Fitness for Duty Evaluations (FFDE)

A psychological Fitness for Duty Evaluation (FFDW) is typically employer driven and is initiated when an employee may be unable to safely or effectively perform their job functions and it’s reasonable to believe the cause could be ascribed to a psychological impairment or condition. It’s important to remember that a FFDE is DIFFERENT than a Pre-employment psychological evaluation, a stand alone clinical evaluation, or other types of forensic evaluations (like Worker’s Compensation). A FFDE is typically initiated for an employee that’s already been employed but his/her behavior has become troublesome. Some examples might include the following: 1) an employee has a history of good conduct but there’s a sudden onset of hostility, irrational speech, withdrawal, or isolation; 2) allegations of unexplained or excessive use of force; 3) threats of violence; 4) the employee displays behavioral problems that suggest difficulty with effectiveness or judgment; or 5) reports of bizarre off duty behavior. According to the American Disabilities Act (ADA), there are some conditions that allow the employer to initiate this type of examination of an employee. Notably, an employer can require a medical examination “as long as the examination or inquiry is shown to be job related and consistent with business necessity…or that an individual not pose a direct threat to the health or safety of other individuals in the workplace.” (ADA, Title I). After evaluating the employee, a psychologist can determine, that due to a psychological condition, it is reasonable to believe that the condition may prevent the employee from safely and effectively performing the essential functions of the position held by the employee. Alternatively, if the psychologist feels this standard is not met, the employee will be deemed able to return to their duties. 

The Las Vegas Massacre - How to Cope

The deadliest mass shooting in modern US history occurred in the evening hours of Sunday, October 1st, in Las Vegas during an outdoor concert. By now we all know the details, the name of the shooter, some of his history, and many names of those killed. But do you also know anyone that survived this horrific incident? Maybe someone you know was there and survived the incident intact but with some cuts and bruises. Or maybe it was you? There were reportedly 22,000 in attendance at the concert so it’s safe to say that many people were impacted.

 

Because of the life threatening nature of the event in Las Vegas, it’s safe to say that thousands of people will walk away from the experience with not only cuts and bruises but also some confusing emotional responses. I’m here to talk about that.

 

Post-traumatic Stress Disorder (PTSD) is now a term heard by the general population more than ever before. Not only are many returning military veterans struggling with the symptoms of this disorder but also any individual who has faced a traumatic event certainly faces the likelihood of developing symptoms. If you, or someone you know, experienced the massacre on Sunday, you could potentially develop symptoms of PTSD and it’s important that you know what to do next.

 

Certain criteria must be met for the diagnosis of PTSD to be made. First, the individual has to experience, witness, or be confronted by an event that involves actual or threatened death or serious injury. The individual must ALSO respond by experiencing intense fear, helplessness or horror. If an individual was at the concert on Sunday, they will likely fit this description.

 

There are three categories of symptoms that point to someone potentially developing PTSD. The first category involves the individual repeatedly re-experiencing various facets of their experience. They ruminate about the sound of gunshots, for instance. They keep remembering the bodies they saw on the ground. They remember crying. They can’t seem to stop thinking about their experience, and they even probably dream about it. What’s important is that these thoughts are INTRUSIVE, DISTRESSING, and PERSISTENT. They can’t seem to stop brooding or ruminating.

 

The second symptom category is taking great lengths to avoid aspects of the trauma. This often takes the form of not wanting to talk about it, avoiding anything that might remind them of the event, including the news; avoid talking to people who were there with them, or some other reminder of the event. In this case, the person might avoid going to another concert, might avoid large crowds, or might avoid any sounds that remind them of the gunshots, like the sound of motorcycles or fireworks. Another example of something that might occur is the inability to recall an important aspect of the experience. For instance, their timeline is missing important sections and they can’t remember how they got from one place to the next.

 

And then finally, the third symptom category includes persistent symptoms of increased arousal. That’s a fancy way of saying difficulty falling or staying asleep, outbursts of anger or significant irritability, or an exaggerated startle response. The person is jumpy, easily startled, and feels constantly “on edge.”

 

If you, or someone you know, seem to fit these descriptions, there are some important things that can be done to make sure the symptoms don’t worsen. First, it’s absolutely essential to get help; specifically, professional help. A therapist who specializes in trauma is trained to help walk you through this experience. Some people reading this might be tempted to think they can do this on your own. THAT thought is absolutely false. The QUICKER you reach out for help, the more likely you’ll heal from this experience and more quickly. And a therapist won’t respond with clichés (i.e. – you should be grateful that you survived this!). Study after study indicates that talking through an event like what happened in Las Vegas is associated with a reduced risk of developing PTSD.

