![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 39. This is the beginning of the thread.
Posted by Dr. Bob on October 5, 2000, at 10:09:11
Hi, everyone,
I belong to a group of therapists who are discussing the use of the Internet with patients. Some "working hypotheses" have been developed, and we'd like to know what you think about them. The originals are at:
http://www.rider.edu/users/suler/psycyber/workinghyp.html
I've selected, adapted, and regrouped them with Psycho-Babble specifically in mind. The numbers in parentheses refer to the original hypotheses. Any comments? Thanks!
Bob
--------------------------------
Hypotheses about Online Text Communication
A. Characteristics of online text communication
1. A person with a history of chaotic relationships, physical trauma, or strong feelings of shame or guilt tends to experience online text communication as safe. (1.3, 1.4, 2.4)
2. A person's writing style reflects aspects of their personality, and changes in it reflect changes in their thoughts and feelings. (6.1)
3. The "handle" a person chooses reflects aspects of their personality. (6.4)
4. If a person has a web site, it reflects aspects of their personality. Having others visit it and visiting those of others is emotionally significant. (7.6)
B. Positive aspects
1. The act of writing fosters self-expression, self-reflection, and cognitive restructuring. (1.2)
2. Online text communication that does not take place in "real time" enhances impulse control, self-reflection, and cognitive assimilation. (4.1)
3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)
4. The opportunity to send online text communications to others, even before --- or without -- any replies, can help a person feel the others are available. (4.3)
5. A person can use online text communication as a way to explore and experiment with new behaviors or different aspects of their identity. What they learn or rehearse online can be carried into their offline life. (7.2, 7.3)
6. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)
7. Access to online information tends to be empowering and transformative. (7.10)
C. Negative aspects
1. Online text communication is more subject to "simple" misunderstandings and conscious and unconscious distortions of meaning or intent. (2.1)
D. Potentially positive or negative aspects
1. With online text communication, a person can be less inhibited and -- deliberately or not -- more open about aspects of themselves, including their "true self". (2.2, 6.2, 7.1)
2. With online text communication, a person can be less inhibited and -- deliberately or not -- more likely to act out. (2.2)
3. With online text communication, a person can be -- deliberately or not -- more guarded about aspects of themselves, including their "true self". (6.3, 8.4)
4. Ambivalence about intimacy can be expressed as a preference for online text communication and its blend of openness and distance. (2.3)
5. Saved text can reduce errors in recall -- or be taken out of context, distorting its meaning. (3.2, 3.3)
6. With online text communication, others try to help more quickly by giving advice or problem-solving. (11.2)
E. Online support groups
1. Online support groups benefit from having rules about appropriate behavior, effective enforcement of those rules, and knowledgeable and confident leaders. (10.1)
2. Online support groups tend to be less cohesive. (10.3)
3. In online support groups, a person can explore and experiment with different "identities" at the same time. (10.7)
F. Therapy
1. Differences in status are less apparent in online text communication. Clinicians tend to be perceived less as authorities and more as consultants or even "twins". (11.4)
Posted by noa on October 5, 2000, at 12:07:15
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
>2. A person's writing style reflects aspects of their personality, and changes in it reflect changes in their thoughts and feelings. (6.1)
Comment: yes, but sometimes the personality that comes across in text is one that is rarely exhibited in person, or the relative intensity of that aspect of the personality is different, ie, some aspects find expression in writing and less so in person, and vice versa. Writing gives the opportunity to play and try out different aspects of our personalities.
4. If a person has a web site, it reflects aspects of their personality. Having others visit it and visiting those of others is emotionally significant. (7.6)
Comment: yes, I think that having others visit your website is incredibly significant, and a risk, if the person has also disclosed personal info and feelings in a forum like this.
1. The act of writing fosters self-expression, self-reflection, and cognitive restructuring. (1.2)
Comment: very much so, at times. For me, a significant problem is that a big part of my sense of self that is negative, is non-verbal, and feels beyond the reach of language. Writing helps in the attempt to bridge my cognitive/logical/verbal self to this non-verbal sense of self. I wonder if others have similar experiences?
2. Online text communication that does not take place in "real time" enhances impulse control, self-reflection, and cognitive assimilation. (4.1)
Comment: definitely. "Chat" rooms in real time tend to get kind of primitive. That happens here, too, though, and people can still be somewhat impulsive and reactive in this format, too, but less so than in real time. At the very least, even if they are as impulsive, it isn't as disruptive to other threads of conversation as it is in a real time chat format.
3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)
Comment: Yes, hearing something once, the idea might be lost, and thus not integrated as an "internal voice", but somehow having access to "quotable" text allows us to visit and revisit ideas which facilitates integration.
4. The opportunity to send online text communications to others, even before --- or without -- any replies, can help a person feel the others are available. (4.3)
Comment: Yes, I agree, and with the added benefit of not worrying if you are "bothering" them, ie, it is there for the other person to read at their convenience.
5. A person can use online text communication as a way to explore and experiment with new behaviors or different aspects of their identity. What they learn or rehearse online can be carried into their offline life. (7.2, 7.3)Comment: Definitely (similar to my comment above).
. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)
Comment: yes, and that is one reason it is so useful for people with social anxieties.
7. Access to online information tends to be empowering and transformative. (7.10)
Comment: I have found this so. I feel much more empowered as a patient, to be able to find information so easily about medications, different health issues, etc.
1. Online text communication is more subject to "simple" misunderstandings and conscious and unconscious distortions of meaning or intent. (2.1)
Comment: Don't we know it!!
