Integrating Technology into Modern Therapies

A Clinician's Guide to Developments and Interventions

Jessica Stone, Jessica Stone

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351014090
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Integrating Technology into Modern Therapies provides clinicians with an innovative, research-based foundation for incorporating technology into clinical practice. It offers an overview of current technological developments in therapy, such as the use of therapeutic texting, virtual reality programs, tablet apps, and online games. Chapters examine therapeutic applications of technology for those who have experienced trauma and a variety of conditions including autism spectrum disorder, ADHD, and speech concerns. The book also offers suggestions for how technology can be used in hospitals, as well as with migrant, refugee, and homeless populations. Combining theory and research with a wealth of case studies and practical resources, this book will be relevant to all mental health, speech and language, and child life specialists.

Part 1

Overview of the Use of Technology in Psychotherapy

The Screen Door Thinking about Technology in Psychotherapy Henry Kronengold

1

Sarah and I chatted as she walked with me into the office for our first session. As I prepared to give her a quick tour, I saw her eyes focus on a pair of familiar objects resting on my desk. Making a beeline for my laptop and phone she asked eagerly,

“What games do you have? Can I play with that?”

I admit to great ambivalence as I write about technology and therapy. As a child psychologist, I also admit to even greater disappointment when I see a child or teenager glued to his or her phone, obsessed with the latest video or online game or constantly texting, taking selfies, and chatting on whatever app is in vogue. At those moments, I look at the toys in my office and I wonder, what happened to the excitement of playing with castles, puppets, or building blocks? What about the days when kids would open my toy closet and search for an action figure or rummage through arts supplies? Those toys offered a creative and expressive venue that was most of all a shared experience. What am I supposed to do with a computer game that certainly entertains but can also appear solipsistic? At least to me.

I remember when I first tried to use online games some years ago. It was in the old days of an early kid’s social media site called Club Penguin. A few kids came in to show me the site and asked if they could play. I agreed and was curious about how our work would evolve with this new game. I spent several sessions watching kids play with adorable animated penguins as the children occasionally smiled but mostly ignored me. I felt as if I was running an arcade rather than a therapy office and I shut the Club Penguin experiment down.

I am drawn to a therapeutic space that is shared and co-created and have struggled with how to integrate technology. I’ve often set limits or tried to explain how I think it’s hard to play or talk together when there’s a device involved. On the other hand, I also feel that I’ve been avoiding the actual challenge of these new technologies. It’s deceptively easy to hark back to imagined good old days, but I can similarly recall the dim view that a previous generation had of my own childhood pursuits, such as television, modern music, and yes, early electronic games.

A quote by Roland Barthes, comes to mind:

Current toys are made of a graceless material, the product of chemistry, not of nature. Many are now molded from complicated mixtures; the plastic material of which they are made has an appearance at once gross and hygienic, it destroys all the pleasure, the sweetness, the humanity of touch.

(Barthes, 1972, p. 54)

While I’m not going to quibble with the loveliness of handmade wooden toys, it is worth mentioning that Lego, Playmobil, and any number of plastic molded action figures have been prominent in wonderful moments of play. Barthes’ quote suggests that we have an instinctive tendency to romanticize the past and see innovation as technically impressive but existentially inferior.

I work from the assumption that therapy is predicated on my willingness to jump into another person’s world. With that comes a need to consider my own perspective and in this case, the realization that my relationship to the digital world is primarily functional. I frequently check news and information online, enjoy easy shopping, and even the occasional online quiz. I use technology but it’s not a fundamental part of who I am, though I suspect people seeing me on my phone as I walk down the street would disagree. However, technology is central to how many people engage with the world. It’s how they interact socially. It shapes how they think. I can easily wax romantic about my Lego and puppets, but what about someone who builds virtual worlds in Minecraft or inhabits favorite characters in a computer or online game? To an entire generation, digital life is about as foreign as a subway is to a native New Yorker.