 

Secondly, it’s absolutely essential that you acknowledge you need help to your family and friends – and that you TALK to them. I say this with a caveat though. If there is a family member or friend that just doesn’t seem to know how to respond to your tears and distress; if they respond in a way that dismisses or invalidates your distress, then find a different friend or family member. Research after research study shows that one of the things that helps someone deal with a life-threatening event the most is the experience of being connected to those you love, of feeling heard and supported. In other words, you must feel socially supported.

 

Thirdly, try and return to your normal schedule as soon as possible. I know this may be hard for some. Traveling on the metro, listening to the song Jason Aldean was singing when the shooting started, working with large groups of people, or driving on the freeway next to motorcycles might bring back horrible recollections of the images, sights, and sounds that feel distressing and remind you of what happened. However, as best you can, try to return to your normal life as soon as possible. Over time, it’s like your psyche and brain need the predictability of your everyday life. And it will gradually get better.

 

And lastly, try and remember that your feelings are going to be all over the place. They will also feel confusing. You’ll likely feel both heartbroken and guilty. You’ll feel sad. You'll feel angry. These are NORMAL feelings/responses to an ABNORMAL event. It makes sense that you would feel sad, right? People were KILLED at this event. That is sad. It’s also heartbreaking that innocent people who were enjoying something benign like a country music concert are now no longer alive. It’s also normal that you would feel guilty. You survived. Others didn’t. That’s going to take some time to journey and process.

 

My last thought – don’t go this alone. Get help, reach out to those you love and need. Life will return to some normalcy eventually but for now it’s important to get the support and help you need. 

My first podcast discussion!

I was recently invited to join a panel of 3 other psychologists to discuss the 2016 election. I know, I know, people are growing weary of this. But if you have an interest and a couple of extra minutes in your day, go to the following Twitter link to find out more. It might be worth a listen.

https://twitter.com/PsychRally/status/790581244773924865

A Psychologist's View on Why Trump is Polling So Well - Part 2

It is no secret that our nation has been experiencing chronic dissatisfaction with the politics of Washington. Congress’s approval ratings are abysmal and have been for a long time. Both sides of the aisle, Democrats and Republicans, seem to be really good at pointing the finger, causing stalemates, and getting very little accomplished.  This impasse is even potentially putting our lives at risk on a daily basis. In a recent 60 Minutes segment called “Falling Apart,” Steve Kroft reported on the aging infrastructure in our nation. Roads, bridges, and airports are “out of date,” he said. The main reason for this massive problem is the inability of our current government to raise the necessary funds. “Another example of political paralysis in Washington,” Steve Kroft chirped.

Adding to this sense of national helplessness are the colossal cultural shifts occurring and the enormous global issues facing our nation. Take the issue of gay marriage. For those staunchly against the redefinition of marriage, I imagine it feels deeply alarming to witness national opinion shifting on a belief that was so assumed for many centuries. It even feels like an immense spiritual and cultural crisis for some. I also suspect that the repeated instances of mass shootings contribute to our national fear, particularly when the discussion after is so riddled with strong opinions about the issue of gun control. Then there’s the Affordable Care Act – and our conflict with the Middle East – and the issue of global warming – and the drought in California – and …well, you get my drift. It is my opinion that national and world events leave us feeling nervous, scared, and perhaps even helpless - no matter what political persuasion we might espouse. What I’m trying to say is that the combination of all these events and circumstances can leave us feeling vulnerable.

Whenever humans face a situation that stirs feelings of helplessness or fear, they’ll do a lot to try and AVOID it. It’s why we have a hard time facing the loss of a beloved lover or friend. It’s part of the reason why grieving a death is so painful. It’s why we find facing our own limitations difficult.  It’s why parents have a hard time letting their teenage children have some independence. The feeling of helplessness, or fear, is uncomfortable, and it’s inherently difficult to lean into or tolerate it. We don’t tend to like feeling vulnerable.

So what does all this have to do with Donald Trump?

When feeling helpless, scared, and nervous, we humans tend to respond in typical ways. We try to take back control. Depending on the situation, we might get angry. We want to feel omnipotent. We want to feel powerful. And therein lies the seduction of Donald Trump. On the face of it, Donald Trump is not an obvious choice for President. He’s failed at marriage and business numerous times; he says profoundly offensive things; and he’s deeply narcissistic (more than your average politician!). However, for many I suspect he feels like a superhero, able to swoop in and regain control, leaving us all feeling less scared, vulnerable, and helpless. Without being able to provide details, Trump promises to subdue Isis, take back trading power from foreign entities (such as China and Mexico), build a wall between the US and Mexico, and tax the wealthy. When he’s pressed for details during interviews, Trump frequently says, “I know how to do it.” Or “We just do it.” Just because he says he can do it, it can be done. Because he says he can take back control from foreign powers, it will be accomplished. Just because he says he will build a wall, it will be completed. “It will be an amazing wall,” he said in a recent interview. He’s a “superhero” – able to regain control, punish the wealthy, put money in your pocket, and re-establish our power in the world – all in one bounding leap. He’s omnipotent. He’s also unpolished in how he expresses his opinions. I suspect that because of the chronic paralysis of Washington, our nation is frustrated and angry – very angry – and I wonder if some are tired of polished candidates that say all the right things but don’t follow through. In contrast, Trump is uncouth, brash, and cusses on national television. He’s a bully. I think some actually like it because it’s mirroring their own anger and frustration at Washington. He’s the bully that can go in and fix everything. Trump is saying what some wish they could say.