1. With online text communication, a person can be less inhibited and -- deliberately or not -- more open about aspects of themselves, including their "true self". (2.2, 6.2, 7.1)
Comment: Yes, as I wrote about in an earlier comment. Mostly, I think this is a positive potential, however, I think that it could also provide opportunites for expressing negative, even dangerous aspects of personality, as well as opportunities to "practice" these aspects and gradually loosen inhibitions, to the point that someone might turn to actually acting out these aspects. I think this is an especially important issue with kids, because their personalities are still developing, and are more vulnerable to this influence.
4. Ambivalence about intimacy can be expressed as a preference for online text communication and its blend of openness and distance. (2.3)
Comment: Yup! I agree this could go either way--either to enhance development, or to shield from taking "real" and necessary risks.
1. Online support groups benefit from having rules about appropriate behavior, effective enforcement of those rules, and knowledgeable and confident leaders. (10.1)
Comment: Definitely!!!
2. Online support groups tend to be less cohesive. (10.3)
Comment: Less cohesive than what? In-person support groups? Perhaps.
3. In online support groups, a person can explore and experiment with different "identities" at the same time. (10.7)
Comment: Yes, and this can be helpful to a person who is just getting their feet wet in connecting with others, but it can also lead to big problems, as we all know here.
1. Differences in status are less apparent in online text communication. Clinicians tend to be perceived less as authorities and more as consultants or even "twins". (11.4)Comment: Wow, how interesting!! Throws a whole monkey wrench into theory on transference/countertransference. Can you explain the "twins" concept??
Posted by Sigolene on October 5, 2000, at 14:56:49
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
I agree with your hypothesis.
But I think there's a big danger in exchanging between doctor and patient through internet. The danger is that the doc doesn't see the effect on the patient of what he says, at the moment the patient read the text. As many psychiatric patients tend to make misinterpretations of intentions of others (due to his/her projections linked with bad early experiences), they are prone to misunderstand. For exemple they could interpret a simple neutral message as a rejection. Normally in face to face situation, the intention of the doc can be seen in his non verbal attitude. And he can see the reaction of the patient to what he says. Normally the sens of a message is at 80% given by non verbal attitude of the speaker. But if he don't have this info, the patient could think: he/she hates me, he don't want to talk with me and so on...and the patient in left alone with these feelings.
I don't want to say that everything is bad with internet therapy, but just try to draw your attention on this particulary problem. I hope my english is not too bad and you understand what i mean.
Sigolene.
Posted by Cindy W on October 6, 2000, at 22:39:03
In reply to Re: Hypotheses about Online Text Communication » Dr. Bob, posted by Sigolene on October 5, 2000, at 14:56:49
> I agree with your hypothesis.
> But I think there's a big danger in exchanging between doctor and patient through internet. The danger is that the doc doesn't see the effect on the patient of what he says, at the moment the patient read the text. As many psychiatric patients tend to make misinterpretations of intentions of others (due to his/her projections linked with bad early experiences), they are prone to misunderstand. For exemple they could interpret a simple neutral message as a rejection. Normally in face to face situation, the intention of the doc can be seen in his non verbal attitude. And he can see the reaction of the patient to what he says. Normally the sens of a message is at 80% given by non verbal attitude of the speaker. But if he don't have this info, the patient could think: he/she hates me, he don't want to talk with me and so on...and the patient in left alone with these feelings.
> I don't want to say that everything is bad with internet therapy, but just try to draw your attention on this particulary problem. I hope my english is not too bad and you understand what i mean.
> Sigolene.Dr. Bob, I agree with most of your hypotheses about online text communication. Still, I'd rather see a live human being, f2f, because that adds a lot for me (the unambiguous nonverbal cues, I guess, plus the feeling that a real live human being cares...it's still hard for me to realize that when I write a message online, the person is reading it, and there is no immediacy of reply. --Cindy W
Posted by CarolAnn on October 7, 2000, at 10:22:56
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
Dr. Bob, this is the only point I totally disagree with:
> 7. Access to online information tends to be empowering and transformative. (7.10)Having been a 'late comer' to the internet, I'm sure that any dramatic change in myself, relating to internet use, would be extremely noticeable. Whether "online" or not, I have found the gathering of information to be neither "empowering" nor "transformative". I think that adding to one's store of knowledge could not empower or transform, unless the information is accompanied by a 'guide' (therapist) who would lead one to use the knowledge correctly, in order to be transformed, which would then lead to empowerment.
CarolAnn
Posted by noa on October 8, 2000, at 10:43:53
In reply to Re: Hypotheses about Online Text Communication » Dr. Bob, posted by CarolAnn on October 7, 2000, at 10:22:56
Carol Ann,
Interesting point, and I think a lot of doctors would agree with you, that patients need doctors to filter and guide the information.
However, the internet, for me, has given me unprecedented access to a wealth of information about health issues of interest to me, and being able to educate myself in this way has enabled me to seek out the care I needed. I would absolutely not have been able to do that without the internet.
This doesn't at all substitute for any of the doctors I see--psychologist, psychopharmocologist, endocrinologist, gynecologist, inernist. It has empowered me to ask the right questions, to work more collaboratively with my doctors. In the case of the endocrinologist, it actually allowed me to find the right doctor for me (through a recommedations page on a thyroid site).
At Syms, they say, "where an educated consumer is our best customer" and I think this is true a millionfold when it comes to healthcare, particularly in today's health care environment, when the average doctor spends about 4 minutes with each patient.
