Invite me in; I am so honored as you open up this
world of yours to me, and I am eager to learn.”
The universal language of online identities, profiles and
experience is that of understanding and acceptance. The different grammar, new
vocabulary, and unfamiliar “persons, places, and things” (media sites,
postings, games, research, etc.) will be interesting, fun, and, yes, sometimes
alarming – and all of it serves as information you may draw from to work with
the parts of this young and complex client coming to your office for help.
Online Identities and Ego States
You know from your own experience and life online that there are
many facets of you out there. There are parts of you that you have shared with
family, friends, colleagues, online communities, gaming sites, and many more. Your
family members get a side of you, your professional contacts another; your
friends know one side, and your clients another. Because it is a digital
galaxy, these facets multiply and overlap with time and exposure.
I have my competitive word game side (my mother was a Scrabble
devotee who taught her kids from early on to play it hard and well) that comes
out when I play with my son, my niece, my sister, and some friends. Then there
are many texts to husband, son, family, friends. There are the parts that I
share in different professional online classes. I use texting/email as
appointment reminders to some clients. When I am Skyping a friend in France,
another part emerges, as our friendship feels as easy as if we are still living
in the same town. There’s my six international/national
“Sorrento” group of good friends/colleagues, who frequently share both deeply
personal and professional journeys. These are just a few of my sides. I look up
things online out of curiosity and there are some places I would never bring up
in polite conversation. Is this my adolescent ego state still stretching a
boundary?
At this point in my life, I do feel that my internal ego states
are more congruent with ego states shared online. But I am still growing and
learning. Yes, you can teach an old dog new tricks!
But your adolescent/young adult clients are still forming and
developing their internal ego states, and many of their sides are occupying
digital time in their formation. Sometimes they are in harmony with internal
states but often they may be unaware of them; uneasy, dissonant, and
compartmentalized, or cut off from each other.
As your client practices and experiments online, you will find
out which “cyber-ego-states” (those sides being expressed online) are being
manifested. They can be active or passive. For example, Lindsay, a 25-year-old
client who struggled with compulsive overeating and body image, was able to
find a community online where she could share her shame and get support. This
was her cyber-ego-state being active. It helped her internal ego state IRL
begin to believe she would be able to like and accept her shape and size a bit
better. And there was the case of 15-year-old Maria who watched hours of
YouTube videos of TV shows that showcased unpopular girls who found acceptance
and triumphed. This triggered her ego state of feeling unattractive, yet she
could dream of acceptance and friends who would like her for who she is (her
cyber-ego-state). This was a passive cyber-ego-state because she was the
observer, not interacting firsthand. In both of these examples, the online
experience and profile helped to foster healthier ego-state development.
Adolescents, as well as many young adults, who mainly text –
perhaps with some FaceTime – their romantic or platonic relationships, do
experience positive feelings of closeness, which is part of practicing their
developmental tasks. However, online exposure within these relationships can
also bring out strong ego states of jealousy and possessiveness, and the acting
out of those feelings, both online and off, are all part of the maturation
process. Your understanding of how powerful these states are as they are
triggered and acted out online increases your ability to help your clients
understand what parts of them are being so activated and how other maturing
parts can assist with better coping and down-regulation skills.
In other ways, the developing client may find cyber-ego-states
that impede healthy development. As we know in our work with developing clients,
different parts can experiment and practice with varying degrees of
self-destructiveness at times. Early drug and alcohol use, sexual acting out
and a “f**k you” to societal norms are among potentially destructive forays. Or
there may be secret bingeing, or incidences of bullying or being bullied. Because
online practice and acting out are also part of the developmental process,
today we have to be as aware as possible of this in the digital life of our
young clients. Some of their biggest dramas are being played on the digital stage.
Often, the acts are short and short-lived, as the next act appears and quickly gets
their attention.
Remember fierce and lively 15-year-old Emma from earlier? By
gaining entry to her digital life via the SMA and integrating her online
persona in the therapy room, I could help her see that her cyber-ego-state of
being mean and angry and fighting aggressively online when she felt betrayed by
a friend was really a hurt part of her internal ego state, a still-active part
of her from when she had been bullied when she was younger. Finding her voice
online was exhilarating, but learning when to respond and when to shut up was a
maturational task of discernment I could help her with, encouraging her to take
that pause, to breathe, and to listen to another internal ego state, her
developing Inner Selfie.
Leaders in online addiction research and treatment, such as
Patrick Carnes, report a very high percentage of sexual behavior online
starting as early as middle school or even earlier. You may think this can’t be true, or that young people would never disclose it if it
were. Once you are able to enter their digital world within their comfort zone,
by asking the right questions from a nonjudgmental, non-threatening stance,
your young clients will be more willing to open doors to those cyber-ego-states
that are operating under the radar and may be risky. And, by “risky,”
I mean self-destructive and highly vulnerable.
I find that many teenagers will admit to sexting or going to
porn sites and often regret later that they acted on impulse. Denise, a
freshmen in high school, had sexted nude pictures to a boyfriend, a connection
that lasted less than a week. She knew he had sent them to his friends and she
felt terrible. Her impulsive cyber-ego-state now has a footprint in digital
eternity. In real life, without using smartphones that record sexual
experimentation, it stops there, still lingering in her memory as the years
progress. Today, with its eternal digital footprint, unless she hears that her
“here now and gone tomorrow” boyfriend has continued to send his friends “the
evidence” or it shows up later in her life, she feels she can move on – cyberspace’s special gift of nurturing amnesia, compartmentalization, and
dissociation.
As therapists, we must be aware that online and offline sexual
behavior and intimacies have become the norm for many young people. Because the
lines have blurred, it is important that you encourage your younger clients who
may be expressing sexual ego states online to understand the permanency of
sharing this decision. Many of my clients in their 20s report that this is part
of their serious relationships or that they play around on provocative sites as
part of their sexual activity. They tend to be quite comfortable with this. However,
there are exceptions. There was 28-year-old Lisa, for example, who became quite
worried when she and her partner of two years broke up and she realized that in
his vindictiveness he might share intimate pictures. There are laws being
written to make this a crime, but they will be difficult to enforce. The
cyber-ego-state that Lisa shared with her fiance matched her sexually maturing
internal ego state until the digital footprint she’d left
threatened it and activated a long-term ego state of shame from her childhood.
Integration of Cyber-Ego-States and Internal Ego States
Cyber-ego-states are here to stay, operating in sync with
internal ego states. This doesn’t mean they are in harmony
and congruent, or that your client has an awareness of them or has even
connected the dots. We now recognize them as vital parts of our clients and use
our work to flush out the ones that impede healthy ego development and support
those that are contributing to a new integrated whole. You can now discuss
these ego states with your clients and move back and forth between their online
and offline ego state parts as you work toward integration of self and building
healthy ego boundaries.
You are the master magician and you now juggle at least three
balls: the internal ego states of your clients, the real life (IRL) experiences
they have, and their practicing cyber-ego-states. Once you embrace these, you
will move among them easily as you strategize interventions and integration.
Therapeutic App: As you continue in your work with your adolescent/young
adult clients, using the universal language of acceptance and understanding,
you embrace their cyber-ego-states and interpret their digital language of
expression, both positive and negative, active and passive. This recognition of
and invitation to their online identities and experience allows the canvas of
their internal ego states and real life to be painted with all the colors and
depth that reflects who they are, how they are maturing, and how you can be
most effective in your work with them. Their Inner Selfie invites you to see
them in their entirety so that you can guide them to be the best that they can
be!
Destination Psychotherapy: A Future-Paced Syntonic Approach
I was half listening to the radio on my commute to the office
one morning when I heard a story about a “destination wedding” on some exotic
island. The invited guests were sent their save-the-date postcards with the
location, accommodations, and planned events. I imagined everyone trying to
figure how they would get there, what they would bring, and how much time off
they would need. They would be anticipating and visualizing what it would be
like when they arrived and what a great experience it would be.
As I thought about it, I realized that what I practice with my
clients is Destination Psychotherapy. Most of us, whether we are old-school or
new-school practitioners, work in a goal-oriented way. We look down the road
with our clients to a journey where change is made possible. We make strategic
decisions that map our therapeutic travels for experiential change, with
defining moments along the way. We use our therapeutic experience, training,
and orientations, but most of all we bring ourselves, our being, into this
space we share with our clients, who by sitting in our office, have invited us
in.
When we are attuned to our clients in the deepest most organic
way, we have really listened, paid attention, and resonated with their
experience. The foundation of therapeutic and transformational change is
empathy. When we feel “seen” or really paid attention to by another person, we
experience them as taking in our stories and confidences, as forming a felt
experience of who we are – and when this happens to us it feels good. Dan Siegel,
MD, proposes that this mindfulness “involves a form of internal attunement that
may harness the social circuits of mirroring and empathy to create a state of
neural integration and flexible self-regulation” (2007, p.132). Once again, the
hormone oxytocin that releases when two people are really connecting in
relationship adds to the receptivity for change. Empathy, with its qualities of
nonjudgment and acceptance, is the segue for you to begin your own Destination
Psychotherapy. This “orienting toward” your client begins to lower resistance
and defenses. Your empathy with them makes way for the “yes-set” (an openness
to change and positive suggestion).
The words, “destination psychotherapy” imply and create a
post-trance, post-therapeutic, post-hypnotic suggestion: How will it look when
you get there? How will you get there? How do you want your experience
(emotional, social, physical) to be when you arrive? How will it differ from
where you are right now? When you can “see” it, how does it feel in your body? All
that you know about your client – beginning the moment you meet him or her in
your waiting room, from their SMA, their online personas and experiences, their
internal ego states, their experiences, roles, and interaction in real life – allows
you to be fully attuned to that person and to tailor those therapeutic
destinations to meet their unique individual needs.
Intervention Apps: Tools of the Trade
To meet the pace and lifestyle of your adolescent and young
adult client, your therapeutic approaches must be multidimensional and
flexible. Think about it like the apps on the smartphone; apps we download tend
to have a purpose, and we use plenty of them. Your therapeutic intervention
apps will combine your training, experience, and approaches. Some of the
following intervention apps can be incorporated into your work with these
clients to help them make friends with their Inner Selfie and integrate their
digital and real-world selves. Whatever your comfort level and expertise, use
it as conceptual awareness and be open to using some of the following
techniques to help frame how you look at your clients’ cyber-presence
and cyber-ego-states alongside their real-life presence and internal states. Whether
you use direct or indirect trance in your work, these can facilitate the mutual
goals of building healthy ego strengths and boundaries.
The “intervention apps” I use all the time
and in a synergetic way are unique to my training, experience, ease – and are
rooted in who I am:
Hypnotherapy Lens App
Using this lens, I can observe, assess, and intervene in a
strategic way (thinking forward with a target) that ties it all together. I can
observe how the digital hypnotic phenomena experienced by my young clients can
be utilized by absorbing them in real time within their internal states, as
well as seeding what destination goals we are headed for with direct or
indirect inductions. With this lens we can prepare our clients for being in a “readiness
state” for experiential change. It helps me synthesize exploring their IRL parts,
internal ego states, and those parts being practiced in cyberspace.
I can think in terms of Dr. Zeig’s
structure (2006) of a strategic hypnotherapy intervention, for example. Stated
simply – setup: induction (direct or indirect, coordinate with the therapy to
follow, identify resistance, and elicit a related phenomenology and
relationship); ratification: (underlining the phenomena a client is
experiencing, i.e., increased circulation, lower heart beat); seeding the
target: (planting themes and associations that connect to intervention goals);
and tailoring: (making the therapy fit the client, not the client fit the
therapy). Then finally, intervene (the defining experiential moment, the shift
in experience, the meat of your goal); and follow through (post-hypnotic
suggestion, future-pacing, helping the goals stick).
The use of metaphors, stories, destabilization, and humor all
come from using this framework in my approach. The hypnotherapy lens is a big
app and I offer just a hint here. The thing I love about it is that I see
myself as an artist, using my own creativity and everything I have learned. I
stand on my mentors’ shoulders, gratefully, and stand with
my clients to offer what I know.
Discrimination Lens App
I look through the discrimination lens to ask: “Do clients lean
more toward internal or external locus of control? Are they global or specific
rigid? Are they future-paced or age regressed?” I use truisms, which connect to
the goal. I might use the story of 9/11 and the community of support and
rebuilding for an isolated client who needs to reach out as part of healing –
and build strong “yes-sets,” the Ericksonian assumption, “of course you can!”
that begins to initiate hope and receptivity. In my mind, Michael Yapko’s clear underscoring of the need to assess: HOW the client sees
the world; HOW do they manage what they manage? HOW are they looking for
change? HOW will they move from age regression to age progression? HOW will
that specifically look? HOW, HOW, and more HOW! HOW this has helped me over the
years!