Ultimately, I doubt Trump will make it to the White House. But I do think the amount of support for his campaign reflects a dynamic that frequently occurs within the human psyche – when we feel helpless, vulnerable, and scared, we overcorrect by wanting control, wanting to feel powerful, becoming angry, and denying the layered complexities of life as it really is.  It is my humble opinion that the support for Trump represents and embodies that over-correction.

How to Find a Therapist

I can imagine that trying to find a mental health provider might feel like a daunting task, especially with so many different suffixes. You’ll see PhD, PsyD, LMFT, LPC, or LCSW. You also might see M.D., MA or the term Psychoanalyst. What do they all mean, you might wonder? The following is my attempt at distilling the various options in a quick and concise manner. That way, you, the consumer, can be better informed about the various levels of credentials and corresponding training, enabling you to make the best choice.

Are all THERAPISTS the same?

The term " Psychotherapist" is actually an unregulated title, meaning that anyone can use it to identify the type of work they do. There are no legal restrictions on designating oneself as a psychotherapist. The training and experience of each of these professionals is different and therefore their approach to psychotherapy will most likely be different. Typically, psychotherapists are one of the following:

Clinical Psychologist
A Clinical Psychologist is an individual with a doctoral degree (usually a Ph.D. or a Psy.D.) in clinical psychology who has training and experience in understanding human behavior, brain-behavior relationships, and the diagnosis and treatment of emotional disorders. They may provide psychotherapy, psychological testing, supervise other mental-health providers, or teach. Clinical psychologists have acquired their skills through a rigorous graduate school curriculum that is accredited by the American Psychological Association, received substantial training experiences in mental health settings, extensively researched an area of academic interest, and written and defended a dissertation. Because of their doctorate level training, clinical psychologists can also pursue specialized training in neuropsychology, forensics, industrial psychology, expert witness, and family mediation for the court system. In order to become licensed to practice psychology, individuals must complete an approved internship, receive significant post-doctoral experience under supervision, and pass a series of licensing exams.

Psychiatrist
Psychiatrists are physicians who earned a medical degree (M.D.) and completed specialized training internships and residency in psychiatry (a medical specialty focusing on the study, diagnosis, and treatment of mental illness). They often go on to train in post-doctoral fellowships in psychiatry and have ample psychiatric hospital experience. Psychiatrists are specialists in the prescription of psychotropic medications, and are the only mental health specialists who can prescribe medications that treat psychiatric conditions (except in the US Army, Illinois, Louisiana, and New Mexico. Psychologists also have prescribing privileges in those states/jurisdictions).

Clinical Social Worker
A Licensed Clinical Social Worker (LCSW) holds a masters degree in social work. Many go on to secure further clinical training in areas of specialized interest. They are trained in both psychotherapy and social interventions aimed at helping the individual cope with problems in his or her environment and/or relationships with others. They may also provide case management and community consultation, but cannot do psychological testing, nor prescribe medications.

Marriage and Family Therapist
MFT’s (individuals with a Masters degree in marriage and family theory) may become licensed by the state to practice psychotherapy. MFT’s generally focus on diagnosis, treatment, evaluation, assessment, counseling, and management, of mental and emotional disorders, whether cognitive, affective or behavioral, within the context of marriage and family systems.

Counselors
Counselors (usually individuals with a masters degree in education, counseling, or psychology) may become licensed by the state to practice counseling. Their designations are usually Licensed Professional Counselor (LPC) or a Master’s of Arts or Science (MA or MS) with a particular focus in Clinical Psychology. Counselors generally focus on problem solving, prevention, development, and adjustment. They often provide psycho-educational techniques focusing on lifestyle and career development, social, cultural, or family issues, and substance abuse.

Psychoanalyst

Psychoanalysts already have a matriculated degree (such as a psychologist, MFT, or psychiatrist) but are interested in pursuing the study of psychoanalysis, which is often another 4 – 5 years of training! The psychoanalytic doctorate is made up of two parts: a clinical training component followed by a research component. The degree usually consists of undergoing one’s own psychoanalysis (meeting with a psychoanalyst 3 – 4 times a week), methodology seminars, research workshops and writing a thesis.

