Web Secret #236: Recalibrating Therapy for a Digital World

A couple of months ago, the New York Times devoted its entire Science News section to look at some of the many ways technology is changing the world of medicine. This is the third and final in a series of blog posts devoted to a further analysis of some of the articles in that section.

As psychiatrist Richard Friedman, MD wrote in his thoughtful article the virtues of the digital age are not always aligned with those of psychotherapy. These days, as never before, therapists are struggling to recalibrate their approach to patients living in a wired world.

For some, the new technology is clearly a boon. Let’s say you have the common anxiety disorder social phobia. Your therapist who sensibly recommends cognitive-behavioral therapy. You find that this treatment involves a fair amount of homework: You typically have to keep a written log of your thoughts and feelings to examine them. As it turns out, there is a smartphone app that will prompt you to record these social interactions and your emotional response to them.

Struggling with major depression? An app might ask you to rate depressive symptoms like sleep, energy, appetite, sex drive and concentration in real time. When it comes to collecting and organizing data, software is hard to beat.

But also worrisome. Technology enables patients reach out via text, e-mail, Facebook, Twitter. For some of them, the easy connectivity that technology makes possible is a decidedly bad idea. For example, a patient with borderline personality disorder would love instant access to a therapist whenever an uncomfortable feeling arises.

Perhaps even more problematic, digital technology can make therapists more real and knowable to their patients. "This cuts both ways. Recently, a patient I had treated for depression was struggling with the approaching death of his beloved dog. Just divorced, he was dreading another loss. One night while surfing the Internet, he came across a piece I wrote years ago about the death of my own dog. 'So you understand what it’s like,' he said during one of our sessions."

Friedman wonders if it’s even possible for therapists to remain anonymous in the age of the Internet, where we can all be found in the electronic cloud. A Google search might not reveal a therapist’s deep, dark secrets, but even basic information begins to alter the relationship.

He concludes that digital technology has the potential to either enhance or confound therapy.

When it comes to technology and psychotherapy - nothing is simple.