Ego-State Therapy, Parts Work, Role-Playing App
The goal of ego-state work is integration, or “when the parts
are in communication with each other and are working together harmoniously and
cooperatively” (Frederick & Phillips, 2010). From this perspective, I can
appeal to my clients’ “multiple personalities” (online and off) – parts of
themselves that they can begin to grow their awareness of, and so develop an
“observer self” and move toward greater self-acceptance. The reparative work
that evolves from this view of ego states can heal conflicts among the parts,
while beginning to use those that are ego-strengthening to de-amplify those
that trample self-worth (a negative “inner voice,” for example, may reflect a
punitive parent), and work toward harmony and growth. I love how this
therapeutic app can legitimize the digital parts and cyber-ego-states of my clients
in a way that feels authentic for them, helping them learn and acknowledge
those parts of them IRL and their internal ego states. By both of us joining in
the viewing of this whole gestalt, each part can be identified and processed. The
ego-state and parts therapeutic app communicates and synergizes with the
hypnotherapy therapeutic app very effectively.
Role-playing these parts in the office with
“chairwork” (family sculpting, gestalt, and psychodrama methods) and
exchanging the posture, tone, and voice of any of the client’s
parts gives the experiential moment a gigantic boost. Since your client is
profiling, role-playing, and posturing online, bringing this into your office
in a felt way is freeing and significant for them. I can initially take on some
of their parts if they are unsure or inhibited, but they soon become the
sculptors of each of these parts; I am the clay, allowing them to mold this
part of themselves. We can go back and forth with this. I find they engage
deeply. Once they are playing one of their parts or ego states opposite
another, they are simultaneously observing and experiencing. I can then use a
very short “trancette” to help them land in their bodies
and explore this part from a kinesthetic place, something that may be new for
them. And it feels safe for them; it’s just a part of who
they are, but often has huge emotional impact, the genus for transformational
change.
When 27-year-old John, who is reserved and self-conscious, first
agreed to talk from his young adult self to his “phobic fear of driving more
than 10 miles from home part” (the “I don’t take risks”
ego state), he told me what to say, what intonation to have, and how to sit.
Soon he took one part and then the other too. He was surprised by the physical
and emotional intensity of the experience. In the next session, he reported
driving to a friend’s house, a good 100 miles away. His
young adult ego state had been able to reassure the panicked dependent younger
ego state. Although John had dated in his 20s, it became difficult as his
anxiety about driving was an obstacle, but now he could follow through with a
new energy and confidence.
Cognitive Behavioral App
Cognitive Behavioral Therapy (CBT) is known for its many
effective tools for changing distorted thoughts such as those related to
depression and anxiety. Having used The Therapist’s
Toolkit (Burns, 1995/97) and its updated versions for years after training in Burns’
workshops, I find that connecting thoughts to emotions to somatic experience is
often of great educational and concrete value for my younger clients. When they
read his list of distorted thoughts (i.e., all-or-nothing thinking, jumping to
conclusions, mind reading, emotional reasoning) and identify with them, a
lightbulb goes off and they realize that having the thought or feeling doesn’t make it real. For example, Burns’ Daily
Mood Log works with an upsetting event, moving from identifying the event with
negative thoughts and feelings, seeing how those thoughts fit with which
distorted thoughts, and then replacing them with more realistic responses. It
is a very effective anxiety-lowering technique, especially for a highly anxious,
obsessive client.
Eighteen-year-old Emily, a senior in high school, was
experiencing performance anxiety in combination with feeling she has let her
parents down in a competitive gymnastic tournament. She watched the stumble
over and over on her smartphone. The Daily Mood Log allowed her to step outside
herself as she labeled her distorted thoughts. Working through this exercise
helped her down-regulate, which we later used as a positive reference
experience with trancework.
Loretta LaRuche, a stress humorist on staff when I trained at
the Harvard Mind/Body Institute for Continuing Education some years ago, called
worry and anxiety “catastrophizing and awfulizing,” and encouraged us to
stop “shoulding” (the “shoulds”) and “musterbating” (the “musts”).
This way of labeling and identifying cognitive distortions has been highly
effective in my work with adolescents/young adults, again giving them access to
the “observer” self. Humor and laughter can grease the squeakiest, most jammed
up wheel so that things can begin to flow. And the unstuck wheel begins to roll
to places one may not have gotten to nearly as easily had it been left
unattended. Laughter is one way of being present, of letting go, and it is an
experiential basis for change.
Mindfulness/Relaxation Therapeutic App
There are many apps for smartphones that teach breathing
techniques, relaxation skills, and mindfulness exercises. Even better, learning
these skills in your office is personalized and tailored to the issues and
uniqueness of your young clients, within the context of relationship and
presence. You may have many ways to bring this to your clients, including
through guided imagery and silence, meditation exercises, and trancework. This
therapeutic app has effective practical value because clients can more easily
access and practice what they have done experientially in your office. These
tools overlap with our other therapeutic apps and exercises or homework that
create targeted change.
Other Therapeutic Apps in Your Repertoire
You have so many tidbits of wisdom and knowledge tucked away in
your lifetime of training and orientation to be the therapist you are today.
There are so many other concepts I have picked up over the years that add to my
therapeutic app screen or toolbox, and there are so many more to discover. Our
work with this fast-paced digital generation of adolescents and young adults
demands that we keep up, that we bring everything to the room. Yes, it takes
energy and commitment! But if we aren’t energized by our
work, the vital dynamic in the transformational relationship we have with
clients will become stale and uninspiring. If we view ourselves as therapy
“artists,” we remain open to constantly changing and evolving in what we bring
to bear and how we do what we do.
Therapeutic App: Integration of hypnotherapy (being
strategic and thinking forward with a target) and ego-state or parts work can
move seamlessly with your clients’ external IRL experiences, internal states,
and digital life. This is an approach that promotes an embodying experience in
therapy, which then has emotional impact that fosters real change. If there are
other approaches that you are more specifically trained in and comfortable
with, they can easily be added, mixed, and matched, as you help your clients
progress toward mastering their developmental tasks with an eye to all three of
their life spheres: online, offline, and evolving internal states. Most
importantly, what you bring to the table with your presence, empathy, and
attunement will allow the therapeutic apps you use to be accepted in the
trusting environment you have elicited with clients. You can have such a
positive influence in helping them live in the real world and supporting the
evolving Inner Selfie while helping them regulate, calibrate, and grow.
Finding Common Ground
Therapy Is Changing and So Are You
Do you remember the days when the digital world did not permeate
our lives and our smartphones were not with us 24/7? Or are you a younger
therapist who grew up navigating social media? If the latter, you have
travelled in this digitized galaxy most of your life. It’s
incredible – your skill, understanding, and participation in this world. Well, we
need to learn from each other.
Levels of self-disclosure, the dress code in session, the length
of the session, the frequency of sessions, what attention and interaction
mobile devices are given in the therapy room, how accessible we are to our
clients, new methods of treatment at the forefront of education – all of this
is part of the new age of therapy practice. Whether we have been doing it for
years or are just setting up our practice, we are working toward the health and
well-being of our clients.
In many ways, this changing therapy climate requires heightened
awareness and due diligence to adapt to new ways to integrate into our own work
and orientations. When I am at a conference or in a peer consultation, I love
hearing from the younger therapists. Their education and training is peppered
with research and methods currently at the forefront of the psychotherapy
field. And the truth is that embracing new practices and techniques is
essential for any age or level of therapist. One other important truth is that
a far less experienced therapist who is authentic, caring, a true listener, and
who brings his/her sincerity into the session can be just as connected and
effective as a seasoned therapist with years of training. It is that precious
relationship we share in the space with our clients that holds them with trust
and support to do the work they have come to do.
My challenge to both old and new school practitioners is to
cooperate and cross-pollinate in the effort to create a richer therapeutic
field that is both contemporary and grounded. Ericksonians are known for
welcoming the masters of all psychotherapy approaches and inviting a rich
sharing and learning. Old and new need to be interactive, not parallel. This
approach matches the way we desire to work together with our younger clients. What
we model outside of the therapy hour gets reflected in our work.
Synchronize
I read a wonderful article by Ofer Zur in the Psychotherapy
Networker (July/August 2012) about the subject of old school/new school
adjustments to cyberspace and changing therapeutic ethics in the digital age.
He called those who are growing up in this time “digital
natives” – the younger therapist and our adolescent and young adult clients. Besides
comfort and ease with texting, online chatting, Twitter, Instagram, YouTube,
online magazines, FaceTime, role-playing, blogs, Facebook, and the new apps and
sites that appear every few months, cyberspace natives are comfortable with
self-disclosure, short messages, and often feel “real” time is also online, and
tend to see confidentiality and dual/multiple relationships as the same thing.
Zur described those of us who didn’t enter
the digital age until later as falling into three categories: (1) enthusiastic
immigrants, who are technologically smart and adept to begin with, who took to
it like a bee to honey; (2) avoider immigrants, who continue to live as if they
never left the “old” country; and (3) reluctant immigrants, who adapt gradually
and maybe never totally feel like an assimilated native (pp. 26-32, 56). Although
I have entered the digital world by gradual osmosis, I still love email, phone
conversations, print books, and my privacy.
When I remember sharing one phone in my family growing up, with
little phone line privacy, it is my history. When I remember living in Central
America for a semester abroad in college, my boyfriend putting $25.00 worth of
quarters in a pay phone in the US, it is my history. When I remember, as a
graduate student and research assistant, the computer that filled up an entire building,
it is my history. I still like 60 Minutes and CNN, and I miss Newsweek. Today,
my cell phone follows me around the house, sits next to me in my office all
day, and I check it more than I want to admit. I’m old
school, part new world, and still adapting.
I’m thinking of one young therapist
colleague whose posts on LinkedIn and Facebook, not to mention her tweets, have
garnered her a sizable following. I am impressed. Her website has links and a
video of her talking about her therapy practice and approach. I can definitely
learn from this woman. I watch many old school therapists who have joined the
digital age as well, with great marketing, webtalks, and other global
networking tools. I am learning – more eager than proficient at this point!
Quality supervision from the experienced therapist and/or
mentoring to the less experienced or trained therapist is what makes our field
one that recognizes the exponential value of teaching, modeling, and
encouraging growth in resources and skills. In addition, we also need to engage
in the dialogue of an even playing field.
We want to be aware and diligent in both directions: not to be
so caught up in the bells and whistles of being digitally current that we lose
the thread of our focus. And not to ignore the digital world the young client
lives in and go about therapy as usual. We need to be committed to solid and
skilled therapy that sees the whole person as embracing both digital personas
and experience and internal states, and help the person move to real life in a
connected undissociated way.
Yes, the therapy room is qualitatively different from what it
was 20 years ago. The ethics of handling digital information and sharing, the
perspective we now hold that includes the digitized persona and experience of
both our clients and ourselves, the way it weaves into the administrative part
of our practice and other subtle contexts – these changes in circumstances have
changed us. But the therapeutic relationship, the real felt presence of each
other in an authentic trusting atmosphere, has remained and I hope will
continue to be the backbone of our work.
Therapeutic App: We must sort for both differences (learn
from each other) and similarities (mutual goals). Older and younger therapists
must sit down, catch up, and share. The field will benefit from attention to
both the roots of learned and intuitive wisdom and the fresh growth of current
efficacy-based research and new ideas. Your adolescent and young adult clients
will thrive under your guidance as their Inner Selfies are enriched by engaging
with the therapeutic community in its rich diversity and its shared values,
ethics, and goals of integrative health and wellness.
Finding Checks and Balances in a Digital Landscape that Doesn’t
Have Them
Cyberspace is a place we go willingly, quickly, and often. We
have a destination of some sort in mind, even if we are just scanning general
areas of interest. It doesn’t feel particularly risky or
dangerous most of the time. We just don’t think about it.
And yet, it is a lot like visiting a world in anarchy, since there are very few
laws or rules to govern.
In real life, if you were in a place where the cars had no
brakes, you would likely proceed slowly and figure out how to slow down by
downshifting or putting on the emergency brake or turning sharply in order to
stop. If there were no traffic rules, you would work out how to negotiate
changing lanes, how fast to go, and how to stay out of the way of oncoming
traffic. Your horn would be your best friend, and you would find a way to make
it from point A to point B, using caution and staying in touch with your GPS in
order not to get sidetracked and ending up somewhere other than where you
wanted to be.
Still, people tend to be curious. We will always venture out to
explore the new and unknown. We travel, seek new experiences, and we enjoy
gathering information and social connections. Cyberspace provides these
opportunities and more.
But how do young people figure out how to stay away from danger?
How do they know how to stop before it is too late, set limits for themselves,
and improve online decision making? How can they create healthy checks and
balances that make sense to them and still promote positive ego strengths that
can handle the emotional challenges of life?
Four Signs on the Digital Road that Point in the Right Direction
- Practice, practice,
practice.
- Location, location, location
- Time, time, time.
- Maturation, maturation,
maturation.
Practice
We have to give our clients due respect for managing cyberspace
as they develop skill, language, and sense of place there. We know that
adolescents and young adults practice their developmental tasks by trial and
error. This is no different in digital time. They come loaded with their own
personality structure, temperament, family values (structure and health),
social influence, and their entire “in real life” experience. Practice on the
digital court finds them making mistakes and learning from them (we hope);
sifting out what hasn’t worked; reforming and hammering it
out; and moving to more evolved responsible ego-syntonic digital behavior that
echoes their daily living. It requires practice, practice, practice.
Location
Where one goes in cyberspace is a free-for-all. Where clients
go, what kinds of sites they frequent, what happens there, and the pulse of
activity are as important as what they are practicing. With the SMA, you are
more informed about where clients are spending their time – positive, neutral,
or negative. In discussion, you get a sense about the pressure they feel on
various social media sites. You will begin to understand how they feel they are
being perceived, the “work” it takes to keep up their presence there, and how
they believe they will be treated if they withdraw for any amount of time.
