Exploring how digital tools are changing the way we develop alliance with our clients
What is significant about the use of email, personal business websites, Skype, texting, Facebook, etc. for the psychotherapist? Are there ways these tools enhance the therapeutic alliance or impair it? 
Is this a curiosity for you?How are these current human crafted technological changes impacting our relationships and our understanding of not only the direction that we are evolving as therapists using digital tools, but more importantly, the SPEED with which these changes are occurring.
Internet media tools have increased and facilitated the capacity for a person to communicate, not only with one, but also with many simultaneously. And the speed with which information flows is incomparable to any other time in history. We can take a photo or text a short message, and in a split second, that image or idea can go half way around the world. Information going viral is a common notion today. Does this calm our nervous system, or does it agitate it, or both? Do we feel more connected or less, safer or more at risk of being hurt? Perhaps it is not either/or, but both/and. Is there a sense of information flowing so fast that it becomes disorganizing to our interactional systems?
Our introduction to an individual has swiftly changed. Business colleagues introduce each other by way of email, text and LinkedIn. Love mates are often introduced through some kind of online matchmaking service. The initial meet and greet is done through iconic winking, email, and text. Emerging and continuing relationships maintain object constancy with the help of periodic and continuous love taps through texting. Digital interaction has in less than three decades become an integral part of our worldwide routine providing the illusion that our friends and intimate others are only one tap or one click away.
To the seeking client, the therapist is "the product", and the client is "the consumer." With so many therapists available online, the client approaches the therapist as a commodity. Especially among the nimble and agile digital natives (those born post 1980 who naturally are inclined toward the use of digital tools), the idea of finding a therapist (maybe like an intimate partner) vis a vie a search engine is quite normal. They rely less on personal references and feel perfectly at ease to shop around online. After one or two initial sessions, the client may write a short email: "Thank-you for the session, but I don’t think we are a match”. The relationship is expediently and efficiently closed, similar process to how one finds a “match” on Okay Cupid or Match.com. The client continues her/his hunter-gatherer routine. No need for extra sessions or face-to-face exploration about where the resistance showed up. Was there a mis-attunement? Was there a communication rupture? Those moments that may be grist for the mill in a collaborative therapeutic alliance are dropped. In spite of a signed protocol, to not use digital messaging or voicemail to end a relationship, this type of unilateral assessment and termination is becoming more common.
Relationship always rides the risk of failure to empathize and attune, which is why we attempt to safeguard the relationship with some kind of structure, including spelling out expectations, writing protocols and standards of ethics – to remind each other about what are the boundaries for cultivating a wholesome relationship and when is it out of integrity. The issue today is how to define integrity that reflects the context we are living in. We have to be cautious when a relationship is reduced to a commodity that can be acquired and dispensed of at the strike of a click.
Bottom line, technology is neutral, it is neither good nor bad. For most psychotherapists the psychotherapy relationship has long ago left the couch, but is it ready for a digital format? Is it possible that some patients, especially youth, the generation that experiences digital ware as “organic”, may feel more comfortable communicating vulnerable content through text? The therapist who works with youth today knows– this is part of their culture and therefore how these kids use these tools is paramount to understanding their social and even family life communication patterns. Kids flash photos to each other that only last a maximum of 3 seconds before they dissolve into cyber space. They rarely use phone, voicemail or email, but rather send messages through SMS, twitter, Instagram, Facebook, etc. There is a lot of excitement and candor conveyed through these means although admittedly, the sphere of influence is uncontained. Although we speak affectionately and with admiration about the phenomena of the democratization of information, clearly, there can also be unintended consequences.
At its essence, the task of the therapeutic relationship is about healing intimacy capacity, increasing the ability to bond and attach to another. Sue Johnson, author of Emotionally Focused Therapy says,“ Attachment is a theory of affect regulation and how it is accomplished through relationship. Contact with a responsive attachment figure calms the nervous system and teaches that nervous system to calm. Attachment security is the ability to maintain or regain emotional balance in order to avoid chaotic reactivity that shapes mental disorganization."
Ninety-three therapists responded to a survey about their use of digital tools. All agree that “yes, email does increase accessibility”, but this does not translate necessarily as more engagement, more responsiveness or a representation of the relationship being “a safer haven”. In fact, some are worried that it muddies the boundaries, introducing ambiguity into the system. A few therapists questioned whether it may support a sense of entitlement – an expectation that we are available 24/7. Others asked how do we track nuance and tone in an email sent to us, and how do we send back “just enough” so the client knows we received the email, that we care about what he/she is saying, and that the content will be addressed in the next session. It begs the question for therapists: What are the expectations we ought to set for our clients? What shall we make explicit? How shall or shall we not respond to an email?
Although digital tools may not be changing the goal of the therapeutic alliance, they are suggesting a change in the frame. If a client sends a text to inform the therapist they are running late, (“I’m on my way”), they are more likely to have some of the shame of tardiness assuaged by the time they arrive in the room. If the therapist reaches back with a text to say, “take your time – I am here” it may calm the nervous system, both theirs and the therapist. However, is it an obfuscation of an issue that needs to be addressed in person? If so, it may not be an enhancement of the attachment system. And it is done instantaneously. Clearly, the frame is altered. The boundary seemingly for the client, is experienced as expansive, made possible by the immediacy of the response. Seems like a good use of a tool. Is it also in context with “the times”?
A growing number of therapists and coaches are using video-conferencing formats to work with clients who find it easier to meet virtually than in-person. This format is certainly becoming more typical for the teacher-student context. There will always be both a bright side and a dark side to these formats. The skeptics and the fearful may ask: Are these formats shortcuts to intimacy, are they encouraging faux intimacy? Others may say these are just advanced tools, not much different than the telephone. We all surely agree that the pace of interaction is exponentially faster, and that alone has an effect. If these communications are moving more rapidly through channels, could it translate as less sincere, or less deep? Or could they be interpreted as more frequent, greater accessibility, therefore reassuring that someone is constantly there for us?
We are obviously in a post-secret and Big Data era, and so it makes sense we are exploring the relationship with technology use and how it may or may not support secure and confidential relationship systems. How may we approach the use of technology with openness and curiosity while also applying our common sense to evaluate both the benefits and limitations of these electronic means? Hopefully we will continue to inquire as to what is appropriate, what is meaningful, and what uses of technology are helpful to the therapeutic alliance.