I have a "team" of very smart, talented, skilled, highly trained experts, whom I could never replace with internet information. But I think of myself as my own health care case manager, because there is no one else coordinating all the different elements of care, trying to integrate them and look at the whole picture. This role, which was only possible with the help of the internet, is the "missing puzzle peice" I needed.
Posted by Kath on October 9, 2000, at 10:55:01
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
Hi Dr. Bob,
I found this interesting. I recognize myself in most of the points. I only post under one name, however, so that point didn't apply to me. I'm not using the computer much anymore - I've developed hobbies, interests & friends & my available time has decreased. PB, in particular has been a very supportive & important part in my mental health - especially in feeling cared about & supported through a difficult time in my life.
Thanks, Kath
> Hi, everyone,
>
> I belong to a group of therapists who are discussing the use of the Internet with patients. Some "working hypotheses" have been developed, and we'd like to know what you think about them. The originals are at:
>
> http://www.rider.edu/users/suler/psycyber/workinghyp.html
>
> I've selected, adapted, and regrouped them with Psycho-Babble specifically in mind. The numbers in parentheses refer to the original hypotheses. Any comments? Thanks!
>
> Bob
>
> --------------------------------
>
> Hypotheses about Online Text Communication
>
> A. Characteristics of online text communication
>
> 1. A person with a history of chaotic relationships, physical trauma, or strong feelings of shame or guilt tends to experience online text communication as safe. (1.3, 1.4, 2.4)
>
> 2. A person's writing style reflects aspects of their personality, and changes in it reflect changes in their thoughts and feelings. (6.1)
>
> 3. The "handle" a person chooses reflects aspects of their personality. (6.4)
>
> 4. If a person has a web site, it reflects aspects of their personality. Having others visit it and visiting those of others is emotionally significant. (7.6)
>
> B. Positive aspects
>
> 1. The act of writing fosters self-expression, self-reflection, and cognitive restructuring. (1.2)
>
> 2. Online text communication that does not take place in "real time" enhances impulse control, self-reflection, and cognitive assimilation. (4.1)
>
> 3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)
>
> 4. The opportunity to send online text communications to others, even before --- or without -- any replies, can help a person feel the others are available. (4.3)
>
> 5. A person can use online text communication as a way to explore and experiment with new behaviors or different aspects of their identity. What they learn or rehearse online can be carried into their offline life. (7.2, 7.3)
>
> 6. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)
>
> 7. Access to online information tends to be empowering and transformative. (7.10)
>
> C. Negative aspects
>
> 1. Online text communication is more subject to "simple" misunderstandings and conscious and unconscious distortions of meaning or intent. (2.1)
>
> D. Potentially positive or negative aspects
>
> 1. With online text communication, a person can be less inhibited and -- deliberately or not -- more open about aspects of themselves, including their "true self". (2.2, 6.2, 7.1)
>
> 2. With online text communication, a person can be less inhibited and -- deliberately or not -- more likely to act out. (2.2)
>
> 3. With online text communication, a person can be -- deliberately or not -- more guarded about aspects of themselves, including their "true self". (6.3, 8.4)
>
> 4. Ambivalence about intimacy can be expressed as a preference for online text communication and its blend of openness and distance. (2.3)
>
> 5. Saved text can reduce errors in recall -- or be taken out of context, distorting its meaning. (3.2, 3.3)
>
> 6. With online text communication, others try to help more quickly by giving advice or problem-solving. (11.2)
>
> E. Online support groups
>
> 1. Online support groups benefit from having rules about appropriate behavior, effective enforcement of those rules, and knowledgeable and confident leaders. (10.1)
>
> 2. Online support groups tend to be less cohesive. (10.3)
>
> 3. In online support groups, a person can explore and experiment with different "identities" at the same time. (10.7)
>
> F. Therapy
>
> 1. Differences in status are less apparent in online text communication. Clinicians tend to be perceived less as authorities and more as consultants or even "twins". (11.4)
Posted by Dr. Bob on October 9, 2000, at 11:16:45
In reply to Re: Hypotheses about Online Text Communication » Dr. Bob, posted by Sigolene on October 5, 2000, at 14:56:49
> I agree with your hypothesis.
> But I think there's a big danger in exchanging between doctor and patient through internet...Sorry, I should've been more clear. Although the original hypotheses did mostly refer to a therapist and a patient communicating online, I tried to adapt them to the situation right here at Psycho-Babble: people supporting each other online. If you have any thoughts about e-therapy, please do share them, but I'm especially curious about the extent to which you think the hypotheses apply in *this* setting. Thanks!
Bob
PS: Also, for the record, the original hypotheses were drafted by John Suler, so I don't deserve any credit for them!
Posted by Dr. Bob on October 9, 2000, at 13:30:03
In reply to Re: Hypotheses about Online Text Communication, posted by noa on October 5, 2000, at 12:07:15
> [F] 1. Differences in status are less apparent in online text communication. Clinicians tend to be perceived less as authorities and more as consultants or even "twins". (11.4)
>
> Comment: Wow, how interesting!! Throws a whole monkey wrench into theory on transference/countertransference. Can you explain the "twins" concept??Thanks for all your comments! Let me just follow up on the above. What kind of a monkey wrench? Regarding twins:
> In ... the twinship or alter-ego transference, the patient perceives the therapist to be psychologically similar to himself or herself. Conceptually the patient perceives the therapist and himself or herself to be twins, separate but alike. In the twinship transference for the selfobject cohesion to be maintained, it is necessary for the patient to view the therapist as ‘just like me’ (Manfield, 1992).