When Sandi, a 20-year-old college student, reflects that she was
on “chat roulette” (showing her breasts to young servicemen she did not know)
when she was a sophomore in high school but is now troubled by some of her
earlier online and offline casual sexual behavior, I can help her work through
some residual shame. She now stays on certain social media sites and although
her digital friend number is high, pursuit of a high number is no longer her
focus. She no longer takes “selfies” daily or posts constantly. I can support
and applaud her intentional editing of digital destinations.
It is hoped that as our young clients mature, spinning the
roulette wheel and taking whatever road comes up is gradually replaced by a
more thoughtful process, one that is more selective and intentional.
Time
The checks and balances with regard to how much time is spent on
the internet are conspicuously absent too. Parents of young adolescents will
give time limits, but often don’t realize that teens find
ways to spend more time online anyway. Tracie, a 15-year-old client who
struggles with low self-esteem and poor grades, will often come to session
without her smartphone, having had it confiscated as a consequence of some
negative behavior, such as back-talking a teacher. She still finds electronic
access via computer, her mother’s iPad, or other ways. For
her, the cyberspace restriction accentuates her social isolation. She will
easily spend 6-8 hours online and she scans her smartphone constantly. But I
can see a stirring in her awareness of how the excessive time she spends there
is blocking her desire for real connection. I can encourage her to be more
present with one of her close friends as a start.
Cyberspace fatigue is often reported as the adolescents and
young adults with whom I work grow tired of spending so much of their time
online but aren’t sure how to better manage their time.
They often feel pressure to stay on to avoid rejection and do not feel
confident enough to try cutting down. Being able to modulate digital engagement
is a skill that will more easily emerge as internal states develop. You can
help clients install those digital brakes as you guide them to their Inner
Selfie.
Maturation
Digital use and presence changes as the adolescent and young
adult matures. If young people can get the support and attention they need as
they proceed through these practice years, they will be many steps ahead of
those who are going down digital roads without any sense of direction, who may
lack guidance in mapping their routes and cyber identities. The ageless
existential questions of “who am I and where am I going?” mark the journey of
the maturational process. Cyberspace experience can provide both the
fragmentation and the integration of their identity formation.
On observing that she is posting selfies, editing blogs, and
increasing her twitter following on multiple sites, I figure out with
17-year-old Stacy, who is bright, intelligent, and hyperactive, that she has at
least 20 cyberspace identities or presences, not to mention her presentation at
school, at home, and in sports. We can look at what each of these means to her,
as well as what emotional or cognitive states are expressed by them and how her
online/offline life may conflict or synchronize. Stacy is already discussing
cyberspace activities/personas she has discarded, what she has held on to, and
what she is developing. Even she seems somewhat amazed by the multiplicity of
her parts or ego states. Her awareness of how these digital states are a real
part of her is growing. I can help her sort this out as she works toward a
stable sense of self.
Maturation then moves forward as a natural process. If your
young clients get stuck or thwarted along their path, your understanding of
their digital engagement can help smooth bumps and signal dead ends or
stumbling blocks on the cyberspace journey that is running parallel to their real
life and internal states.
Using the Hypnotherapy Lens toward a Growing Sense of Self
We have looked at the digital landscape where little exists that
governs time and location. Meanwhile, our clients are spreading their
developmental wings. Again, there is little censorship and there are no rules
of engagement, conflict resolution, or tests of authenticity.
Pointing the hypnotherapy lens at this digital world provides
therapeutic photographs and videos that sharpen our focus as to how we assess
and evaluate, seed and tailor with each individual young client. This view
helps us plan our inductions, interventions, and follow-through for treatment,
as we invite the client’s dissociated digital parts or ego
states into the body and felt presence. We can use this lens to help clients
down-regulate or experience an elicited internal state that is heartfelt and
authentic, as well as to integrate digital parts with the real self. Thus, we
encourage the strengthening of internal checks and balances, which translate
into online brakes and speed limits that foster digital responsibility and
accountability for healthy ego development.
Therapeutic App: There are few parameters in the digital
landscape. And it is in this digital wilderness that younger clients practice
and mature, where preference, performance, and persona of pattern and change
are now almost completely filtered through an encompassing digital experience. Some
young people proceed to develop a healthy balance between cyberspace and real
time. Others lose their way, end up on self-destructive paths, and find
themselves struggling with increasing despair and loss of self. Those who sit
in your office seeking guidance will benefit from your tuned-in hypnotherapy
lens that melds their online and offline worlds with a creative experiential
integration of all parts or ego states that they share.
Life as a Reality Show: The Paradox of Global Privacy and Secrecy
Facebook may have been there first, but many young people have
moved on to other social media sites. This information comes out in the SMA
and, of course, from discussions in my office. And there will be new sites and
lingo and behaviors that add to the ways and ease of sharing one’s
life online so that today’s latest thing will already be
vintage tomorrow. The SMA helps keeps us up to date! Most of us, and for sure,
our young clients, will also absorb, adapt, and embrace the next advancements
in technology and online novelty immediately and without hesitation.
Is Anything Private or Sacred Anymore?
This digital “global village” creates a generalized
consciousness (Carnes, 2001) in its world wide web of sharing of what used to
be considered private. Your client wanders through this village and decides
where to share what and with whom. What they reveal about themselves makes many
of us older folks squirm uncomfortably and question their sense of privacy. Younger
therapists may raise an eyebrow, but accept it as the way it is now.
When 25-year-old Amanda moves home after college and graduate
school, her social life consists of posting and selfies, bar hopping with a
large group of college/high school friends, and trying hard to find a
relationship with someone who likes her for who she is. With a fragile ego
state and in a job requiring only a high school diploma, her sense of
self-value and her decision-making are very dependent on the advice of her
40-plus “friends.” She confides in one of them about her lack of sexual
experience and within a nanosecond the entire group is weighing in with words
of young wisdom, suggestions, and graphic encouragement. She is only slightly
embarrassed. Of course, none of this gets discussed at happy hour, when she
actually sees them.
One’s best self – from physical appearance
to how one wants to be thought of – takes practice but is generally not
difficult to achieve. Young people create their selfie, profile, and identity
through the process of posing, writing, editing, and remixing until it
accomplishes what they want in that moment. Often, there is some amount of
misrepresentation of self with “real” parts, which then elicits responses from
others who are doing the same thing. I suggest that these contrived personas
are actually parts of our client’s online ego states. It
is who they want to be. It can be seen as an aspect of their experimentation in
mastering the developmental tasks. But although the “selfie,” for example, can
be fun and provide simple documentation of life, many young clients use their
social media sites to show themselves in an over-the-top starring role, more
confident, experienced, and, often, less naive than they actually are.
Social technology promises friendships of a kind, but has
difficulty delivering the real thing. Its focus is really on performance; it’s in the business of manufacturing “friends.” The more
“friends” one has online the higher one’s perceived social
status (Turkle, 2011). Turkle quotes a study of 14,000 college students that
saw a dramatic decline in empathy and interest in others (2011). With the
constant focus on self and self-promotion, this is not a surprise. Part of our
therapeutic resolve is to help young people transition to real time and develop
an authentic relationship with themselves and with others.
Pressure with regard to one’s response time
on social media sites and how often one is posting can be high. Keeping it
current assures continued online cyber relationships. Many report strong
feelings of rejection when they are not responded to quickly or are ignored,
chastised, or “unfriended” when they disappear for too long. Every mistake or
false step leaves a cyber footprint and threads that can expose people at any
time in the future. Deleting the photo or piece of writing doesn’t
mean it no longer exists; it is still out there somewhere, even if just in the
hands of viewers who choose not to get rid of it.
Tikki, a 14-year-old client who sent out her deepest secrets to
one of her Twitter posts with a following of more than 2,000, decided to delete
it after just 20 minutes. She knows her mother still has access to that site
and doesn’t want her to freak out if she reads it. What
she cannot ascertain is how many of her followers will keep it.
The New Wailing Wall: The Online Confessional
Cyberpresence is, in part, a reality show, revealing the
deepest, most personal and confidential information to the listening digital
ear and prying digital eye. It used to be that friends, family, church,
teachers, or mentors were our confidantes. Now, disclosure takes place with
whomever is on the virtual site, where an unknown someone substitutes for the
IRL friend or other trustworthy person. Opinions from online friends and
anonymous responses can swing from kind encouragement to cruel and ugly tear-downs.
Venting is considered by some as the new online sharing. With the maturing and
ego-fragile young client, positive support can go far, but negative responses
can create more self-loathing and can lead to dangerous self-destructive
behavior. You can be as nasty or as pleasant as you want to be. You have
permission to say anything. And saying anything is exactly what many young
people are doing.
No-holds-barred fights with friends or strangers in the “safety”
of online space can be a projection of what our clients don’t
like in themselves and be a short-term fix (Turkle, 2011). Or they may offer
pearls of wisdom and positive affirmation that someone on the other end finds
inspirational. It is a throw of the dice. Whether one is being dissed roundly
or strongly supported, cyberpresence is a land full of intense reaction in the
moment of delivery and receipt that then can be dismissed quickly and easily – if
one is confident and in a good place. When it comes to that young person who is
depressed or anxious, and is vulnerable to negative suggestion and who believes
what is being said, the negative, sometimes vicious, feedback reinforces their
despair and self-loathing. We are all too aware of stories of suicide,
self-injury, or of harm being done to others that are the result of
cyberbullying and other negative online experiences. If the young person is
also experiencing this IRL, it can form a fatal perfect storm.
Two quick examples:
Ana, an 18-year-old bulimic, was encouraged
online to keep bingeing and throwing up, with suggestions on how to do it more
effectively. She reluctantly agreed to stay only on positive sites for eating
disorders, but this took some time, as her internal ego strengths and healthier
behaviors needed time to grow.
Jen, a 28-year-old woman with depressive symptoms and suicidal
feelings, would enter negative chat rooms to inflate her self-hatred. She
admitted to me that they suggested easy ways to “do it”
and she had begun to collect her “supplies.” Intervention central! Evaluation
for inpatient treatment immediately. Luckily, after she was stabilized, and
because we had a history of openness and conversation about these risky social
media sites, she could include in her contract for safety an agreement to stay
out of those rooms completely, and to build a network of sites that were
helpful and encouraging.
On the more positive side, I have many clients who have shared
uplifting texting and messages from social media sites they receive after they
fully disclose their own upsets and negative feelings. Or they tell me what
they say to the down and forlorn who share with them, nuggets so loving,
positive, and wise, they sound like shrinks in the making. I am often blown
away by their understanding and sincerity.
Texting as the Primary Mode of Communication
Who makes phone calls these days? Or even listens to messages?
Texting lets us decide when to respond, and to whom, and how. It is a quick and
effective way to communicate anything, from schedules and meeting times, to
check-ins among family and friends. Able to be carried out at almost any time
in any setting, texting is convenient beyond description, and few of us would
vote to get rid of it. We can worry less about our children and loved ones on a
certain level, and are able to keep in touch across the globe. It has become
the primary mode of communication.
Of course, every manner of message is transmitted in a matter of
seconds: arguments, sexting, love talk, flirting, breaking up, breaking news,
alerts and alarms, and the whole range of human communication. While focused on
the text, we are dissociated from being fully present IRL because we are
cyberpresent. We can use texts as “stand-ins” to write a better apology to
someone, finalize a “break-up,” and even flirt for us more effectively. Any of
these interactions face-to-face requires effort; we can be more distanced from
our feelings using stand-ins. We want to believe this is all sincere, but how
can we really know? People may fake their feelings or posture, or they may
sincerely mean what they are texting. It’s even tough to
discern the sincerity of our own communications when time and feelings are so
fleeting.
And remember, the dinging of our smartphones, with that little
hit of dopamine each time we hear a text come in, increases our interest and
compulsion to use texting; it’s more immediately compelling, perhaps, than
picking up the phone or planning to meet in person.
Texting is convenient and effective. To our young client, it
represents all of the above. But “cybertrust” is cheap,
leaving a lot to the imagination, and there are no guarantees. When l6-year-old
Amanda texts a friend her recent horrible experience of being drunk at a party
where she heard she was videoed naked, the friend had already seen the video
because it had been sent to her by another so-called “concerned friend.” She
berated Amanda (although she had been drunk at the same party) and forwarded
her admonishing rants with Amanda’s confidential text to a
large group of high school peers. The betrayal felt overwhelming, but also
important, as Amanda began to examine who her “real” friends were.
Dissociation when absorbed online seems to protect people
against the fallout of using online behaviors as a reality show, at least in
the moment. Many of the adolescents and young adults I talk with just shove
things that they have said or done in cyberspace – things that shame or
embarrass them, things they wish they hadn’t shared – out
the memory window and into a faraway place they just don’t
visit. Since feelings can then be kept at a distance, dissociation and
compartmentalization have become staple mechanisms for surviving digital life.
Three Ways to Help Your Clients Manage Online Reality
- Ask them to take that pause to breathe, think, and
verbalize how they decide what they share in cyberspace.