Reasons Why Trump is Polling So Well - Part I

Donald Trump is a narcissist – diagnostically so. Narcissists tend to exude a sense of self-importance, show a lack of empathy, and have a profound need for admiration. (Trump cannot build anything without putting his name on it!)  A narcissist also typically believes they are special and unique and they tend to exude a sense of entitlement - the individual believes they deserve special treatment. They also frequently exhibit arrogant, haughty behaviors and attitudes. Another little known fact about narcissists is their capacity to show contempt. If someone disagrees with them (in other words, doesn’t show them the admiration they feel they deserve), they’ll show contempt by eviscerating the other person. People witnessed this during the Fox News debate when Trump criticized the female moderator after she asked a challenging question. Narcissists cannot help themselves and, even on national television, Trump could not either. Ironically, narcissists are popular at first. It’s only later that they get into difficulty interpersonally. And because of a narcissist’s high levels of grandiosity and superiority to others, they eventually have trouble with any type of long-term relationship. Individuals who are in relationship to a narcissist eventually feel exploited. (How many times has Trump been married?)

If Donald Trump were a certified narcissist, why would he be polling so well as a potential President of the United States? Why aren’t more people actually disturbed by his interpersonal dynamics? I’d like to address that question with a two-fold answer. I’ll provide a superficial answer first. Then, in Part 2, I’ll try and address the question from a deeper, analytic point of view.

A recent study done by Back et. al (2010) provides a possible answer as to why Trump is polling so well at the moment. In the study, 73 college freshmen that had never met each other took turns standing up in front of the room and introducing themselves. They were then asked how likable each speaker was and how much they’d like to get to know the speaker better. Interestingly enough, it was the most narcissistic students (they were tested and scored high on a questionnaire) that were better liked. And not only that but the type of narcissism that scored the highest on likeability was the most malignant kind, meaning the type of narcissist that actually enjoyed manipulating and exploiting people. It was the manipulators and exploiters who were the most popular when they introduced themselves!

Interesting right? But I bet you're still wondering how in the world can this be? It’s actually quite simple. The malignant narcissistic tend to exude four attractive characteristics when you first meet them. They have charming facial expressions, they dress well, they can be verbally witty and find unforgettable ways to introduce themselves, and their body language tends to be self-assured. They are also often very successful. Unconsciously, we humans feel naturally drawn to these characteristics when we first meet someone. When someone exudes an air of self confidence, is interesting to talk to, or seems successful, we naturally TEND to like them and feel drawn to them.

(To be Continued)

Psychological Evaluations for Surrogates and Egg Donors

The American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology make a very strong recommendation that both surrogate candidates and egg donors undergo a psychological screening before being cleared. Hence, most reputable clinics or agencies that work in this field require their egg donors or surrogate candidates to do just that. Think about it for a second. If you were someone in the market for securing an egg donor, wouldn’t you want that individual to be screened for a history of mental illness? And for “open donors,” contact between the child and the egg donor is legally allowed once the child reaches 18 years of age, suggesting that a future, long-term relationship might transpire. Any thoughtful potential parent will want to know the mental health history of the individual whose genetics will be forever embedded in their child, as well as knowledge of their socio-emotional capabilities. The genetics of that person will be forever a part of one’s family. Likewise, when it comes to choosing a gestational surrogate, the potential impact of the relationship between the gestational carrier and intended parent should be explored, as well as any plans that may exist relating to disclosure and future contact. Although the genetics of the surrogate are not at play here, their family and socio-emotional world is. The environment within which the growing fetus/baby is developing includes not just the physical world of the carrier’s uterus but also the psychological, emotional, spiritual, and social components as well. For example, a review of research on prenatal depression effects on the fetus and newborn suggests that they experience prenatal, perinatal and postnatal complications. Fetal activity is elevated, prenatal growth is delayed, and prematurity and low birth-weight occur more often. Being a gestational surrogate is serious business and the candidate needs to be screened carefully. At the same time, it is important to keep in mind that egg donors and surrogates provide a useful and life changing service. For intended parents who cannot have children the traditional way, these individuals provide something that otherwise would not occur and that’s pretty cool!

Choose Life

"Choose life."  That's God's call for us, and there is not a moment in which we do not have to make that choice.  Life and death are always before us.  In our imaginations, our thoughts, our words, our gestures, our actions ... even in our nonactions.  This choice for life starts in a deep interior place.  Underneath very life-affirming behaviour I can still harbour death-thoughts and death-feelings.  The most important question is not "Do I kill?" but "Do I carry a blessing in my heart or a curse?"   The bullet that kills is only the final instrument of the hatred that began being nurtured in the heart long before the gun was picked up..."