Which brings us to what I think are the core issues of technology in therapy. Therapy takes place between two people. The therapeutic encounter allows for a degree of healing, an important forum to work out difficulties, and to develop new ways of relating. Competing theoretical orientations disagree on the role of supportive, cognitive, unconscious, and behavioral factors in the therapeutic process but all hold dear the primacy of the therapeutic alliance and relationship. If therapy is dependent on an engaging and nurturing therapeutic relationship, then where does technology come into the equation? Can it be integrated or even enhance therapy? Or is it detrimental to fundamental interpersonal and imaginative experiences that are so critical to therapeutic progress?

Case Studies

Naomi

Naomi barely spoke in our first sessions. The 14-year-old was being homeschooled after dropping out of 9th grade due to depression and anxiety. Medication helped her get out of bed but she showed little interest in anything else. A behavioral approach hadn’t worked as Naomi refused to participate in sessions, ignored the homework assignments designed to help manage her emotions, and struggled against the constant negative thoughts that echoed in her mind. In our first sessions, I tried to speak to her about any number of topics but Naomi sat silently and occasionally would venture a ‘yes’, ‘no’, ‘fine’, or just a shrug. Her best friend appeared to be her phone, which she’d look at frequently during sessions.

“Can I ask what you’re doing on that thing?” I asked. There was no response. “It’s ok. I’m not going to lecture you about it or anything. It’s your phone. Just wondering.” I paused for a moment before adding, “It looks interesting.”

Silence again. I paused for another moment. For a second I thought about getting up and looking but decided that would be too intrusive. I had to be patient, so I sat quietly.

“It’s not a phone,” Naomi said, her eyes fixed on the screen.

“Oh, what is it?” I wondered.

“Nintendo,” Naomi explained.

“Really,” I said with genuine interest. I hadn’t seen one of those in the office in ages. “Old school,” I nodded appreciatively. “Respect. What game are you playing?”

“It’s not a game. It’s a show. Have you heard of Soul Eater?” Naomi asked.

“No, what is it?”

So, Naomi started explaining the intricacies of a Japanese anime show she had been watching obsessively over the past week. I couldn’t follow all the details exactly. I knew it was complicated, somewhat morbid but, most of all, of great interest to Naomi. She had shared it with her older cousin who lived nearby, and now she was telling me about it as I asked questions and tried to follow the plot.

“Here,” Naomi motioned, “I’ll show you.”

Naomi stepped out her chair, walked over, and showed me the anime show she had been watching. I watched with great interest, curious about the content but mostly interested in finding a way into her world. What if I had told her no devices were allowed in my office?

Nick

Nick, a 7-year-old devotee of all things electronic was eager to show me his favorite app.

“Henry, I have to show you this. Here!” he enthused. I reached to get my phone back from Nick who was waving my phone precariously in the air. “Do you have an iPad?” Nick wondered.

I figured maybe this would be interesting. Perhaps Nick had something important to show me. I took an iPad out and Nick showed me a drawing activity. It certainly looked as if it could be creative. How would it be different than if the two of use took out colored pencils and markers? I sat with Nick, who began to play with the iPad as I followed along. He worked diligently but ignored me, changing the colors I had added and disregarding my comments. After about 10 minutes I felt a familiar feeling of disconnection, as Nick tapped away and could have easily stayed in the same position for hours.

As I think about Naomi, reaching out to me through her parallel reality, and Nick, shutting me out as he melted into his device, I recall a decade earlier when I worked with the Grand Theft Auto-obsessed James and Michael, two 16-year-old gamers who struggled to balance their virtual and everyday worlds. I was never comfortable with the game’s violence or the extent to which both boys played it for hours at a time. James stayed up all hours, playing and trash talking with people he talked to online. He would barely sleep, did poorly in school, became less social, more moody, and withdrew from much of his life in favor of his gaming. Even in our sessions he kept glancing at his watch, fidgeting as he thought about his next game much like an addict imagining his next fix.