- Have them consider what filters or privacy walls they
use. This includes checking whether they filter people they know in real life
from those they don’t know. If they use “cyber
friends” only, remind them that even though it feels private and safe
from those they do know, it remains forever online … always, somewhere. Awareness
of how they filter and share begins to build internal states of healthy
boundary-setting.
- Encourage them (after exploring what sites they go to
when upset) to put an internal block on negative and harmful sites that make
them feel worse about themselves. This can start with an external block;
however, working with them on the pause to take another direction toward a more
positive online experience – whether it is a place they can get more positive
feedback or even changing course with a distraction – can be reinforced with an
anchor (i.e., a trance or a visualization). Check in regularly to monitor their
success with this. Support them reaching out to other adults for help with the
goal of finding good detours away from unsupportive, stressful, or harmful
sites.
Therapeutic App: You and your client share in the
experience of the digital reality show through the ever-growing cyberspace
footprint that is online forever. The sharing and exposure there by your client
is extensive, from harmless minutia to risky, extremely private and personal
data that often includes the person’s innermost thoughts,
fantasies, and longings. When online, cyberpresence, cybersincerity, and
cybertrust can range from total honesty to embellishment, fabrication, and
misrepresentation (each one of these in varying degrees). With texting as the
primary choice of communication, and “selfies” as the trending self-promotion,
your clients need encouragement for self-regulation online, using healthy
filters and coming into themselves in real time for essential practice and
growing comfort with their Inner Selfie.
Discerning Healthy, Compulsive, and Addictive Use
As you assess your client’s use of and
relationship to their smartphone, mobile devices, and computers, remember to
assess your own! The Seven Stages of Smartphone Attachment outlined in the
discussion of “the phantom appendage” will help you determine where you are and
where your client is. Your evaluation of your client’s use
takes into account the information from the SMA and from your observation of
his or her computer use, as well as what the client discloses in discussion
about the use of all devices, including gaming.
Healthy Use
What constitutes healthy use? It is not a precise science with
clear guidelines; it is more about developing an awareness of how dependent
people are on their devices. Healthy use may allow for continuous connection or
proximity to the device, but only for a limited time actually spent on it. Part
of healthy use includes periodic times of being unplugged and the intentional
decision to disengage sometimes. Since we know that most of us – and especially
young clients who have grown up using technology – are connected many hours a
day, healthy use might be defined in terms of time spent there not taking the
place of time spent here.
Does digital engagement perpetuate the client’s
avoidance of IRL interactions? The IRL sphere includes relationship across
multiple dimensions: interaction among IRL friends, school work and study,
physical movement and activity, responsibilities at home, job commitments,
in-person conversation and meals shared, along with rich moments of solitude. Healthy
use means the important successful practice and experimentation of
developmental tasks IRL, not only online.
If Amy, 19 years old and going into her sophomore year of
college, runs 3-4 miles a day and belongs to a recreational volleyball team;
and if she tells you about a healthy open relationship with her parents,
hanging out with her boyfriend and good friends, sometimes opting to avoid
texting when together; and that she keeps an old-fashioned journal on paper;
you might surmise she is engaged in healthy cyberspace use. Although her
smartphone sits next to her in session, she checks it rarely. As a therapist,
you will keep tabs on any changes in use during the course of treatment, but
for now, this client’s use appears pretty healthy.
Determining healthy use also encompasses what is done online,
the kind of interactions that take place there, and how one feels about the
experience when cyberpresent. If clients seem satisfied with the threads of
their travels with both those they know IRL and those cyber-only connections,
with low conflict, and you don’t hear the clanging of
guilt or shame, you might conclude that they practice fairly healthy
engagement. But be vigilant. Some behaviors remain hidden or are withheld for a
period, but as the trust between you and your client builds, perhaps these too
will be shared.
Healthy use can cross the border into excessive use for any of
us. We can creep across that line at any time as usage is so normalized that we
have a hard time tracking what is okay and what is too much. We must pay
attention. As I keep going to the cupboard to break off a morsel of dark
chocolate, an automaticity sets in where I lose track over time of how often I
have returned there. It shows up later in weight gain or blood sugar level. Long-term
overuse of our electronic devices also has side effects that compromise
physical and mental health. It can be slow and subtle. You may be vaguely aware
of backaches or fatigue and irritability. You may plan to get up and move but
you have just one more thing you want to do. You wake up one day and there it
is, the bundle of symptoms that range from muscular tension to mood changes. As
online hypnotic phenomena have been noted earlier in this course, there are
clear examples of when compulsive or addictive digital time promotes
dissociation, time distortion, catalepsy, and more!
Compulsive/Addictive Use: Electronic Crack
Okay, if you and your client can straddle healthy use in every
area except time spent online, then you have a comorbid (mixed and complex) diagnosis.
Excessive time puts both of you on the compulsive continuum. Perhaps you are on
the milder axis side but you’re there.
Compulsive use is a gateway to more addictive use. Make no
mistake, cyberspace is highly addictive. Remember the short-term rewards of
having a squirt of dopamine released every time we a get a response (ding),
which charges the compulsion engine, just like a gambler experiences every time
a new card hits the table. And when this compulsion engine morphs into
addictive behaviors and symptoms, one can lose the ability to regulate
boundaries. Even those who have no history of other compulsive or addictive
behavior can develop this behavior online (Carnes, 2001).
The compulsive urge to respond to the ding (the knock, the
chime, or trumpet) can land us in unsafe behavior. Think about it: in most
states texting while driving is against the law because so many more accidents
occur when a driver is distracted; still, many people continue to do it because
they want to respond immediately and not miss out on anything.
Other normal adolescent and young adult practices and
experimentation online, such as exploring various sexual sites, role-playing
games, political forums, or looking for the novel and “forbidden,”
can lead to increasing compulsivity that demands more time and more dramatic
behaviors, which then become “normalized,” and, of course, then lead to more. All
the while, symptoms of anxiety, physical complaints, depression, irritability,
and avoidance of IRL increase.
Although it is not listed in the current American Psychiatric
Association’s DSM-5-TR (2022) there was a lot of discussion
about adding an internet addiction disorder before it went to press (Internet
Gaming Disorder is listed in Section 3 as needing further research to warrant
it as a diagnosis in the future). You can find many references online, though,
to Internet Addiction Disorder (IAD), so a lot of folks believe it exists. It
can be seen as being similar to other addictions and behavior, causing (among
other things):
- Cycles of mania followed by depressive
stretches
- Lack of sleep, exercise, face-to-face
time due to the amount of time spent online
We’ve heard of “phantom
vibration syndrome” (thinking our cell phone is vibrating when it isn’t). Symptoms of overuse have been dubbed “Facebook
depression” and “cyberspace fatigue.” With teens
averaging over 3,700 texts a month, and over 38 hours a week “plugged in,” it’s easy to lose perspective on how common compulsive cyberspace
behaviors have become. In studies of those under 50, it has been found that
checking social media sites or emails every 15 minutes is common. The more time
spent online, the more compulsive personality traits. Many people check their
mobile devices before bedtime, during the night, and before getting out of bed
(Rosen, 2012).
The brain of a cyberspace addict looks a lot like the brain of a
drug abuser/alcoholic (Hao, et al., 2012). This is the opposite of what the
brain looks like when people are engaged in relaxation practices, meditation,
silence, or trancework. If abnormalities from overuse show up in areas of the
brain that regulate attention, control, and executive function, then this is
also interfering with the normal growth and development of those still-forming
areas in the adolescent and young adult.
Patrick Carnes, a leading researcher and educator on online
sexual and addictive behaviors, describes such compulsive behavior as “the loss
of being able to choose to stop or continue a behavior” (p.25, 2001). According
to Carnes, this inability to create such boundaries may manifest as:
- rituals and obsessions, particularly in
cyberspace;
- continuing behavior despite negative
consequences;
- a cycle of frustration, self-blame,
powerlessness, and hopelessness, and increases in anxiety and irritability; and
- increased time online and surfing
(i.e., chat rooms that develop powerful pseudo intimacies).
Many of us note that today’s youth culture is open to almost
anything sexual online; it is “cool” to be so accepting. I attended a
lecture a few years ago in which Patrick Carnes noted that 34% of middle school
students were involved in some kind of sexual behavior while doing homework. And
when addictions begin between the ages of 11 to 16, high-risk behaviors often
continue into adulthood.
And, again, we know what makes compulsive use so compelling. Everything.
Contact is only a click away, the user can be anonymous, connection is
affordable, little effort is required, it’s easier to
cross lines that are not easily crossed IRL, and consequences seem unreal.
Everything is available, or so it seems.
Your client, who is practicing, experimenting and mastering
developmental skills in “privacy” from IRL, is running with the wolves. With no
limits on use, it is no wonder that compulsive behaviors are also unlimited. Since
there are hardly any rules, it feels as though no rules are being broken. And
that dopamine rush …
Shame
The positive side of being de-marginalized in cyberspace cannot
be stressed enough. If young clients have obsessions, desires, or fantasies,
their feelings of shame can be reduced and more positive feelings developed
when they know they are not alone. One client, a college student, found a site
that matched a particular fetish she had. She developed a relationship with
someone there and the real time spent with him grew into a positive friendship.
This “normalizing” of their developing identities can be either a positive or
negative consequence. It is important to keep vigilant about the degree of
compulsivity of the behaviors and to track whether the experiences are
detrimental or lead clients to a better sense of themselves.
Shame can often develop from digital behaviors and activities. The
“secrecy” or sense of risk-taking may heighten the
arousal template and be a signal that a boundary for our client has been
crossed. This arousal template begins when one is very young, and is influenced
by thoughts, smells, sights, fantasies, images, sounds, and objects. It also
includes physiology, biology, genetic factors, culture, religious and ethnic
background, family history, experiences of physical, emotional or sexual abuse
or exploitation, if any; and general life experiences and sexual history
(Carnes, p. 84-89, 2001).
The more one is absorbed online, the more dissociated one is,
which can make cyberspace-based shame behaviors and experiences feel detached
and easily dismissed. Jamie, age 16, may respond to any attention from young
men who sext with her. She can’t stop herself because as
bad as she feels right now about her body, the attention is a temporary balm. Doria,
age 14, feels like she is always being left out at school by peers; online she
lets her anger out uncensored and claims it doesn’t bother
her a bit. It gives her a sense of control as compared to her shyness at
school. David, a senior in high school, poses as girls he knows his friends
have crushes on. He sees the upset and drama at school that result from his
anonymous faking it, but he feels vindicated because he has been rejected by
many of the girls he has approached. As a consequence of these and other
problematic encounters, our clients may describe high generalized anxiety that
they can’t place. It is helpful to keep exploring their
online personas and cyber-ego-states. When brought into the therapy hour
without judgment and with support, a young client may experience a flood of
emotions that can begin to move toward an awareness that the behavior is just a
part of who they are (ego state) and work toward acceptance with a resolve to
establish a healthier online presence.
Jenni, a bright articulate 19-year-old client, frequently visits
certain social media sites when feeling blue and down on herself. The posts are
sadistic and nasty and take her to a familiar place of shame. Her father
emotionally and verbally abused her when she was growing up. He verbally shamed
her when he found her touching herself once as a young child, an event she
still feels traumatized by. She can barely speak through her tears when she
admits a big secret, that when she is being put down by posts on this site, she
feels sexually aroused, which adds to her feelings of self-loathing. As she
realizes how her cyber-ego-states on these sites of anger and hostility feed
into her confusion about her sexual identity and self-worth, she begins to move
toward reparative work in our sessions. She hears that I am acknowledging her
experiences without judgment, and she says that I understand. By looking at
both her online and internal ego states, plus utilizing trancework for building
her ego strengths and diminishing the trauma, she has come close to being able
to stop her travel to those sites. She has had a couple of slip-ups, but they
are few and far between.
Blurring of Digital Life with IRL and Extreme Use
With extreme use, and choosing digital interactions over those
IRL, boundaries can become blurred. Believing that a digital relationship is
authentic and real is ultimately a huge letdown once it is discovered just how
contrived the relationship may be. One of my clients, 15-year-old Tamara, who
spends excessive time on many sites, was told after she and a “boyfriend” broke up, that all the texting conversations
they had had were actually sent by a couple of his friends to see if she would
bite. And most of us have heard of LeBron Williams from Notre Dame, up for the
Heisman trophy, who made headlines a couple of years ago when his fiancee, whom
he had met and connected with online, turned out to be a fraud. Unbeknownst to
Williams, he had fallen in love with a man and his accomplice who were posing
as a young woman.
When a young client tells you he or she would rather be online
than off, this can be another sign that compulsive use has trumped fully living
IRL. There are so many examples of extreme use. An article in Newsweek (2012),
just before it went out of print, described some extreme international use of
the internet … a young couple whose baby died of neglect while they cared for
an online baby … a reported case of a young man who bludgeoned his mother to
death and then used her credit card to purchase more hours online. There are
reports of users dying from blood clots from sitting too long while using the
web. Although sensational and extreme, such stories speak loudly to a global
need for balance and internal regulation.