Henri Nouwen

Moments of Meaning - Therapists tell THEIR side of the story!

There is often stigma attached to psychotherapy. I hear it all the time - in the media, comments made by clients, or by fearful family members. But if you take a moment to listen to these therapists tell their side of the story, you'll be touched by their candor, their humanity, and the ways they were touched by profound moments with their clients. Psychotherapy can be a beautiful endeavor, life changing, and result in deep lasting change. So go to the following link and see, watch, and hear for yourselves.

http://www.momentsofmeaning.org

Psychotherapy is for "Crazy people" - or is it?

Psychotherapy is for “Crazy People” – or is it?

Although many of Sigmund Freud’s theoretical ideas have since been debunked or altered in significant ways since his lifetime, one the ideas of his that I find still relevant today is the idea of defense mechanisms. I say this because I see them emerge all the time in my psychological practice. Defense mechanisms operate at an unconscious level and help ward off unpleasant feelings (i.e. anxiety) for the individual. Freud’s original list included such defenses as projection, regression, displacement, and denial. (More have been added since his time!)  It’s important to note that even healthy people use different defenses throughout life. For instance, sublimation can be useful. Sublimation is turning an uncomfortable feeling into something acceptable – like turning aggression into boxing or marathon training. It can be an adaptive response to an uncomfortable feeling. A defense mechanism becomes pathological only when its persistent use leads to maladaptive behavior such that the physical or mental health of the individual is adversely affected. For example, an individual who experiences social anxiety may avoid so many social situations that her/his ability to engage in normal adult behavior becomes compromised. Perhaps the individual has dreams and goals for his/her life but can never take the steps toward their fruition, leaving them feeling stuck and depressed. One of the defense mechanisms I most often see is that of Withdrawal – or what I like to call avoidance. Withdrawal entails removing oneself from events, stimuli, and interactions to avoid being reminded of painful thoughts and feelings. The common stigma attached to psychotherapy is that it’s for “crazy folks.” Or that it’s an endeavor only to be pursued for “weak” people. On the contrary, pursuing and committing to the process of psychotherapy actually takes a lot of courage and has consistently been shown to result in greater psychological health and more contented human beings. Believing that therapy is only for weak or crazy people is actually a perfect example of a defense mechanism – it’s finding a very creative way to avoid an uncomfortable situation BECAUSE of the difficult feelings that can emerge with authentic self-reflection.  Once an individual begins therapy, it’s also not uncommon to see missed or cancelled sessions (always for VERY good reasons, mind you!) or discussing safe topics and avoiding the more difficult ones.  The human being is very creative and often committed to avoiding the very thing that needs to be addressed. Hopefully, with the assistance of a safe and genuine psychologist, people can overcome humanity’s natural tendency toward avoidance and face their pain (or difficult feelings), allowing themselves to experience greater freedom and healing.

 

 

Happy National Psychotherapy Day!

Happy National Psychotherapy Day - 9.25.14

 

Fight Therapy Stigma

Educate the Public

Support Community Mental Health

Share Effectiveness Research

& 

Wear Something Turquoise to Show Support!

 

Stay tuned for video from last week's therapy storytelling event in Pasadena, California, “Moments of Meaning.” In our first public event, we gathered six local therapists to talk about the most incredible moment from their practice (de-identified, of course). It was like a TED talk or Moth Radio Hour for psychotherapy, promoting and demystifying psychotherapy one moving story at a time. They’ll be edited and ready to go viral soon! 

 

"I'm pleased to support National Psychotherapy Day and honor the therapists and patients who courageously travel together on this most intimate, meaningful and big-hearted journey." - Irvin Yalom, M.D.

Six therapists tell funny, touching, thought-provoking moments...

Psychotherapy is a mysterious art, and this mystery scares some people away. One in four Americans are afflicted with mental illness, but many avoid seeking help because of the shame and stigma about having and treating these problems. We’d like to present one entertaining, educational, and meaningful solution.

On Friday, September 19, a group of Pasadena therapists will demystify psychological treatment by giving a glimpse behind the doors of their own practice through a spoken-word performance. In the tradition of TED Talks or the Moth Radio Hour, these are funny, moving, engaging ten-minute stories from six real clinicians — client information appropriately disguised to protect confidentiality, of course.

This event is presented by the San Gabriel Valley Psychological Association (SGVPA) to raise awareness and funds for the San Gabriel Valley chapter of the National Alliance on Mental Illness (NAMI-SGV), in honor of National Psychotherapy Day. There will be wine, light appetizers and live music during intermissions to promote a festive, meaningful evening for all in attendance. 