--adapted from: http://www.npd-central.org/theories.asp
Bob
Posted by Dr. Bob on October 9, 2000, at 13:59:17
In reply to Re: Hypotheses about Online Text Communication, posted by Cindy W on October 6, 2000, at 22:39:03
> > I think there's a big danger in exchanging between doctor and patient through internet. The danger is that the doc doesn't see the effect on the patient of what he says, at the moment the patient read the text.
That's right, the doctor gets less information and might misunderstand the patient...
> > As many psychiatric patients tend to make misinterpretations of intentions of others (due to his/her projections linked with bad early experiences), they are prone to misunderstand. For exemple they could interpret a simple neutral message as a rejection. Normally in face to face situation, the intention of the doc can be seen in his non verbal attitude.
And it goes the other way, too, the patient gets less information and might misunderstand the doctor.
> > Normally the sens of a message is at 80% given by non verbal attitude of the speaker.
People have asked me for a percentage, and I've told them I didn't know. Do others agree with 80%?
> > But if he don't have this info, the patient could think: he/she hates me, he don't want to talk with me and so on...and the patient in left alone with these feelings.
> I'd rather see a live human being, f2f, because that adds a lot for me (the unambiguous nonverbal cues, I guess, plus the feeling that a real live human being cares...
Thanks for raising those scenarios. One line of thinking might be that it's *helpful* for those cues to be missing. Because feeling hated or not cared about would be important to address. And if they met in person and there were cues that reassured the patient, those feelings might never be brought up. What do you think?
Bob
Posted by Greg on October 9, 2000, at 18:40:51
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
> Hi, everyone,
>
> I belong to a group of therapists who are discussing the use of the Internet with patients. Some "working hypotheses" have been developed, and we'd like to know what you think about them. The originals are at:
>
> http://www.rider.edu/users/suler/psycyber/workinghyp.html
>
> I've selected, adapted, and regrouped them with Psycho-Babble specifically in mind. The numbers in parentheses refer to the original hypotheses. Any comments? Thanks!
>
> Bob
>
> --------------------------------
>
> Hypotheses about Online Text Communication
>
> A. Characteristics of online text communication
>
> 1. A person with a history of chaotic relationships, physical trauma, or strong feelings of shame or guilt tends to experience online text communication as safe. (1.3, 1.4, 2.4)I don't believe that is necessarily true. A lot of people with this type of history communicate via the net because they want to be heard, not because it's safe.
>
> 2. A person's writing style reflects aspects of their personality, and changes in it reflect changes in their thoughts and feelings. (6.1)I think that's very true. I see that in myself.
>
> 3. The "handle" a person chooses reflects aspects of their personality. (6.4)Partially, but I think it also represents a need to protect themselves from others getting too close.
>
> 4. If a person has a web site, it reflects aspects of their personality. Having others visit it and visiting those of others is emotionally significant. (7.6)Absoulutely true.
>
> B. Positive aspects
>
> 1. The act of writing fosters self-expression, self-reflection, and cognitive restructuring. (1.2)Writing is the purest form of expression and self-recognition.
>
> 2. Online text communication that does not take place in "real time" enhances impulse control, self-reflection, and cognitive assimilation. (4.1)For some perhaps, for others like me (especially during manic episodes) it gives you the opportunity to speak what's on your mind without fear of immediate recrimination. I often go back and read my own posts and wonder "Did I really write that?"
>
> 3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)Depends on whether the communication is positive or negative. Positive feedback can breed positive self reinforcement. Negative feedback...well, you get the point. Perception is everything.
>
> 4. The opportunity to send online text communications to others, even before --- or without -- any replies, can help a person feel the others are available. (4.3)Only if the person replies. If you post to a specific person, and that person doesn't reply, how can that possibly make you feel as though they are available?
>
> 5. A person can use online text communication as a way to explore and experiment with new behaviors or different aspects of their identity. What they learn or rehearse online can be carried into their offline life. (7.2, 7.3)Interacting with someone via the net and talking to that person f2f, are two completely separate animals. I can hone my communication skills on the net, but that doesn't mean I will be successful using those skills in real life.
>
> 6. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)I imagine it can and does. But I've also seen negative social interaction force people into hiding. Once again, it depends on the type of interaction, positive or negative.
>
> 7. Access to online information tends to be empowering and transformative. (7.10)If the info is clear, concise and understandable, then I agree with this statement. If the info is masked in "Doctor Speak", then it can be very intimidating.
>
> C. Negative aspects
>
> 1. Online text communication is more subject to "simple" misunderstandings and conscious and unconscious distortions of meaning or intent. (2.1)Depends on what is being said and how important the subject matter is to the person reading it. There is no black and white here. A lot of subtle shades of grey though...
>
> D. Potentially positive or negative aspects
>
> 1. With online text communication, a person can be less inhibited and -- deliberately or not -- more open about aspects of themselves, including their "true self". (2.2, 6.2, 7.1)I think once you get to know your "audience" this is very true. For most people it's a matter of trust. I discuss things about myself at my own website and one other that I frequent that I would never consider discussing here. Why? Trust, pure and simple. I have come to know, love and trust those people, and the door swings both ways.
>
> 2. With online text communication, a person can be less inhibited and -- deliberately or not -- more likely to act out. (2.2)I suppose this is true.
>
> 3. With online text communication, a person can be -- deliberately or not -- more guarded about aspects of themselves, including their "true self". (6.3, 8.4)Once again, I think this depends on how well you know the people you're talking to.
>
> 4. Ambivalence about intimacy can be expressed as a preference for online text communication and its blend of openness and distance. (2.3)True.