Therapeutic App: You can join your client in assessing
where they are on the continuum from healthy use (the ability to go on and off
digital time with intentional awareness) to more compulsive behaviors that can
easily morph into online addictive behaviors and symptoms. With the SMA and the
Seven Stages of Smartphone Attachment, you have a place to start that will open
doors for helping those who are using cyberspace in a compulsive or addictive
way. Your acceptance and nonjudgment of your clients’ activities
and experiences will add to the total picture you will use as you bring them,
once again, into the space of being present IRL, building internal awareness,
and finding their Inner Selfie. As you guide them in self-regulation skills and
relationship-building with others and themselves, you can appreciate the value
of including the digital experience of your client as essential for
comprehensive and deep emotional impact that is relevant to their world.
The Inner Selfie Technique: An Instant-Access, Mobile Device Support System
I encourage everyone to incorporate this technique into therapy
practice with adolescent and young adult clients. It integrates the hypnotherapy
lens and the ego state and “parts” work. This approach acknowledges digital
personas and behaviors, IRL experiences and personas, as well as clients’ developing ego states. Using their smartphone or mobile
device, clients create an instant-access video that reflects the part of them –
the Inner Selfie – that can encourage them when there is self-doubt or they
need a boost to remind them of their strengths.
Many of us record trancework, homework assignments, and
meditations on our clients’ smartphones already. Erickson’s poetic image, “My voice will go with you,” has become today’s literal message. The recordings can be very powerful and
useful in times of trouble.
In my work, I wanted to find new ways to bridge clients IRL and cyberpresence. I began to think about the ubiquity of
the selfie. Young people, especially, spend many hours creating and editing
pictures of themselves, the external picture carefully crafted for the digital
world. How these pictures are rated by others can affect their view of
themselves – what others think is central to young people. Cyberpresence is the
manifestation of the imaginary audience (Ryan & Kuczkowski, 1994), what has
been considered the egocentric belief of adolescents that they are constantly
being scrutinized, judged, and evaluated by others. This audience, in fact not
imaginary anymore, lurks in clients’ imaginations and
cyber-realities well into their 20s. With maturation, most clients become more
realistic about the importance of other people’s perceptions
or supposed perceptions. While the shift in understanding does not mean that
people are necessarily less likely to react to positive or negative feedback,
but the feelings may be less intense and easier to let go of than in a younger
adolescent.
The Inner Selfie takes an already-familiar idea to the young
person – how their selfies are received by others (external locus of control) –
and expands upon it to acknowledge an inner voice of positive, supportive
self-regard. The Inner Selfie enlists the developing ego strengths (internal
locus of control) that are being encouraged in the therapeutic work being done
with them. It seems like a good bet that watching themselves would be much more
appealing to them than listening to “trancettes” made by
me. In a paradoxical way, this method of watching themselves actually invites
less egocentricity due to the messages coming from deep within rather than from
more superficial sources.
My clients report using the Inner Selfie videotape regularly
when they need encouragement because their insecurity is high or their
self-esteem is low and they feel vulnerable. Sometimes the negative self-talk
just won’t quiet down. It is important to glean from your
discussions the origins of their self-doubts. Do they come from social media
shunning that accentuates an already low self-image? Do they come from IRL
influences of friends, family, or others? Are they self-inflicted or are they
the consequence of a combination of factors?
Here’s how it works:
Prep Work
The therapy with your clients so far has enabled them
to become aware of their different “parts” or ego states online and off. They
have experienced both down-regulation and defining moments in therapy, perhaps
with direct or indirect trancework, where they have been able to adjust,
change, or move toward greater self-worth and resiliency. They are comfortable
sharing online and offline realities as they know you “see” them fully,
starting from the SMA and your understanding of both worlds. They are aware of
“parts” of them that get in their way and stop them in their tracks or sabotage
their movement forward.
Creating the Inner Selfie
Now you and your client are ready to
access a new or developing resource that is reliable and flexible. They will
come on board as you discuss the value in filming (capturing and preserving)
the stronger more confident part of them. You will discuss what they might be
struggling with and then invite them to video a way to remind themselves of the
ego strengths that can overcome shakier insecure or self-destructive aspects of
them.
First, ask them to remember what they will tell themselves when,
for example, a part of them that is feeling insecure has surfaced in an intense
way. You can rehearse this with them before recording. Then, press the video
button on their phone and begin.
You are the coach, so guide them along as you are videotaping
and remind them of those stronger internal parts they have been working on. These
videos are short, from one to several minutes. You will look at the video
together, and redo it if they think it necessary. In general, clients are
pleased or appear to feel more peaceful and more confident when they see it.
You will want to check in with them about what they are feeling. I generally ask
clients to go into their body for a few minutes and get in touch with how
seeing themselves support their inner strengths feels. This will anchor an
internal awareness of inner strengths that will fire up when they watch the
video at other times.
Encourage them to watch the Inner Selfie that has been taped
when difficult feelings arise so that they can be reminded of their greater ego
strength and how far they have come at the press of a button.
Always follow up and encourage the use of the Inner Selfie in
future sessions. Make new ones in the course of your treatment. The evolving
Inner Selfie is a good image for them as they grow and change. If the client is
near the end of the therapy, you can support the use of the Inner Selfie
recording when self-doubt and low resolve creep up later on.
Two Quick Examples:
When Suzanna, in her mid-20s, decided to stop using drugs and
alcohol, being with guys who were just using her, and jumping from one low
level job to another, it was her self-loathing and addictive sides that often
reared up. She had been in and out of hospitals and rehab centers since high
school. She had little ability to focus inward and her impulsivity led her down
many dark destructive streets. After a few months of sobriety and committing to
attending AA and church programs, she was able to use the Inner Selfie
technique when her urges were strong. It helped her choose another direction
rather than going to the downtown area where engaging in self-destructive
behavior was a high probability. We made several Inner Selfies that
corresponded to where she was in her progress. Her chronic lack of object
constancy was counterbalanced when she remembered to use this technique.
Tim, a young man now in his early 20s, whom I had seen when he
was in high school, returned to therapy for direction and confidence-building. His
parents, who were divorced, both had drug or alcohol issues and had been unable
to give Tim much guidance for managing life. He used the Inner Selfie technique
to stop comparing himself to others. He talked about his ability to figure
things out on his own, like graduating from high school, holding a job, and
knowing he could manage college once he decided what he wanted to pursue. He
felt more confident to go at his own pace and in his own time.
The Inner Selfie Technique Synthesizes Hypnotic Phenomena with
Building Healthier Ego States
When your clients watch their Inner Selfie videos, they are in a
self-trance which is down-regulating and activates changes in mood and brain
activity. Thus, they are dissociated in a way that brings them into the body
and yet they are absorbed by watching the video. A simultaneous double
entendre: a felt emotional presence with their inner ego strength alongside
their external focus on the video where they watch themselves send what is
positive, good, and strong back to them. This “feel-good”
message resonates deeply and underlines their gifts of inner strength and inner
wisdom. The video provides encouragement to actually believe in these attributes
with the same instant access they have on social media sites; clients are
enabled to begin to self-mentor. This technique is both post-hypnotic and
future-paced by anchoring belief in self and ego states that are helping
clients master developmental tasks successfully.
Because the Inner Selfie is available 24/7, your clients can use
it as their own personal ego-strengthening app when they need a reminder that
they have confident parts that can overcome more vulnerable ones.
Therapeutic App: You are adding to the emotional growth
and well-being of your young clients by introducing the Inner Selfie
ego-strengthening technique, a video “trancette” made on
their smartphones. You are the videographer and coach, guiding them to give
voice to the part(s) of them that are positive ego strengths that can be called
upon instantly when they are struggling or lose sight of them. This can help
them avoid or minimize self-destructive behavior and negative self-talk. This
post-hypnotic and future-paced technique encourages the positive internal sense
of self while simultaneously providing an external view. The experiential
moment that your client can access when using the Inner Selfie video allows for
a readiness state of deepening inner strengths to be experienced over and over
again. It can create empathy and understanding toward the struggling ego
states, moving away from egocentricity, while affirming their ability to
overcome self-doubts and blocks. You have given them another way for essential
emotional impact that transforms and transcends – a trance that goes deep
within, using the very same device that so often keeps them focused outwardly.
Ways to Help Clients Down-Regulate and Increase Affect Regulation
Down-Regulation Goals
Being able to evaluate the level of mastery of developmental
tasks in the maturation of our clients helps us to formulate the goals for
helping them down-regulate, interiorize, and regulate affect. We want them to
improve in their decision-making skills, executive control, and ability to
create healthy boundaries. The following discriminating observations will help
guide the implementation of interventions.
Physical Affect
Are clients active or inactive? Do they need to slow down or
expand their energy? Do they know how to use abdominal breathing exercises and
relaxation techniques? Are they able to decrease dissociation levels to be more
present, more in their bodies and more aware of their physical surroundings?
Psychological Affect
How can clients become more oriented to the present, being more
in the moment and mindful? Has their experience expanded to self-awareness, and
how can this be enhanced? How developed is their “observer self” in improving
regulation? How can their skills in diminishing intrusive negative thoughts or
an unhelpful “busy” mind be improved?
Social Affect
How much real time do clients spend connecting with others? How
significant are their online relationships? What is their progress from social
self-consciousness to more self-awareness? How much enjoyment and contentedness
in their daily life do they report? How do they report the quality of social
networks and relationships, including those IRL (friends, family, love
relationships)?
When we sort for affect differentiation like those just listed,
we uncover clues for strategic interventions. Indirect suggestion is often the
meat of our interventions. For example, if 22-year-old Maggie is listless and
depressed, you might be very lively when using a trancette with her, and use
stories and metaphors about “waking up” or about “how time flies when you’re having fun.” You may have her stand and stretch, reaching up
to the sky with you, both before and after the trancette. Teaching concrete
ways to reach these goals of down-regulation, affect regulation, and healthy
ego boundaries provides a script they can follow that has both the experiential
and indirect benefits built in. As you look at the following suggestions, think
about how you might help your clients incorporate them.
Lack of Trust and the Need for Constant Feedback Are Down-Regulation and
Affect-Regulation Busters
“My generation is constantly needing to know someone is there” (Derrick, age 19).
“My generation is more guarded. When you
think you are sharing something confidential, it could be going out to anyone
at the same time” (Amy, age 22).
These quotes from two of my clients refer to their online
feelings of constantly seeking feedback and surfing until they find it (a type
of cyber self-medication to lower anxiety) and knowing that even with
self-disclosure, the receiver may not keep it to themselves (trust is
conditional). This experience is common life online for most of our younger
clients. If the feedback or evaluation is negative, anxiety doesn’t
abate, it increases.
Difficulties being alone (feeling lonely and anxious) and
trusting others fully (the guard is always slightly up) add to the importance
of working toward these next goals of affect regulation, down regulation, and
creating healthy boundaries.
Seven Things You Can Do to Increase Affect Regulation,
Down-Regulate, and Build Healthy Boundaries
Teach Resiliency
Our clients often come to us unaware of their strengths and
resilient characteristics. Educate them as to what resiliency means. Provide
examples of resiliency. Here are a few that I find helpful:
Seeing problems as a challenge. Being flexible and
thinking before making a decision. There is always a way to approach,
reconsider, and tweak what may initially feel like “no way out.” Not seeing
oneself as a victim caught in a vicious cycle of defeat is a huge step in
building confidence, creating that connection with the Inner Selfie, and
seeding feelings of empowerment.
Setbacks are a fact of life. If your clients understand
the realities of “falling down and getting back up” as an inevitable part of
life, they may not feel as ambushed every time they experience a disappointment
or roadblock. This awareness lowers feelings of isolation, self-recrimination,
and self-doubt. They can remind themselves: “Hey, this happens to everyone”
(even though they might not be able to see it).
Developing strong problem-solving skills. You can use a
limitless number of therapeutic ways to approach a problem or state clients
feel stuck on. Beware of being convinced they have “tried everything” and
getting sucked into their defeatist mindset. This is a caveat for all of us; to
not join in the belief, “If you had my life, you would give up too.”
Being aware of self and others: Strong social connections
IRL as well as online are essential. Commend clients’ ability
to ask for help and reach out; they are not alone (psychotherapy, support
groups, positive online forums, courses, etc.). In reaching out and helping
others, perhaps a friend who is struggling or a grandparent who will light up
when they walk in, clients can act on their altruism, which can then increase
empathy, an important aspect of their growing self-awareness.
Good self-care habits: Having good personal hygiene,
healthy levels of physical activity, and maintaining a nutritious diet would
seem to be no-brainers; however, for many of our clients, these are areas that
are in a blind spot. And young people are sometimes unaware and dissociated
from the long-term effects of ignoring one area or another since a youthful
body can tolerate a lot of abuse or neglect on these levels before evidence
emerges.
The ability to laugh at oneself. Being able to laugh at
oneself puts us automatically in the “observer self” and simultaneously relaxes
our physical body.
Novelty and change: What young person isn’t
drawn to something a little different, out of the box, against the “norm” (even
as they seek to “fit in” and be accepted)? Young people love the idea of this
even if they need help identifying and relaxing areas of rigidity. You can use
their openness to novelty to underline untapped resources and enhance their
emotional responsiveness to that “yes-set” of change.
Increasing internal locus of control: These roads lead to
further developing the Inner Selfie. The reflection, “I can affect my life by
my actions” echoes your message, “Of course you can.” What a pleasure to
witness the young client’s burgeoning ability to sit alone
in silence from time to time as he or she cultivates a growing awareness of the
benefits of mindfulness – that ability to be right where you are right at that
moment and nowhere else, the conscious and present mind and body.