Please join us for “Moments of Meaning” at the Senior Center in Old Pasadena (85 E Holly) on Friday, September 19th from 7 to 9pm. The cost is $15, and seats are limited. Email to RSVP: stephanie@drstephanielaw.com

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Taking Risks Seem to Encourage Growth

I’ve found myself reflecting on risks, taking steps of faith, and jumping into the unknown. I work in a field that inherently asks individuals to constantly take risks, to make oneself known, and to allow vulnerability. Theodore Roosevelt said it best: “It is not the critic who counts; not the man [or woman] who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man [or woman] who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly…who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly.” Research seems to indicate that taking risks or stepping into the unknown encourages anxiety and excitement, fear and anticipation. Somehow, the uncertainty, risk, and emotional exposure can leave one feeling enlivened and eager with the promise of possibility. As frightening as risk and vulnerability may be, it’s also the birthplace of love, authenticity, and meaning. As we play and work and live – both personally and professionally, the combination of blessings and challenges in life can leave you with the experience of living more fully.

Television Interview on the adjustment to American culture

The practical and psychological challenges of adjusting to the American culture is no more apparent than in the populations of 1st and 2nd generations of immigrants in the United States today. California, and especially Southern California, is a frequent destination for the immigrant population. As a local psychologist who often works with this particular population, I was interviewed by an international Chinese Television station. To view that interview, go to the following link:

http://www.ntdtv.com/xtr/gb/2014/05/24/atext1111593.html

Metaphor, Empathy, and Intimacy - Will Technology Circumvent?

One of the things that make us uniquely human, Summers (2013) states, is our ability to use metaphor. Within the context of psychotherapy, particularly because of the deep exploration of self it provides, the use of metaphor is a frequent consequence. If this opening up of creativity and the use of metaphor is uniquely human, how might constant interfacing with technology and mobile devices disparage this process?

Summers states that psychotherapy is a process between two people who engage each other for the express purpose of transforming and expanding the subjectivity of one party. The patient begins to understand herself more deeply. Subsequently, one of the hopes we have as therapists is that the transformative power of this very dynamic generalizes to other relationships and situations for our patients. The insights one gains in psychotherapy can begin to change relationships OUTSIDE of therapy. But if our patients live in a world of tethered technology, of potential disconnected-ness, doesn’t this circumvent the very changes we’re hoping to effect?

When considering the developmental arc of growth in the human being, the child is helped to master negative feelings by parental responses to the pain and the offering of a different viewpoint. Simply put, when a child is comforted and soothed, rather than dismissed, a child is left feeling valued and healthy self worth grows. As a result, the optimal conditions for the child are both mutual and self-regulation. The child learns to regulate his own emotional responses to life challenges. Children need the responses of primary caregivers to learn how to master their own feelings in order to learn how to self regulate. But what happens when mobile devices become so embedded in and between human interactions? Will our absence with each other serve to circumvent our learning to self regulate, to feel comforted by another’s response?

Summers makes the statement that concentrating on the patient in psychotherapy, with all his/her complexities, is a mode of engaging human experience that makes psychotherapy inquiry unique and powerful. This singular focus on the experience of the other person, might it be thwarted by constant interaction with “others” that are only experienced through email, text, or Facebook?  Doesn’t communication, when it primarily occurs through technological means, inherently create a wall of intimacy whereby the participants cannot intimately engage with one another?

This might sound a bit simplistic. The longer I’ve been a psychologist, the more I feel like the main goal of psychotherapy is not only assisting clients in gaining insight about themselves, but helping them learn to tolerate their God-given feelings, and thereby growing in their ability for intimacy and vulnerability. This seems to occur the most powerfully in-between people and WITH each other. While technology is not inherently evil, my fear is that our world of tethered technology provides a ready made defensive and avoidance of the very conditions that help us feel like humans. Instead of conversation over dinner together, we feel tempted to check our mobile devices. Instead of noticing each other’s facial expressions, and thereby allowing for connectedness, we gradually become more and more distracted from each other. Instead of starting conversations with others in parks, coffee shops, gyms, or the grocery checkout line, we play games on our phones, listen to music with earphones, or check our Facebook page. In essence, we lose our ability for human relatedness.

Mobile Technology: The Self, Shifts in Attitudes, and Computer Psychotherapy?

It is precisely in the interaction with another that the self grows and flourishes. When cyberspace is used as a means of forming relationships, it withdraws the nutrients people need for the growth of self and therefore impedes self-development. While most endorse the importance of conversation, few ponder the hard truth that dialogue is what makes us human and without the ability to converse, people are in danger of losing their very humanity. Cut off from the world of meaningful human conversation, the individual is left in a space that remains empty and static. The very same individual, in attempt to fill that void, will fill this void with the stimulation of technology, a strategy that only serves to leave the person even more removed from human relationships.