Michael

The socially isolated and anxious Michael also spent too much of his time gaming and it similarly interfered with his schoolwork. But Michael, who was socially isolated before getting into the game world found a new and ironically safer venue where he could encounter others. He played the game but he also started to join online discussion groups where he met other players. He brought up online situations for us to discuss in our sessions as he thought about how to engage and dealt with his own feelings from a safer distance. Certainly, this pursuit needs to be monitored properly as we know that forums and chat worlds can be minefields. But, in Michael’s case, the online realm became a place to try out his social skills and to develop connections with others. It is easy and all too alluring to judge these connections, particularly for a therapist who may feel more comfortable having face-to-face conversations and relationships. It is also crucial to appreciate just how difficult and lonely middle school can be, and in Michael’s case, his gaming not a retreat but rather a shift to a different world where he could start to reach out to others and began to grow in confidence. For Michael, his virtual encounters grew to the point where he began to make forays into the local game store to play with and meet other kids with his shared interests.

So, there’s this puzzle: What do we do when the use of technology seems deeply meaningful and therapeutic for some, and just as deeply defensive and isolating for others? Are they actually different? Is there meaning in both?

Others

Then again, I wonder how different Naomi, Nick, James and Michael are from any of the children who have come with a particular interest, such as reading certain books or listening to music. Austin walked everywhere with his copy of Harry Potter and the Sorcerer’s Stone covering his face, the classic work serving as a shield to guard against intrusion from the outside world. Zoe’s headphones echoed with electronic dance music, as I struggled to get to know her amidst all the background noise. On the other hand, Ella brought in the same book but talked to me about the characters, played out scenes with me, and used the books and our sessions as an imaginative springboard for her life. Sam introduced me to his favorite rap songs, trying out the lyrics and hopelessly teaching me their meanings.

Therapeutic Work and Where We Go from Here

In other words, maybe technology raises many of the same challenges that we’ve always encountered. Our goal is to take whatever an individual brings into therapy and work with it in a way that is emotionally meaningful and therapeutic. So, our challenge is—how do we integrate technology in the same way that we may try to integrate anything that is relevant in a person’s life, knowing that the same interest can be used as a means to isolate, engage, or create?

While considering the similarities of technology to other areas of interest, we can still ask: What unique issues does technology raise that we need to confront in thinking about our therapeutic stance? It is not a simple question of whether technology is good or bad. Rather, there are serious questions that technology brings to a therapy room. Attachment theory and research stem from the premise that emotional warmth and sustenance are pivotal to a relationship. If we do indeed use technology, then:

How does it shape the nature of our interactions in therapy?

How do we manage exchanges that can feel so impersonal?

How do we use new mediums to open possibilities to grow and share in therapy?

The nature of the relationship is a crucial one and raises the question of how does the nature of the therapeutic relationship shift and how do we keep it therapeutically relevant for children who are digital natives?

Play-based therapeutic approaches rely heavily on imagination and the development of an internal space from which a child is able to play and relate to others. There is a more passive, and also immediate, nature to digital technology, which often entertains, constantly stimulates, and allows for immediate responses. How do we safeguard the place of imagination and play? How do we integrate apps, games, and other technological innovations while we stay true to our desire to help a child’s sense of agency, reflectiveness, and curiosity? Technology, with all its visual pizzazz, can also heighten our focus on the external, whereas our work in therapy centers on nurturing an interior emotional world. Perhaps the virtual and visual nature of technology allows for a creative and expressive medium? But if it does, how does the role and the nature of fantasy change with technological innovations in play?

The basis of this volume is a wondering about how we can integrate technological innovations in our therapeutic work. How do we honor different developmental stages? Is technology more useful with certain populations? I have seen technology open avenues for individuals who may have struggled with relatedness and flexibility; at the same time, the repetitive and isolative nature of technology may reinforce those same cha...