This list is built on the idea of spotlighting inner resources.
It is so important to acknowledge a useful resource in clients, even if they
are having difficulty. Have them tell you a story about when they have used
this resource and help them deconstruct it to find the pieces of resiliency
there. The “WOW” factor (“It’s true, I did that!”) can
emerge as self-realization, and then awareness really lands in them.
Janie, a woman in her mid-20s with poor impulse control
(episodic rages, drug and alcohol history, constant conflicts, and anger),
couldn’t think of any personal resources. However, she was
bright and responsible, and had worked her way up to acting director of a day
care center. I had her sit in my chair and tell me how she managed the center
and about the daily challenges she had to meet. The lightbulb went on and she
was able to identify areas of resilience that she could then build on.
Trancework
Use “trancettes” with
cyber-friendly language: These can be direct or indirect, as short as
several minutes or as long as 8-10 minutes. Target your goal, use the basic
structure of a trance (or meditation or guided imagery) and intersperse your
language with words and metaphors that acknowledge digital cyberpresence and
cyber-ego-states with IRL alongside internal states experiences. Trancework
always brings our clients into their bodies and a felt sense of self-awareness.
Employ the Inner Selfie technique: This technique uses
your clients’ awareness of parts of themselves to amplify
their ego strengths and to more actively reference them when difficult parts
rise up and cause stress, anxiety, depression, or self-doubt. Clients go into a
mini-trancette, watching themselves on their mobile device, which makes it
experiential and significant. This extends the hypnotherapy lens – which is so
effective for transformative change – into their daily lives, where it is instantly
accessible and “trance-forming”!
Record trance sessions on their smartphones: Encourage
them to listen to these sessions when they are stressed or are needing to calm
down and focus on being more present and in their body. Keep them short when
possible – in accord with clients’ fast-paced life! Follow
up and discuss how and when the recordings were used and how successful they
were. Record all of your trancework on their smartphones, as listening to it
later underlines your therapeutic intervention and gives post-hypnotic
suggestions intensity and “stick-to-itiveness.”
Down-regulating induction techniques: There are scores of
classical and Ericksonian induction techniques (i.e., Geary & Zeig, 2002;
Zeig, 2014), and for the Ericksonian therapist, inductions are always tailored
for the client and can be interspersed from the beginning of therapy to the
end. Here’s one I find young clients can do easily and
without resistance since they are “in charge.” They often report it is easy to
do on their own when they need to “calm down” and it teaches self-control,
gives the experience of down-regulation and self-hypnotic phenomena, a sense of
self-empowerment. In my office, it is often a useful segue to trancework.
“After a couple of easy breaths … bend one arm up to your eye
level and pick a spot on your hand or arm to focus on … as you keep focusing on
that spot and breathing easily … allow your arm to lower
slowly … comfortably … taking its time … all the time it needs … until it rests easily
on your lap … allow your eyes to slowly close … and just rest and be comfortable …
for a couple of minutes … feeling how relaxed you can feel … in your body … in your
mind …”
(Hand and Arm Lowering Technique, adapted from Advanced Hypnotherapy
Training, MHE Institute, Geary, 2010).
Use Ego States and Parts of Self to Build the “Observer Self” and Self-Acceptance
By talking about and identifying online personas, IRL behavior,
and internal states, a change in perspective can begin to percolate and a
greater self-awareness can emerge. Your clients can discuss different parts of
themselves without defensiveness. They can look at these parts of their ego
states and personas as aspects of their whole person. You are helping them
discriminate, de-amplify, and process what parts are troubling – and amplify
strong or healthier ego states. This freedom from self-judgment allows them to
move toward healthier integration and individuation.
Exercise: Get them off the couch and help them move from
one ego state or part to another (different positions or chairs in the room to
represent different aspects of self). It is important to bring their online
states and profiles in here as well (some will parallel IRL states, some won’t). You can begin by playing one of their parts, exaggerate the
role, and have them eventually take over the representation. As the parts begin
to dialogue as “actors,” watch the light go on as they are able to “experience”
these parts as just states, moving away from believing and owning a negative
feeling that these states represent all of who they are. They begin to
transition from emotional reasoning, for example, “I don’t
fit in, I’m a loser,” to a clearer, more accurate
perspective, for example: “That experience triggered my being bullied in fourth
grade, no wonder I reacted that way.” The exercise always closes with the
stronger and healthier ego state (the one that triumphs over conflictual and
self-loathing ones). “Just because I feel that way, it doesn’t
make it true; most people aren’t thinking about me like
that.” (The exercise is an assimilation of ideas drawn from my personal
professional history and experience culled and adapted from family systems,
psychodrama, gestalt, hypnotherapy training, CBT … you get the idea).
Mindfulness Exercises for Building Down-Regulation States
Your clients know how to use the smartphone like a master ninja.
Incorporate their knowledge into new ideas. Teach concrete ways that can help
them down-regulate. Here are a few approaches I have found helpful:
Encourage sending a text message to themselves as a
self-listening exercise when they need help to delay reaction time – things
like, Stop, Breathe, Think,, or Breathe deeply and slowly and count down from
10 to 1. Have them use ringtones that transmit something positive, meaningful, or
relaxing when they hear it so that it may be followed by taking a couple of
breaths. When a ding comes in signaling a message, invite the client to take
those breaths and to wait 15-30 seconds before responding. This encourages an
internal response over an impulsive, reactive one.
Find and develop guided imagery exercises: There are many
meditation and mindfulness practice exercises to refer to. Creating guided
imagery that is more personal to the client’s own life and
issues can increase the experiential change, just like hypnotic trances that
are structured and tailored to the individual’s targeted goals.
Teach a relaxation response they can practice when
anxiety and thoughts are racing. I teach a simple one that can be used readily
and many of my young clients report that it has been very helpful. I start by
pointing out that when they are worried, anxious, or upset, they breathe in a
shallow way, from the chest, or that they even hold their breath. Most are
unaware that this is happening. Further, I explain that by becoming aware of
their breath, and using relaxing abdominal breathing, they will begin to relax.
“Put a friendly guard at your mind’s
door and while you are practicing this relaxation response, if your thoughts
wander – and they will – have that friendly guard tell your thoughts to come
back later, you’re busy right now. Your mind
needs a break, just like your body.
“Breathe in slowly, filling your stomach up like a balloon.
When you exhale, deflate your stomach, like you would a balloon.
“On your in-breath, count down slowly … .5 … .4 … . and on your
out-breath … .3 … 2 … 1 … . Do this at least 8-10 times and when you have more time,
practice longer. Practice this daily, even when you are not upset. The more you
practice the more benefits you will get.”
(Adapted from Harvard Medical School, Mind-Body Institute for Continuing
Education, 1998)
Do this in your office with your clients for 3-4 minutes and
make sure they are feeling more relaxed. Do a body scan with them for awareness
of being in their body and any changes felt. Check in from time to time in
future sessions and go through it again if they need more practice. There are
many variations and ways to practice the relaxation response, but they all will
involve abdominal breathing and focused thought. You may know others that are
just as effective.
Journaling (on paper or online): to relieve emotional
distress and promote well-being. One study showed that those who wrote at least
twice weekly over 10 weeks showed a significant improvement in pre-assessed
social emotional difficulties (Psychological Svcs, Dec. 12, 2011). Many of our
clients love to write and express their thoughts and imagination. This often
includes blogging, twitter accounts, fanfiction sites, Tumblr, etc.
Physical movement: Sports, yoga, walking (with or without
headphones or music), running, martial arts, or any exercise that relaxes,
follows the breath, and reduces busy or “monkey” mind is
crucial. The well-being of every young person is enhanced by physical activity,
especially given that so much time is being spent plugged in and sedentary.
Encourage Real-Time and Face-to-Face Connectedness
Start with short intervals, as comfort with face-to face time
can be like developing muscles in strength training class; it gets easier with
practice.
Phone time versus texting: Encourage picking up the
phone, maybe once a day, for a “live” conversation. Call a
grandparent, plan an event with a friend, anything. Many find this difficult,
as texting feels so much easier.
Psychotherapy hour: Be aware that 45-50 minutes of
face-to-face time with you might be too long for some clients. Use the
smartphone medium as an album of pictures they may share with you or have them
read a text that is current and made them feel happy or upset to create comfort
while they are getting used to this intense face-to-face. Clients often
voluntarily check their smartphone less often as time in therapy becomes more
comfortable and connected. Or you can show your comfort with its presence by accommodating
a short intrusion, as in, “Do you need to take that?” One high school freshman
appeared to be glued to her smartphone, and simply could not put it down. At
some point she agreed to put it under a pillow during our session. She had 65
hits in the 40 minutes it was tucked away!
Daily real-time conversations: Encourage initiating even
5-10 minutes with a friend or parent. This might mean a high schooler agrees to
come out of her room for a while and talk with a family member, or a young
adult plans an activity with a friend where they both agree not to look at
their smartphone for a while. This can be difficult. Talk about the specifics
of how they will accomplish this and follow up in the next session. Real time
in real space, being present physically and mentally, cannot be emphasized
enough. Our clients often default to texting and being online. Real-time
connectedness cannot become extinct or only a rare social occasion. It is an
essential part of what makes us human and real.
Store a Treasure Chest of Metaphors and Stories that Showcase Autonomy and Down-Regulation
Sometimes it’s hard to remember examples
and metaphors that are salient to a young person’s life.
They provide many in our sessions with them. Just keep adding to your list, and
you will be surprised by how many gems you collect and how they handy they are
as you proceed.
Teach Peace in Solitude
It is important for your client to understand that there is a
difference between the serene experience of solitude and the empty feeling of
loneliness. Feeling comfortable being alone once in a while is integral to
general well-being. Solitude can be a place to gather inner strength, a time of
reflection and creative thought. Encourage clients to think about situations in
which they would be comfortable being alone by choice. It doesn’t
have to be for an extended period, just refreshing, like sitting under a tree
or taking a short walk, unplugged. for 10 minutes and taking in what they see
around them so their body can relax.
Tap into clients’ creativity. They might paint, draw, read, write poetry or make or listen to music. Donnie,
a senior in high school with significant ADHD and a history of self-injurious
behavior, but very talented musically, created songs using guitar and voice. He
harmonized with himself on tape. I play one of them in my workshops: He
explains, “I wrote and produced this song because it makes me think of good
times chilling out with my friends and girlfriend.” Making his music meant that
those times of solitude were a space in which to promote his growing sense of
self.
Make solitude versus loneliness a homework assignment. One
client in her late 20s and on disability for a mood disorder with minimal
self-regulation, found a framed poem at home that had given her inspiration
when she was at her lowest point. I encouraged her to record it, to appeal to
the budding actress part of herself. She would listen to it when she needed to
gain a sense of peace. Both the recording and listening to it were acts of
solitude. It was a structured assignment that accessed her budding Inner
Selfie.
Encourage sending someone a card or letter via snail mail. Choosing or making it, and writing, thinking, and mailing it can be a good
experience for both the sender and the recipient. Suggest doing something for
someone else who doesn’t expect it. You might keep some
stamps and cards in your office. Having supplies readily available can serve as
a stepping off from the digital transmitter. I will send cards to clients
sometimes with an encouraging note to model what it feels like to get snail
mail that is personalized. If a client plans it intentionally, it takes some
thinking and action that begins with solitude and then reaches another being.
Remember that even this small gesture (just one example) puts into practice a
sense of altruism, which is an integral part of resiliency, and can tap into
and increase levels of empathy.
Whenever a client tries on a different behavior, does something
slightly different, or views something from that developing observer self-perspective,
the experiential charge of real change moves the person forward. A fruitful
balance can begin to develop between daily time spent in cyberpresence and
experiencing real change in the body, thoughts, behavior, and internal states
from being truly offline in a full way.
Therapeutic App: As you reflect on the different ways you
can help your client down-regulate and build affect regulation and healthy ego
boundaries, be open to trying new techniques and energizing familiar ones. More
novel interventions will occur to you with each client as you polish your
therapeutic focus on providing practical skills that they can participate in
experientially. It is the combination of applying our training and background
and being current with the online life of our young clients that will foster a
healthy alliance. Our own gifts of resiliency and authentic “self” model for
them in the process. Only then can we touch the core of our clients in ways
that resonate and motivate toward building their internal states, that
essential Inner Selfie.
How and When to Unplug
A Sense of Community
The “sense of community” I am talking about here involves
membership, influence, integration and fulfillment of needs, and a shared
emotional connection (McMillan & Chovis, 1986). It means a group of people
in some place, real or virtual, who have particular characteristics in common –
values and interests, intent, needs, preferences, resources, and beliefs. The
members of the community, formal or informal, have a feeling of fellowship or
warm shared identity.
Your adolescent and young adult clients need to feel this sense
of belonging, warmth, and caring in the communities they seek out, both
virtually and offline. When they experience this, there is less reported
depression and emotional pain. This social connectivity – with friends, family,
teachers, religious communities, therapists, positive online and offline
support groups – gives our younger client the protective resiliency needed to
master developmental tasks and to thrive. The communities found in the digital
world, although vital and important for many, are of course relatively
anonymous and thus have less potential for stable ties to be established. And
on sites such as Twitter, Instagram, Snapchat (deleted after a short time),
Facebook, dating and meet-up sites, one can virtually follow folks invisibly.