A powerful example of this shift in thinking is the finding that attitudes toward robots have shifted over the course of the past 20 years (Turkle, 2011). In the early years of robots, children tended to have doubts that robots could substitute for the human interaction they clearly preferred. But 20 years later, children were not so sure. Once robots could speak and express caring responses, American youth became less sure that robots were poor substitutes for the human touch. Now both children and adults are much more likely to believe robots can meet the needs of elderly persons. The importance of this shift, according to Turkle, is not so much the robots’ capabilities but in the transformation in the way young people see humans.

Research suggests that technological advances have had a significant influence on the way children and adolescents regard themselves and others. In some of Turkle’s early work (2004), many MIT and Harvard computer specialists tended to see their minds as computers, information processing organs, machines housed inside their bodies. At that time, such a mechanistic view of human being was found primarily among those who built computer systems. Today, however, this ideology has spread beyond those who work in information processing.

In perhaps the most troubling example of our shift in attitude, research is now indicating that technology has increasingly become a companion. There was a computer program designed at MIT in the 1970’s, called ELIZA, which engaged in dialogue in the style of a psychotherapist. A user could type a thought and ELIZA reflected back in language that offered support or asked for clarification. To “My father is making me angry,” the program might respond, “Tell me more about your father.” Subjects went from benign statements/questions like “How are you?” to “My girlfriend left me” within four or five interchanges.  Four decades later, after the first version of ELIZA, artificial intelligence known as “bots” present themselves as companions to the millions who play computer games on the Internet. It has come to seem natural to “converse” with bots on a variety of matters, from routine to romantic. Participants take the small step from having one’s “life” saved by a bot met in a virtual world to feeling affection toward it. A poignant and disturbing example of this shift in attitude was capture in the recent film, “Her,” starring Joaquin Phoenix. (For those who haven’t seen it, I highly recommend it!)

A natural outcome of this attitudinal shift is the contemplation of “Computer Psychotherapy.” In the late 1970’s, there was considerable reticence about computer psychotherapy, but soon after, opinions shifted. The arc of this story does not reflect new abilities that machines to understand people, but people’s changing ideas about psychotherapy and the workings of our own minds, both seen in mechanistic terms. Thirty years ago, psychotherapy or psychoanalysis, was seen as a context for coming to see the story of your life in new terms. This happened through gaining insight and developing a relationship with a therapist who provided a safe place. Today, many see psychotherapy less as an investigation of the meaning of our lives and more as an exercise to achieve behavioral change or work on brain chemistry. There is now increasing research that shows a greater willingness to enter into a relationship with a machine if people think it will help them feel better. This attitudinal shift risks many things – our souls, our humanity, our sense of self. 

Absence, the Facebook Façade, and Avoidance of Vulnerability

Robotics and connectivity call each other up in tentative symbiosis. The mobile device signals we receive tell us we’re together. Networked, we’re supposed to feel like we’re together but I have begun to wonder if our expectations of each other are so lessened that we can feel utterly alone (Summers, 2013). And there is the risk that we come to see others as objects to be accessed. In this new regime, a train station, café, or park is no longer a communal space but a place of social collection. People come together but do not speak to each other. Why is this? It is those on their mobile device who mark themselves as absent. Sometimes people signal their departure by putting a phone to their ear. But it also happens in subtle ways – a glance down at a mobile device during dinner or a meeting.  A place used to comprise a physical place and the people within it. What is a place if those who are physically present have their attention on the absent? Once we remove ourselves from the flow of physical, messy, untidy life, we become less willing to get out there and take a chance. When media is always there, waiting to be wanted, people lose a sense of choosing to communicate. How often do people now break up over text, rather than in person? And how many intimate “conversations” now take place over email, rather than in person? Research portrays Americans as increasingly insecure, isolated, and lonely. We work more hours than ever before and many have left behind the religious and civic organizations that once bound us together. (Turkle, 2014)

While for some, social networking and dating service websites have become a means to an end, for many people it has become the PRIMARY means for social interaction. Approximately 100 million people use Facebook in the US (Turkle, 2011). The average user has 130 “friends,” sends out 8 requests each month for new friends, visits the site 40 times every month for an average of 23 minutes per visit, and creates 90 pieces of content per month. As a whole, 30 billion pieces of content are shared every month leading to 770 billion page views in a typical month. In a few years, online communication has gone from a casual way of conversing to a primary method of social contact and interaction. “Being connected” used to mean an emotional bond but now refers to available communication technology. Turkle’s research found that the average adolescent fretted over their profile on Facebook, wanting to present an acceptable façade. Ages 13 to 18 were once the years of experimenting with identifications, they are now the years of profile writing, which Summers argues, is façade creating. These well-constructed facades would not be such a cause of concern if they were seen as acting. But these online personas are taken seriously.