>
> 5. Saved text can reduce errors in recall -- or be taken out of context, distorting its meaning. (3.2, 3.3)If you are talking about quoting sentences out of a poster's paragraphs for the purpose of responding, I think it is rediculous and irritating. If you are talking about posting your reply above or below the original message, I do that all the time. It allows me to refer to the original so I can make sure I've answered any questions asked of me.
>
> 6. With online text communication, others try to help more quickly by giving advice or problem-solving. (11.2)I think that depends on subject matter. Sometimes you have advice or info, sometimes you can only let a person know that they are in your thoughts and that you are wishing them good luck. Sometimes you are best served just to keep your mouth shut. I guess as a generic statement, this is mostly true.
>
> E. Online support groups
>
> 1. Online support groups benefit from having rules about appropriate behavior, effective enforcement of those rules, and knowledgeable and confident leaders. (10.1)Absolutely! A successful support group must have one golden rule, respect. And as painful as it may be, someone has to enforce the guidelines.
>
> 2. Online support groups tend to be less cohesive. (10.3)Depends on the closeness of the group. People who have been together for a long time tend to be very cohesive, perhaps because you get to know each other's moods and personalities. A site where there are a lot of new people coming and going, such as Babble, may not be as cohesive simply because you don't know everyone as well. It's again a trust issue.
>
> 3. In online support groups, a person can explore and experiment with different "identities" at the same time. (10.7)For some that's very true. But those are generally people who like to play games.
>
> F. Therapy
>
> 1. Differences in status are less apparent in online text communication. Clinicians tend to be perceived less as authorities and more as consultants or even "twins". (11.4)I don't know about this one. We have experts here, some who are approachable on a personal level and others who aren't. It depends on how I can talk to them in how I perceive them.
Greg
Posted by CarolAnn on October 9, 2000, at 21:21:47
In reply to Re: Hypotheses about Online Text Communication, posted by Greg on October 9, 2000, at 18:40:51
I think it would be beneficial to combine online and face to face therapy. When I was in therapy, I would often have very low weeks, but sort of 'perk up' at the counseling office. Consequently, a lot of time would be wasted in the beginning of the session, as I tried bring the feelings and perceptions I had been having back into focus. Even now, though I suffer extreme fatigue, lethargy, and no motivation, my Psychiatrist has only rarely seen me exhibiting these symptoms. It's like I get a surge of adrenaline for my appointment. I am very brisk, talking fast, very animated. All of which, I had to explain to him, as he seemed to doubt that I was really suffering fatigue, etc.
I think it could be interesting for therapy to involve weekly 'face to face' visits and short (10 mins. or so), online sessions on a daily or every other day schedule.
The main benefit I see with online therapy sessions is that the patient would have time to really 'think' about what he wants to say and how best to say it. Also, I had problems with losing my train of thought, which wouldn't happen when you can read the whole thing.
Just a few thoughts. CarolAnn
Posted by CarolAnn on October 9, 2000, at 21:30:31
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
Hi Dr. Bob!
I was wondering if you had ever thought, with regards to these hypotheses, about facilitating an online group therapy session with some people from psycho-babble. It could be interesting to put some of the hypotheses into practice to see how this forum measures up to other research.
just an idea! CarolAnn
Posted by Leonardo on October 10, 2000, at 6:23:55
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
I'm afraid I can't muster enough concentration to analyse the hypotheses, but here are my experiences with online support groups.... You check if they correlate!
1) If you haven't used the internet/newsgroups before there can be a very big barrier to getting started. I read various groups for about a year before actually getting around to posting (I don't have home PC, and was reluctant to post from work, also didn't really understand how private groups are. I now know that some are not very private, you can be traced through IP addresses etc..)
2) Getting positive feedback can give you a boost, but criticism or negative feedback is very damaging when you are depressed.
3) Just posting and getting things off your chest is a help, but getting no replies to your messages is very damaging emotionally (nakes you feel worthless that noone could be bothered to reply.
4) You can get a feeling of being part of a community, but I think this is largely illusory. After returning to a group after a few months I realised I had no meaningful connections left from the contacts I knew before, which made me feel very lonely, and also that the previous interactions were a waste of time.
5) You can definitely get addicted, and rely too much on what you expect to find from the group. Occasionally you can get a gem of support or information, but mostly not on the whole I have found.
Leonardo
Posted by noa on October 10, 2000, at 7:56:26
In reply to Re: Hypotheses about Online Text Communication, posted by Dr. Bob on October 9, 2000, at 13:30:03
>
> Thanks for all your comments! Let me just follow up on the above. What kind of a monkey wrench?Well, I guess I was thinking about how more traditionally psychodynamic therapies bank on the patient forming a transferential relationship with the therapist that is based on a child:parent relationship, which, of course, involves a difference in percieved status, as well as the actual difference in status because of the doctor:patient set-up.
If it is true that online communication levels the balance of power somewhat, then, online communication might be a good fit for approaches, such as feminist psychotherapy, that try to minimize as much as possible, this power differential.
On the other hand, we have witnessed here all kinds of projection onto you, Dr. Bob, about the power you hold as the moderator/owner of this site, and I would venture to guess that whatever way people relate to your authority, they would do so in person or in text, ie, either way, the style in which they react to authority would be expressed.
Regarding twins:
>
> > In ... the twinship or alter-ego transference, the patient perceives the therapist to be psychologically similar to himself or herself. Conceptually the patient perceives the therapist and himself or herself to be twins, separate but alike. In the twinship transference for the selfobject cohesion to be maintained, it is necessary for the patient to view the therapist as ‘just like me’ (Manfield, 1992).