The online practice known as “lurking” refers to visiting
sites without identifying oneself.
Ubuntu
When I was in South Africa, I heard a talk about the Southern
African philosophy of Ubuntu: “The belief in a universal bond of sharing that
connects all humanity,” or “I am because we are.” I was thrilled to embrace
this philosophy as one to teach younger clients about, that would likely be
experienced with low resistance. Authentic relationship. And because most of
our young clients embrace novelty (a trait linked with resiliency
characteristics), threading that interest to a concept that appeals to them can
resonate and trigger positive internal states.
Desmond Tutu, the revered spiritual leader of South Africa,
called it the “essence of being human.” He said, “A person with Ubuntu is open
and available to others … it’s about our
interconnectedness … you can’t exist as a human being in
isolation … you can’t be human all by yourself … you are
connected and what you do affects the whole world … it spreads out …
for the whole of humanity … when you have this quality … Ubuntu – you are known
for your generosity …” (Tutu, 2008).
The relationship our adolescent and young adult clients have
with others can only take root in a solid relationship to themselves. We have
looked at helping our clients land inside themselves and develop the “observer
self.” By seeing all parts of themselves both online and off, they will be
enabled to process internal states and build the Inner Selfie.
(Ubuntu, also a huge operating system on the internet, has been
one of the most popular Linux distribution systems on desktop/personal
computers and very popular on servers and for cloud computing. Committed to the
principles of free software development, the system encourages people to use
its free software, improve it, and distribute it).
A “Sense of Community” Strengthens the Ability and Desire to
Unplug
The SMA provides information about your clients’ activities and
personas in cyberspace, but it does not tell you about their positive virtual
communities or the strength of their family, friends, and other supports in
their day-to-day physical world. As you work with them with the door to digital
experiences now open and they share their lives and struggles with you, you
have gathered the essence of those supports or lack of them and their ability
or challenges in using them.
I find that overall, the stronger the positive social ties are
both online and IRL, the less difficult it is for younger clients to unplug
without high anxiety or compulsive behaviors being obstacles. In my
observation, the less strong these ties, the greater the difficulty in
unplugging from cyber connections.
Still, there are certainly cases where this is not true. For
example, a young high school client, David, who has grown up on gaming and
role-playing sites, seems to have strong family ties and many friends but has
moved from healthy use to compulsive use in terms of the amount of time he
spends online. But stronger positive social connectedness usually reflects more
developed ego strengths and a willingness to try ways to unplug. In David’s case, he cooperated with a structure he could handle and with
an intentional commitment to stay with it during school days.
Promote the Benefits of Unplugging and How to Do It
The Plan Has to Be Intentional: This idea is proactive
and self-initiated. It does not mean losing a charger, leaving it somewhere by
mistake, or an externally enforced restriction by a parent, school, or
activity.
The User Chooses the Amount of Time to Be Unplugged: If
it is intentional, your clients decide the length of time to be unplugged. Some
may only be able to stay away for 15 minutes to an hour, and some may be able
to last longer. Those who may be experiencing “cyber-fatigue”
are often willing to try longer periods off without checking in. Sometimes this
longer period of time does require an “excuse” like their device “running out
of juice” or “misplacing it” so they can handle the pressure from online social
media sites that they feel demand immediate responses or face rejection. Whatever
they need to do to tolerate their time offline, support it.
Unplugged Can Mean Turned Off or Silenced, Out of Sight,
Airplane Mode, or Periodic Check-Ins: Unplugged sounds very definitive as
in being completely off, but there are actually many ways to unplug. For some of our clients who are being intentional for the first
time or who are highly dependent and compulsive in their use, making an
intentional plan to check every so often, like between 15 and 30 minutes but
not in between, is a new concept. At first they may report a desire to check
before the time they have given themselves, but since it is their own intention
setting the parameter, it becomes easier for them and they may find that they
can extend the time more easily.
Concrete Benefits to Unplugging: Discuss some of the
benefits listed here and others that might be specifically relevant to your
client.
Clients will establish opportunities to:
set clearer digital boundaries and feel
more in control;
become more productive (off and
on-line);
have greater focus with a clearer head;
remind yourself of how nice it is to
spend time with people you love;
experience better, more restorative
sleep (without the electronic undercurrent);
be surprised by the lowering of stress
and anxiety; and
enjoy nature, being creative, and
giving yourself (and others) your full attention.
When Not to Unplug: Yes, there are actually times
to encourage your young clients to stay connected to their digital life.
When their positive social communities on social media sites or
FaceTime alleviate or reduce feelings of isolation, loneliness, and despair; or
connect them to loved ones far away who are not accessible in real time. It is
also important when they need affirmation when internal states feel shaky and
no one is available in real time. This level of connection is supplementary and
does not take the place of encouraging their growth and development in real
time in the form of such things as internal reflection and real connectedness
with others.
Being connected online with their mobile devices at their side
is part of their life and it keeps them current, in touch, and accessible. Cyberspace
reality is part of all of our daily lives, and it is here to stay. In the right
amount, for the right reasons, with positive learning, social connections,
skills, and experiences, cyberpresence is a good and essential part of all of
our worlds.
Balance, Balance, Balance: How do you know if your own
life is in balance with your cyberpresence and IRL? This discussion of
community and unplugging applies to every one of us, but our younger clients
need our guidance and continued support in how to navigate. We therapists need
to look at our own SMA, time spent online, levels of anxiety and stress
associated with being plugged in ourselves, and practice intentional time off
as well. It is a challenge for us all. In some ways, perhaps, we may be
“recovering cyberspace dependents” who model what we have overcome as we help
our clients do the same. Let’s go for
“cyber-interdependence” that is the ideal relationship – the rapprochement and
acceptance stage noted in the “Seven Stages of Attachment.” This stage is where
intentional unplugging happens because we know it is vital for our well-being
and our interconnectedness with others in real time.
The National Day of Unplugging: In 2009, a National Day
of Unplugging (every March 6th or 7th), was established and is sponsored by The
Huffington Post. Inspired by the Jewish tradition of turning off
electronics and abstaining from work from Friday sundown to Saturday evening,
the public is encouraged to take this time off from electronic devices.
Participation has grown with each year.
It is recommended that people make specific plans for activities
that can be experienced without mobile devices or computers, even replacing the
GPS with a map. The Huffington Post folks suggest that we finish the
sentence “I unplug to … ” on a large piece of paper. I did this exercise with a
local group of adults and youth with interesting results. Some found that
sleeping, driving, and maybe eating were the only options they could think of
to fill in the blank.
We can ask our clients to reflect on and finish the sentence
too. Some will have a very limited number of ways to complete it at first. The
goal is to practice intentional time off-line, which doesn’t
include sleeping!
Therapeutic App: The ability of your clients to develop
their capacity to unplug in different ways, from an intentional position,
promotes the therapeutic goals of self-regulation, healthy boundary formulation,
and the mastery of developmental tasks. Helping them recognize the benefits of
attaining these goals while supporting them as they do it, creates the
springboard for growth and well-being as they continue their journey. They are
now aware of their cyberspace personas, parts, and behaviors as well as those
IRL. They are aware of cyberpresence as differentiated from social
connectedness IRL and how sincerity and trust can be circumspect on both sides
of the cyberspace communication chain. Threads of authenticity and honesty can
be found there, but the best place to practice and experience them is in
day-to-day life – offline with others and by themselves.
Trauma and the Power of Social Media
With everything both intensified and dulled in the day-after-day of the pandemic, it has been (and will likely continue to be) a special challenge to our young client. The breach in normal expectancy, the isolation, and the tension around how to respond to COVID have created a stressful layer for those who are already experiencing some level of uncertainty as they try to navigate finding their place in the larger world outside of the family of origin. And, although social media has many positive and beneficial aspects as a place for our young clients to explore, experiment, master developmental tasks, practice socialization skills and connect to others, we need to also be aware of when it is less than nurturing and even destructive. The isolation that has occurred as a consequence of the pandemic has magnified the negative impact of hurtful online experiences.
Co-construction theory (Subrahmanyan, Smahel, & Greenfield, 2006) suggests that young people deal with the same developmental issues in their online social lives as they do in their offline world, such as issues of identity and sexuality. Young people engage in digital communication to meet these developmental needs as well. With the opportunity to share with hundreds of “friends” and followers, they constantly browse social media feeds to monitor the activities of others, the number of friends and followers others have, and the amount and quality of peer feedback. This focus on the ways that people “out there” are responding can distract young people from healthy self-reflection and invite some developmental and emotional difficulties. As a 24/7 window into everyone else’s social world, the constant scrolling on social media allows a young person to practice, observe, and percolate, as they are developing their identity, gossiping with peers in the service of self-exploration and negotiation of social norms.
The Trauma Express
Pain Starts From Anywhere
When Tami, age 17, was brought by her mother to therapy because of dropping grades and withdrawal from the family, it became clear in our first session that she had experienced trauma on social media. Six months earlier, she had agreed to sexting with a guy she liked. It was a brief encounter. She was experiencing panic attacks and migraines, although her primary care physician could find no specific medical condition. Tami admitted living with the pervasive fear that the pictures she’d sent were being forwarded to others, and she was experiencing deep shame. She couldn’t focus on her work and imagined the entire school knowing about the pictures and gossiping about her. She was just waiting to be outed! Each day she thought, “This is the day.”
Online, emotional trauma and psychological stress can start from anywhere. Perhaps we have been silenced by others or we are so uncomfortable that we self silence. With a limited repertoire of navigational tools, our young clients may shut down in the face of chronic emotional entrapment. As they attempt to navigate online trauma, they may experience an erosion of a sense of self, identity, and purpose. Add to that the stress hormones that flood the body (headaches, digestive issues, etc.) and we have a recipe for pain. Like Tami, non-specific physical complaints with no medical diagnoses can occur. Irrational behaviors begin to be noticed, such as Tami’s withdrawal and loss of focus in school. Someone else might present with unexplained explosions or sudden change of heart about things they once loved.
The Paradox of Online Sound
The traumatized young person may begin to avoid family or friends, and of course the person(s) responsible for causing the pain. Sensitized to triggers and floods of emotion, their withdrawal adds to feelings of shame or despair. Holding in what happened to them takes incredible energy, and there can be high emotional and physical costs. Damaging online encounters can activate heightened levels of isolation and loneliness, increased negative feedback loops, or can activate retaliation.
Here the autonomic nervous system kicks in and activates neuroception. As Porges (2004) ) explains neuroception refers to “how neural circuits distinguish whether a situation or people are safe, dangerous, or life threatening”( p. 6). Pain and stress from social media experiences can activate “neuroception” in physical or emotional response even though conscious dissociation may be prevalent.
With the “flight” response one might, as Tami did, scroll, lurk or go to self-harming sites in passive silence.
In the “fight” response, we see a defending of the wounded self through retaliation, perhaps “flaming” or bullying back. In fact, many shootings can be traced back to online (and offline) trauma, as part of the case profile.
Immobilization and avoiding sites that are triggering can be part of the “freeze” response. Tami moved between flight and freeze, and found herself exhausted and depleted.
Online Sharing Gets “First Place”
One of the true gifts of social media is that this is where some of our young traumatized people start to share. The process of healing begins when there is the opportunity to name and acknowledge what happened. Often, a young person will tell me they first disclosed a negative social media experience to someone they didn’t know (which sometimes feels safer than sharing with someone they do know) or with a trusted friend. I always applaud them for this as marking the start of healing. Remember, “We are only as sick as our secrets.” Being listened to and understood, or finding others who have similar feelings or can offer advice from a resonant place can initiate the healing process.
It’s important to remember to ask clients if they have shared their experience with someone else. They may not know that the act of sharing begins to change physiology and to reestablish a sense of normalcy. We can explain that the limbic system starts to flicker on, nudging the polyvagal system, and paving the road to a sense of well-being, of community, and of not being alone. Tami told me she had shared her experience and fear with an online “friend,” a connection that would not lead back to her “real life” friends. She was able to let me know that the “friend’s” advice to forget it coupled with my belief in her sincerity that she would not sext casually again, gave her a sense of owning her experience and moving on.
Technology’s Gift To Online Trauma: A Fast Train There
Social media sites are geared to activate the sympathetic system with generous dings of dopamine (the pleasure hormone also linked to addictions), cortisol and other stress hormones. The reaction to pain and hurt online happens instantly. Our online body “first responders” go immediately to neuroception, the defensive circuits of flight, fight, or freeze. Although the incident can happen in a couple of seconds in real time, and the young person moves quickly on to something else online or off, the body and spirit hold the experience, perceived threat, and memory – the residue. Negative social media experiences are quickly dissociated and then return unannounced, flooding a person’s emotional landscape. For Tami, these unwanted thoughts and feelings interfered with her concentration and down time. When she began to share online and engage in therapy, her perseverating thoughts and feelings of shame began to subside and she was able to feel more connected with old friends. It turned out that Tami’s mother’s interpretation that Tami was disengaging from school because of test anxiety hadn’t taken everything into account.