Another thing I’ve found myself reflecting upon is that today’s instant cyberspace connections provide a ready defense against emotional vulnerability. One of the most dramatic findings is that this protectiveness has resulted in the inability to converse among many of today’s youth (Turkle, 2011). High school sophomore subjects readily admitted they avoid direct human interaction through the safety of the Internet.  For instance, texting is preferred because it allows greater control over the communication and less opportunity to feel rejected. Research findings show young people are using the Internet to stay away from the anxieties and vulnerabilities of direct emotional encounter. On the Internet one can ask someone for a date or break off a relationship without having to look into the eyes of the other or even hear their response. Internet communication has become a readily available means for maintaining the aloof, defensive stance adopted by many adolescents to defend against the vulnerability of emotional contact with others. Cyberspace communications tend to be brief, superficial, and do not require spontaneous responses. As a result, it provides a ready means to circumvent the anxieties embedded in interaction. One does not have to confront the spontaneous feelings of either intimacy or conflict when hiding behind the barrier of Internet space.

 

 

A conversation about the current age of mobile devices

We love our new technologies of connection. They have made parents and children feel more secure and have revolutionized business, education, scholarship, and medicine. They have changed how we date and how we travel. The global reach of connectivity can make the most isolated outpost a center of learning and economic activity. One would be hard pressed to not to find families out for dinner, each one glancing on their mobile device.

The contemporary technological world reflects a monumental shift in daily living. The home computer embedded technology into daily living to a far greater degree than anything before. But even then, a person must be in the location of the desktop to use it. Today’s technological world is differentiated from the other ages by its mobility and omnipresence. iPhone, Blackberry, iPads, and Android cell phones are a constant companion. It is this tethering to gadgets that makes the current technological society unique. Text messaging and social networking go on continually – during meetings, while on the phone, writing, doing homework, shopping, waiting in line, or listening to a lecture. Implicit in this constant connectivity is the idea that we increase productivity, a value of the highest order in the post-industrial world. Implicit also is how grandiose it makes us feel; that is, the wonders of mobile technology stimulate the idea of a feeling of exceptional power, an almost inhuman sense of oneself. However, is there a price we pay? In the early days of cell phones it was considered rude to answer a call in the middle of a conversation but within a few years, it’s now considered commonplace and acceptable. Technology not only intercedes between people, but it also takes priority.

In a discussion of the price we may pay for tethered technology, Turkle (2011) found that the impact of omnipresent technology on daily life left many white-collar workers expressing the feeling of suffocation at the expectation that they should be continually available. Business is done on weekends and evenings; and the expectation of continual availability is not uncommon. In essence, mobile technology has blurred the lines between work and home life. And speed has become the highest priority. The constant connectivity also comes with it a constant fear of falling behind, of failing to keep pace. As a society, we have adopted the principle that all should be done as fast as resources allow. When technology accelerates a process, the new speed becomes the new standard. Piaget, the famous developmental psychologist, was known for saying that once Americans discover a developmental process, the American will then ask, “can it be done faster?” Cyberspace has set a standard for speed that enslaves many people to the devices that were supposed to free them.

Research is also now revealing another price we pay for constant connectivity. Research is now finding that young people are doing homework while attending to Facebook, shopping, music, online games, texts, and videos. The omnipresence of mobile technology has led to a pervasive distractibility. Young people have difficulty maintaining concentration on a single activity. There’s a commonly held myth that by learning to manage a variety of task simultaneously, today’s youth are getting better at multi-tasking without the danger of any loss of performance. Research is actually showing the opposite; that is, in multitasking all tasks end up being performed at a subpar level. The reality is that doing several tasks at once serves to degrade performance on each one.

Another danger of our current age of mobile technology is the absent self. Texting and instant messaging are no longer primarily practical activities; they have become a way of life. It has become a venue for gossip and social conversation; and a popular source of seeking romantic partners. Research has found that from a means of quick communication to achieve quick goals, the Internet has become the way adolescents contact and relate to each other. As a result, today’s adolescents seem to feel unsure of what experiences even are outside of cyberspace communication. Today’s manner of continual, and for some almost nonstop, Internet contact, adolescents commonly lack the ability to be alone and reflect on their states of mind. When feeling lonely, the adolescent uses texts and the instant messaging of brief telegraphic communications to feel connected. This “contact” may take the sting out of loneliness but he/she is not engaged with the other. He gains neither the satisfaction of solitude, nor the enrichment of human connection. In other words, he is alone together. (Ideas were also taken from Frank Summers in "The Psychoanalytic Vision, 2103)