>
This concept has always seemed a bit fuzzy to me, I must admit. Perhaps because the therapists I have had are men? I wonder if this twinship phenomenon is stronger in same gender pairings of therapist and client, and I wonder how gender issues are affected by communicating online rather than in person.Another thing about twinship: isn't humor (laughing at the same joke evokes a sense of alikeness) something that would facilitate this, and how is humor affected by the online relationship vs. in-person?
Posted by noa on October 10, 2000, at 8:00:24
In reply to Re: Combined online face to face therapy, posted by CarolAnn on October 9, 2000, at 21:21:47
This makes a lot of sense to me. When I was younger, and first starting therapy, it was so hard to bring up me feelings. I think part of it was embarrassment, and part was how hard it was to verbalize them. Sometimes, when I was overwhelmed with feelings between sessions, I would write my therapist letters. This helped a lot, both to bridge the time between sessions, but also to introduce some feelings that I needed to talk about.
Posted by Dr. Bob on October 10, 2000, at 11:27:43
In reply to Re: Hypotheses about Online Text Communication, posted by Greg on October 9, 2000, at 18:40:51
> > [A] 1. A person with a history of chaotic relationships, physical trauma, or strong feelings of shame or guilt tends to experience online text communication as safe. (1.3, 1.4, 2.4)
>
> I don't believe that is necessarily true. A lot of people with this type of history communicate via the net because they want to be heard, not because it's safe.I agree. But maybe they're more willing to express themselves, and be heard, online because they feel safer there?
> > 3. The "handle" a person chooses reflects aspects of their personality. (6.4)
>
> Partially, but I think it also represents a need to protect themselves from others getting too close.It protects them if they choose a handle that's different from their name? One that's more generic? Maybe in that case their wanting to protect themselves is itself one aspect of their personality that's reflected -- indirectly -- in their handle.
> > [B] 3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)
>
> Depends on whether the communication is positive or negative. Positive feedback can breed positive self reinforcement. Negative feedback...well, you get the point.I agree, the internal voices could be good or bad, so this should go in the "potentially positive or negative" category.
> > 6. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)
>
> I imagine it can and does. But I've also seen negative social interaction force people into hiding. Once again, it depends on the type of interaction, positive or negative.Right, this should also be moved to section D.
> > 7. Access to online information tends to be empowering and transformative. (7.10)
>
> If the info is clear, concise and understandable, then I agree with this statement. If the info is masked in "Doctor Speak", then it can be very intimidating.I understand what you're saying, but what about "access" in general, given that some information is clear and some is intimidating? Would you say that access to that mix of information tends to be empowering and transformative?
> > [E] 2. Online support groups tend to be less cohesive. (10.3)
>
> Depends on the closeness of the group. People who have been together for a long time tend to be very cohesive, perhaps because you get to know each other's moods and personalities. A site where there are a lot of new people coming and going, such as Babble, may not be as cohesive simply because you don't know everyone as well.Good point. To simplify things, I left out part of the original hypothesis, which was "due to the traditional cybercultural assumption that one can join or leave, respond or not respond, as one wishes".
> > [F] 1. Differences in status are less apparent in online text communication. Clinicians tend to be perceived less as authorities and more as consultants or even "twins". (11.4)
>
> I don't know about this one. We have experts here, some who are approachable on a personal level and others who aren't. It depends on how I can talk to them in how I perceive them.Another good point. Maybe the key isn't being online, but in fact how approachable the "expert" is. Thanks for all your comments!
Bob
Posted by Dr. Bob on October 10, 2000, at 11:33:31
In reply to Re: question for Dr. Bob, re: research, posted by CarolAnn on October 9, 2000, at 21:30:31
> I was wondering if you had ever thought, with regards to these hypotheses, about facilitating an online group therapy session with some people from psycho-babble.
Isn't this already an online group therapy session? :-)
More seriously, my question would be, how would an online forum need to be different from Psycho-Babble to be group therapy?
> It could be interesting ... to see how this forum measures up to other research.
I totally agree, "somebody" should do some research sometime on how participating here affects people.
Bob
Posted by Dr. Bob on October 10, 2000, at 11:54:49
In reply to Re: Hypotheses about Online Text Communication, posted by Leonardo on October 10, 2000, at 6:23:55
> 1) If you haven't used the internet/newsgroups before there can be a very big barrier to getting started. I read various groups for about a year before actually getting around to posting (I don't have home PC, and was reluctant to post from work, also didn't really understand how private groups are. I now know that some are not very private, you can be traced through IP addresses etc..)
So it was not wanting to be traced that kept you from posting? And once you learned more about the issue, you felt reassured?
Before you started posting, did you feel comfortable enough to make use of any offline alternatives?
Finally, I think it's significant, and probably worth making into another hypothesis, that online groups can be easier to join because it's possible to get comfortable with them by lurking before participating more actively.
> 2) Getting positive feedback can give you a boost, but criticism or negative feedback is very damaging when you are depressed.
>
> 3) Just posting and getting things off your chest is a help, but getting no replies to your messages is very damaging emotionally (nakes you feel worthless that noone could be bothered to reply.Right, this is along the lines of what Greg was saying, there are two sides to some of these issues.
> 4) You can get a feeling of being part of a community, but I think this is largely illusory. After returning to a group after a few months I realised I had no meaningful connections left from the contacts I knew before, which made me feel very lonely, and also that the previous interactions were a waste of time.