Predicating Factors
Previous Victimization
Logically, negative experience on social media can be amplified for vulnerable young people when there is a history of victimization. These young people are more likely to be bullied, to be solicited and victimized online, to receive negative feedback on social media, and to experience greater difficulty regulating their use of social media. They will spend more time scrolling and lurking, engaging in the passive viewing of others online (Odges, 2015).
Teddy, 18, had been bullied at school and verbally abused by his alcoholic father. He reported being put down by peers from school online, and he spent many hours reading his peers’ postings and feeds. Shy in nature, his aggression came out in the violent games that he played into the night.
Rejection Sensitivity (RS)
Those young people who rate high in rejection sensitivity to real or perceived situations are vulnerable to experiencing more trauma and are less able to bounce back from it. (Check out the Rejection Sensitivity Scale online. ) Frankly, I am not sure I have met any young people who are not sensitive to rejection. Thus, it is important to emphasize the concepts of “cybersincerity” and “cybertrust” with your young clients, making it clear that only the sender knows for sure. So much can be read into social media posts, and it’s my experience that most young people assume the worst. Of course, this is not to diminish the prevalence of outright aggression and bullying, but simply to say that not everything falls into one category.
Psychological Legacy
It is my experience that a history of rejection and judgment from family and important others, or a history of trauma and emotional pain in real life, are predicating factors for vulnerability to hurt on the Internet.
Peer Influence
Peer influence reinforces ideals and social pressure to conform. As teens and young adults, this influence is primary and the need to be accepted can have a powerful impact on discernment and resilience when it comes to online interactions. Young people who are looking for belonging may have a hard time discriminating between healthy and unhealthy opportunities.
Media Influence
Media influence can be overt or covert. No matter what, it sets young people up to internalize certain ideals of happiness, body image (direct and indirect), and identity. Buying into these “ideal” images is difficult to resist when we are bombarded 24/7 by online and offline purveyors of such fantasies.
Darrell, age 22, is obsessed with the size of his penis, and he is exploring numerous online sites that promise physical growth and sexual happiness. The so-called remedies require big financial investment and have no science to back them up. Unfortunately, Darrell’s self-identity was not predicated upon the quality of person he was or all that he had to offer in a relationship. His preoccupation made him easy prey for advertisers who promised the impossible and fed off of his desperation.
Economic Factors
Young people who live at lower economic levels have been found to have overall less parental conversation and participation, and less access to social media. According to recent research (Wang & Xeng, 2018), these young people were more likely than their peers to report online experiences that led to offline fights, face-to-face confrontations, or trouble in school. On the other hand, higher economic status meant greater digital access, and with that expanded digital etiquette and digital safety.
Sleep Deprivation
Young people often describe overactive minds that are difficult to shut off at night, which activates the arousal system. Many of our clients report that they are up late into the night on social media. Online hypervigilance combined with sleep deprivation can cause difficulty in self-regulation, resulting in greater irritability and problems concentrating.
Factors That Foster Digital Addiction
“I can’t get him off his cellphone.” “He’s never listening, totally addicted to his phone.” “She’s always scrolling, even at the dinner table.” Being addicted to the cell phone takes many guises. And, what we so clearly see in others we don’t always see in ourselves. Think of your own behavior. Since the pandemic, my own use is up. And, yes, I can easily justify that being on virtual platforms for teletherapy, trainings, teaching and social engagement is essential. Still, sometimes I wonder, Are we “addicted”?
As therapists, it is our job to be present with our clients, whether in-person or on teletherapy. When our clients are distracted with their smartphones, it can either detract from the interaction between therapist and client or enhance it. The question is whether they are only partway present with us or they are “show and telling” using their phone. We know our part: It is a discipline.
Time Spent on Social Media (TSSM)
It comes as no surprise to any of us, excessive time spent on social media can become addictive. “Behavioral smartphone addiction use begins using neurological connections in our brains in ways similar to how opioid addiction is experienced by people taking oxycontin for pain relief-gradually” (Peper & Harvey, 2018).
According to studies (Shensa et al., 2017) using social media for more than 4-5 hours a day is considered excessive, making one more vulnerable to social media addiction. Frequency of social media use is a distinct behavior component, strongly and independently associated with depressive symptoms. Forty-four percent of young people reported problematic social media use (Shensa et al., 2017).
Multiple Platforms and Multitasking
Digital addiction was also found when multiple platforms were used: 7-11 were problematic, 3-6 marginal and 1-3 low. This was found to be independently associated with anxiety and depression even when time spent on social media (TSSM) was controlled (Computers in Human Behavior, 2017).
In addition, overusers often multitask – on their devices, eating, attending class, etc. With this constant stimulus and activity, the mind has no time to relax, regenerate, and be centered. No wonder many of our young clients report feeling overwhelmed. This “semi-tasking” (the consequence of multitasking) can mean two or more things are done half as well as one thing at a time.
When Stella, a sophomore in college, breaks down with overload, I can educate her about how the factors of time spent on social media, multiple platforms, and multitasking contribute to her anxiety. She then is able to take back some control by closing platforms, taking breaks after an hour or two online, and multitasking less.
Digital Addiction and “Phoneliness”
We know now that too much time spent on social media is associated with greater odds for an anxiety disorder and with more intense symptoms and increased loneliness and depression (Peper & Harvey, 2018). The American Psychological Association defines internet addiction as “a behavioral pattern characterized by excessive or obsessive online and offline computer use that leads to distress and impairment” (APA Dictionary of Psychology).
Social Exclusion on Social Media
When we experience or perceive in others negative social media behavior, it is at odds with our strong human need for stable social relationships, belonging, meaningful existence, and control. With many of our daily thoughts, feelings, and behaviors orienting toward satisfying those needs, this decreased need satisfaction can do harm. The online disinhibition effect on negative behavior includes dissociative anonymity with few social consequences, invisibility, lack of eye contact, and the sense of being unidentified, which can be heightened if in a group context (Suler, 2004).
The following are some of the ways a person can feel excluded or negatively impacted on social media:
Rejection: direct negative attention suggesting one is not wanted or liked or is disapproved of.
Shaming: for body size, other aspects of appearance, or behaviors. This can include rating scales, likes/dislikes and direct shaming or “flaming.”
Phubbing: ignoring someone in real time in favor of the smartphone interaction. Phubbing conveys non-interest in the other person.
Ostracism: the experience of being ignored. Being the target of ostracism of any sort, in person or online, is a painful psychological experience. Those more reliant on social media can be more sensitive to the effects of exclusion (Schneider, Zwillich, Bindl, Hopp, Reich & Vorderer, 2017).(Computers in Human Behavior, 2017).
Ghosting: ceasing all communication while dating someone or by a friend or friend group. The other person(s) ends the relationship with no explanation, and suddenly cuts off all communication. The one who is ghosting most likely handles other conflicts similarly. This can backfire with an unexpected showdown later. The ghosted person might show up at the other’s job, home, or in a public place to confront them. The ghosted builds up anxiety or dissociates with displaced behavioral or emotional symptoms. David, 24, was ghosted by his girlfriend of 3 months. He stopped working out, binged, and was irritable with his roommate. Being ghosted can trigger anger, hurt, shame, and lowered self-esteem. The core dynamic in ghosting is conflict avoidance, not wanting to hurt someone’s feelings (although it certainly does the opposite) and sometimes wanting to directly hurt the other person.
Cyberbullying: these bullies can’t see their victims’ reactions so any sense of impact or consequence is avoided. However, it can cause extreme distress and lead to self-harm and suicidal behaviors. It can also lead to bullying by the bullied, or retaliation. School shootings have often been linked to cyberbullying/social bullying histories (Frogge, 2019).
Direct threats: aggressive and unpleasant messaging when the victim knows who sent it.
Indirect bullying: perceived when a “private” note from the victim is passed on to a group without permission and often without the victim’s knowledge.
Bullying (general definition): According to Merriam-Webster: “[bullying is] abuse and mistreatment of someone vulnerable by someone stronger, more powerful, etc.”
Thirty-three percent of teens have been bullied in person vs. 22% bullied on social media. Seventy-five percent of US teens have social media profiles, young people being the most vulnerable and heaviest users of social media (Influence of Social Media on Teenagers, Huffington Post, 2017).
Trolling: the act of deliberately disseminating hateful or racist comments, or bickering with others anonymously. Thirty-two percent of teens have experienced menacing online advances (Influence of Social Media on Teenagers, Huffington Post, 2017). Why does one troll? The reasons are myriad, including to gain status or stay popular by getting attention by dumping on others. Some do it to feel powerful, or to fit in somewhere, or to get back at a society that they feel does not include them.
The Downside of Sexting: once it is sent, you can’t get it back. As young people are sexually exploring and experimenting, sexting can be an impulsive behavior. And, sometimes this momentary impulse causes lingering pain later. In one nationwide survey, 17% of young people admitted to impulsively sharing sexually explicit pictures or videos and 35% admitted to sharing with more than one person (Influence of Social Media on Teenagers, Huffington Post, 2017). Many young people have received sexually explicit messages or unwanted or unsolicited sexually revealing pictures: “dick” and “tit” pics, as they say. The R- or X-rated world of social media is part of the social media landscape today and it starts early. Our work is to decipher what trauma, pain, and shame result from any of these experiences.
Scrolling: “Compare and despair” is the phrase I use. Passive in nature, scrolling is one of the most prevalent negative experiences reported to me, by young people and adults alike. Excessive scrolling to compare one’s experience with others can lead to anxiety and depression. I see it everyday. If we think about it, how many people are going to post negative? With all the editing and time spent posting around the best life, our clients forget that this is a pumped-up, sometimes outright false reality.
Lurkers: members of a social network community who observe but do not participate. Now, it can be a good thing to simply be gathering information and education, or checking out things we admire and want to know more about. But often there is a downside as we linger on posts that make us feel less than or somehow ashamed of our “imperfections.” This type of experience eats away at self-esteem and confidence, and is a close cousin to the “compare and despair” of scrolling.
Using the Inner Selfie Technique with Teletherapy
Psychotherapy goals are mostly founded in ego-strengthening techniques and resourcing inner strengths. The Inner Selfie Technique utilizes these approaches and combines them with ego states or parts work, anchoring, and hypnotic bridging between a client’s more limiting or insecure parts and their strengths.
The therapeutic alliance, as in any effective psychotherapy, must be strong and reliable. The Inner Selfie Technique is interactional, interpersonal, and intrapsychic all at once. Bringing the smartphone into the service of ego strengthening goals puts us in charge of the smartphone, not the other way around. This technique is current, always available for access (similar to a mindfulness app, except tailored specifically for your client), and promotes the practice and strengthening of developing ego states. The sound of your supportive voice will remind your client that he/she/they are not alone. Your voice will “go with them.”
Since the pandemic put most people on virtual platforms, something that promises to continue, this technique will prove itself an especially useful addition to your repertoire. Instead of you filming clients on their smartphone, as you do when they are in your office, they simply film themselves. The basic technique remains the same. Let’s revisit it briefly.
First, review some of the client’s strengths and resources with them, and then discuss how the Inner Selfie Technique will help them access those instantly when they are feeling low, experiencing self-doubt, or struggling with an issue. When you are both ready to begin, you might have them take a couple of easy breaths. I now encourage clients to squeeze the hand that is not holding their cell phone when they are reminding themselves of their strengths. This doubles up the anchoring of ego strengths that they can use when they are not in a place to view the Inner Selfie Technique.
Once they press the “ON” button, you coach the client, saying something like: (me) “So, Debbie, when you are comparing yourself to others, feeling like you don’t measure up, and are down on yourself, what are you going to tell yourself?” (Debbie)”I’m going to tell myself that I am as good as anyone else, that I have a lot to offer, and that I can hold my head high and be myself.” As you keep coaching around these themes, you provide supportive affirmations as they talk, such as, “that’s great” or “good insight.”
As I have mentioned, this is “trance-forming,” meaning that this tailored and accessible technique has a hypnotic effect, is ego-strengthening, and provides age-progression or post-hypnotic suggestion. It is both present and mindful, and yet simultaneously orients toward the future. The Inner Selfie Technique expands developing strengths and reduces parts or ego states that are flooding a person with self-doubt or despair.
Conclusion
As you work with your adolescent and young adult clients, you will begin to feel how instrumental you can be as you recognize your client’s entire world, starting with the opening door of the SMA and your decision to see them in their wholeness, including both online and offline behaviors, their experience and presentation of themselves, and their complex internal states. You will have assessed their relationship with their mobile device in terms of stages of attachment. You will have evaluated the hypnotic phenomena they experience online to synergize with therapeutic goals using trancework, both direct and indirect, in your office. You can use cyber-friendly language with ease in “trancettes” or interspersed elsewhere in your work. As you sit with your adolescents and young adults, you will bring your whole “self” into action, using all the tools in your therapeutic toolbox. From bringing in hypnotherapy as the lens to ego-state work, to CBT mindfulness training, and many other ways, your unique expertise and knowledge are your artist’s palette, allowing you to move with your client gracefully, courageously, and effectively.
And your client? He or she will have had the profound, perhaps life-altering experience of being both seen and heard. The Inner Selfie – the central resource for the adolescent/young adult client – will have been found, consolidated, encouraged, and nurtured. The road of personal development will now include many new resources that will continue to develop and evolve, as they call on their Inner Selfie to reliably navigate the complex world they (and we) live in, both online and off.
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