Hmm, when you returned, the people you knew before weren't there anymore, or they were still there but the feeling of being connected to them wasn't?
Just because something doesn't last doesn't necessarily mean it's a waste of time...
> 5) You can definitely get addicted, and rely too much on what you expect to find from the group. Occasionally you can get a gem of support or information, but mostly not on the whole I have found.
That's an interesting idea, that you might find gems online, but not enough to make it really worth looking for them there.
Bob
Posted by Greg on October 10, 2000, at 13:02:25
In reply to Re: Hypotheses » Greg, posted by Dr. Bob on October 10, 2000, at 11:27:43
> > > [A] 1. A person with a history of chaotic relationships, physical trauma, or strong feelings of shame or guilt tends to experience online text communication as safe. (1.3, 1.4, 2.4)
> >
> > I don't believe that is necessarily true. A lot of people with this type of history communicate via the net because they want to be heard, not because it's safe.
>
> I agree. But maybe they're more willing to express themselves, and be heard, online because they feel safer there?That's probably true. But I'm not sure that safety would be a major concern for me if I just needed someone to listen. Desperate times demand desperate measures.
>
> > > 3. The "handle" a person chooses reflects aspects of their personality. (6.4)
> >
> > Partially, but I think it also represents a need to protect themselves from others getting too close.
>
> It protects them if they choose a handle that's different from their name? One that's more generic? Maybe in that case their wanting to protect themselves is itself one aspect of their personality that's reflected -- indirectly -- in their handle.Ok, I can live with that. I thought your comment about "generic" was particularly interesting. I've see some people using handles that are so generic that it's nearly impossible to determine whether they are male or female. Although I think a person's writing style eventually brings that info to bare.
Thanks for sharing this with us Dr.Bob, it found it extremely interesting and informative. Do you have any plans to consolidate the answers to see what the Babblers came up with as a whole? I think that would be fasinating.
Greg
Posted by Sigolene on October 10, 2000, at 14:07:10
In reply to Re: Misunderstandings » Sigolene » Cindy W, posted by Dr. Bob on October 9, 2000, at 13:59:17
> > > I think there's a big danger in exchanging between doctor and patient through internet. The danger is that the doc doesn't see the effect on the patient of what he says, at the moment the patient read the text.
>
> That's right, the doctor gets less information and might misunderstand the patient...
>
> > > As many psychiatric patients tend to make misinterpretations of intentions of others (due to his/her projections linked with bad early experiences), they are prone to misunderstand. For exemple they could interpret a simple neutral message as a rejection. Normally in face to face situation, the intention of the doc can be seen in his non verbal attitude.
>
> And it goes the other way, too, the patient gets less information and might misunderstand the doctor.
>
> > > Normally the sens of a message is at 80% given by non verbal attitude of the speaker.
>
> People have asked me for a percentage, and I've told them I didn't know. Do others agree with 80%?
>
> > > But if he don't have this info, the patient could think: he/she hates me, he don't want to talk with me and so on...and the patient in left alone with these feelings.
>
> > I'd rather see a live human being, f2f, because that adds a lot for me (the unambiguous nonverbal cues, I guess, plus the feeling that a real live human being cares...
>
> Thanks for raising those scenarios. One line of thinking might be that it's *helpful* for those cues to be missing. Because feeling hated or not cared about would be important to address. And if they met in person and there were cues that reassured the patient, those feelings might never be brought up.
What do you think?
> > BobHi Bob,
I think that a good therapist should be abble to be a little frustrating to the patient, in order to make the rejection feelings appear, and then talk about it. A little frustration, but not too much, otherwise the patient would go away and never come back. It's very difficult to find the right middle. This is a kind of "manipulation" of the patient. I think the most important quality of a good therapist is to be a good manipulator. First to establish a stong transference, and then to push a little on the weak points of the patient to make the defense mechanism appear. I think you know what i'm talking about.
All this is a long process which need first a face to face situation. But the internet communication could complete this process because it adds someting very important which is not mentionned in the hypothesis: It's the fact that there's things we can't tell directly to someone. It's easier to write them. Especially things regarding emotional feelings. When i will be a therapist i will just mention to my patients that i've an e-mail adress, and they can leave comments on it between therapy sessions if they have something to say...
Sigolène
Posted by Dr. Bob on October 10, 2000, at 15:21:51
In reply to Re: Hypotheses about Online Text Communication, posted by noa on October 10, 2000, at 7:56:26
> Well, I guess I was thinking about how more traditionally psychodynamic therapies bank on the patient forming a transferential relationship with the therapist that is based on a child:parent relationship
Ah, I see what you're saying. But maybe there could still be other transferential relationships?
> If it is true that online communication levels the balance of power somewhat, then, online communication might be a good fit for approaches, such as feminist psychotherapy, that try to minimize as much as possible, this power differential.
Hmm, interesting point...
> > > In ... the twinship or alter-ego transference, the patient perceives the therapist to be psychologically similar to himself or herself. Conceptually the patient perceives the therapist and himself or herself to be twins, separate but alike. In the twinship transference for the selfobject cohesion to be maintained, it is necessary for the patient to view the therapist as ‘just like me’ (Manfield, 1992).
>
> This concept has always seemed a bit fuzzy to me, I must admit. Perhaps because the therapists I have had are men? I wonder if this twinship phenomenon is stronger in same gender pairings of therapist and clientThat would make sense to me...
> and I wonder how gender issues are affected by communicating online rather than in person.
Great question!
> Another thing about twinship: isn't humor (laughing at the same joke evokes a sense of alikeness) something that would facilitate this, and how is humor affected by the online relationship vs. in-person?
Another great question!
Bob
Posted by Dr. Bob on October 10, 2000, at 15:32:59
In reply to Re: Hypotheses, posted by Greg on October 10, 2000, at 13:02:25
> I thought your comment about "generic" was particularly interesting. I've see some people using handles that are so generic that it's nearly impossible to determine whether they are male or female. Although I think a person's writing style eventually brings that info to bare.
There's another gender-related issue. And another hypothesis!
> Do you have any plans to consolidate the answers to see what the Babblers came up with as a whole? I think that would be fasinating.
I was in fact thinking about doing that, listing after each hypothesis all the responses to it. And making it a separate web page. Hmm, it would be possible to automate the whole thing, with a comment area for each hypothesis that would automatically add the comment to the previous ones...
Bob
Posted by Dr. Bob on October 10, 2000, at 15:50:26
In reply to Re: Misunderstandings » Dr. Bob, posted by Sigolene on October 10, 2000, at 14:07:10
> I think the most important quality of a good therapist is to be a good manipulator.
Now there's a hypothesis that would be controversial! :-)
> I think you know what i'm talking about.
I think I do, it's just that "manipulate" can have negative connotations...
> But the internet communication ... adds someting very important which is not mentionned in the hypothesis: It's the fact that there's things we can't tell directly to someone. It's easier to write them. Especially things regarding emotional feelings.
I think that was the idea of:
> [A] 1. A person with a history of chaotic relationships, physical trauma, or strong feelings of shame or guilt tends to experience online text communication as safe. (1.3, 1.4, 2.4)
Maybe it should be "safer" (than communication in person). And maybe it shouldn't be so specific, maybe it's a more general phenomenon...
> When i will be a therapist i will just mention to my patients that i've an e-mail adress, and they can leave comments on it between therapy sessions if they have something to say...
I like your idea, but it might be more complicated than that. For example, see:
Guidelines for the Clinical Use of Electronic Mail with Patients
http://www.amia.org/pubs/other/email_guidelines.htmlBob
Posted by Pritzker on October 10, 2000, at 19:17:18
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
> Dr. Bob,
I think online therapy would be great for a subject with a say, split personality. Online communication would help the therapist identify the branches at a faster rate. Collect more pieces. Just a thought.
Hi, everyone,
>
> I belong to a group of therapists who are discussing the use of the Internet with patients. Some "working hypotheses" have been developed, and we'd like to know what you think about them. The originals are at:
>
> http://www.rider.edu/users/suler/psycyber/workinghyp.html
>
> I've selected, adapted, and regrouped them with Psycho-Babble specifically in mind. The numbers in parentheses refer to the original hypotheses. Any comments? Thanks!
>
> Bob
>
> --------------------------------
>
> Hypotheses about Online Text Communication
>
> A. Characteristics of online text communication
>
> 1. A person with a history of chaotic relationships, physical trauma, or strong feelings of shame or guilt tends to experience online text communication as safe. (1.3, 1.4, 2.4)
>
> 2. A person's writing style reflects aspects of their personality, and changes in it reflect changes in their thoughts and feelings. (6.1)
>
> 3. The "handle" a person chooses reflects aspects of their personality. (6.4)
>
> 4. If a person has a web site, it reflects aspects of their personality. Having others visit it and visiting those of others is emotionally significant. (7.6)
>
> B. Positive aspects
>
> 1. The act of writing fosters self-expression, self-reflection, and cognitive restructuring. (1.2)
>
> 2. Online text communication that does not take place in "real time" enhances impulse control, self-reflection, and cognitive assimilation. (4.1)
>
> 3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)
>
> 4. The opportunity to send online text communications to others, even before --- or without -- any replies, can help a person feel the others are available. (4.3)
>
> 5. A person can use online text communication as a way to explore and experiment with new behaviors or different aspects of their identity. What they learn or rehearse online can be carried into their offline life. (7.2, 7.3)
>
> 6. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)
>
> 7. Access to online information tends to be empowering and transformative. (7.10)
>
> C. Negative aspects
>
> 1. Online text communication is more subject to "simple" misunderstandings and conscious and unconscious distortions of meaning or intent. (2.1)
>
> D. Potentially positive or negative aspects
>
> 1. With online text communication, a person can be less inhibited and -- deliberately or not -- more open about aspects of themselves, including their "true self". (2.2, 6.2, 7.1)
>
> 2. With online text communication, a person can be less inhibited and -- deliberately or not -- more likely to act out. (2.2)
>
> 3. With online text communication, a person can be -- deliberately or not -- more guarded about aspects of themselves, including their "true self". (6.3, 8.4)
>
> 4. Ambivalence about intimacy can be expressed as a preference for online text communication and its blend of openness and distance. (2.3)
>
> 5. Saved text can reduce errors in recall -- or be taken out of context, distorting its meaning. (3.2, 3.3)
>
> 6. With online text communication, others try to help more quickly by giving advice or problem-solving. (11.2)
>
> E. Online support groups
>
> 1. Online support groups benefit from having rules about appropriate behavior, effective enforcement of those rules, and knowledgeable and confident leaders. (10.1)
>
> 2. Online support groups tend to be less cohesive. (10.3)
>
> 3. In online support groups, a person can explore and experiment with different "identities" at the same time. (10.7)
>
> F. Therapy
>
> 1. Differences in status are less apparent in online text communication. Clinicians tend to be perceived less as authorities and more as consultants or even "twins". (11.4)
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