![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 39. Go back in thread:
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)
Posted by medlib on October 11, 2000, at 0:24:47
In reply to Re: Hypotheses about Online Text Communication, posted by Pritzker on October 10, 2000, at 19:17:18
> > Dr. Bob,
> > Hypotheses about Online Text CommunicationAbstract: A lengthy, useful, but not altogether accurate "first pass" at describing the nature of online support groups.
Full text:
> > 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)Anonymity can confer a sense of safety, but not necessarily a feeling of trust. Online communication without anonymity confers neither. I'm wondering how, and/or if, meeting f2f (as some Babblers have) affects this effect.
> > 2. A person's writing style reflects aspects of their personality, and changes in it reflect changes in their thoughts and feelings. (6.1)
Yes. The current emotional state of posters comes through clearly. It's been interesting (and somewhat disheartening) to me that my written communications are every bit as socially inept as my f2f efforts.
> > 3. The "handle" a person chooses reflects aspects of their personality. (6.4)Probably so, at the moment of choice, but this is just a snapshot-in-time which may not have any long-term import.
> > 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)I have no idea if this is true for others, but, for that subset of us who are in the information business, personal websites usually reflect interests, not personality, and represent professional contributions, not emotional mirrors. Often, visitors have more to do with how the site is promoted and the value of the site to other researchers. It may be mildly gratifying to have visitors, but hardly emotionally significant.
> > B. Positive aspects
> > 1. The act of writing fosters self-expression, self-reflection, and cognitive restructuring. (1.2)It's hard to disagree with a statement this general. However, the degree of benefit that writing confers may be affected by the degree of impulsivity the writer exhibits.
> > 2. Online text communication that does not take place in "real time" enhances impulse control, self-reflection, and cognitive assimilation. (4.1)Not necessarily. Even "real time" chat has a composing/reading delay. And we've seen some pretty impulsive, "thoughtless" posts on this board.
> > 3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)Probably so, if you're emotionally equipped to accept and/or believe others' expresions of positive regard. Some of us, however, appear to have flunked the child psychiatrist Erickson's first developmental stage--"Trust vs. Mistrust."
> > 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)I really don't see this one. I believe that in advance of, or in the absence of, replies, posters' anxieties and/or self-doubts may actually be heightened.
> > 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)I'll be interested in Babbler's reponses to this item. Personally, as a result of what I've learned about myself online, I make far *fewer* attempts to connect with others offline. So, I guess that the second statement is true for me.
> > 6. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)This can only be true if the previous statement is true--ergo, this is a corollary. Perhaps it can, but *does* it? I think its clear that writing reflects life, but unclear that life reflects writing.
> > 7. Access to online information tends to be empowering and transformative. (7.10)From my experience, one can be transformed without being empowered--and vice-versa. I think that information leads more often to empowerment than to transformation.
> > C. Negative aspects
> > 1. Online text communication is more subject to "simple" misunderstandings and conscious and unconscious distortions of meaning or intent. (2.1)Personally, I doubt it. I believe that most misunderstandings arise from hearing/reading the communications of others through personal filters or biases. I'll bet that visual stereotyping causes as many misunderstandings as other visual nonverbal cues avoid.
> > 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)But, is the "confessional" behavior observed a function of online communication, or only of *anonymous* online communication?
> > 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)Well, if one is affected at all, s/he is likely to be one or the other, don't you think?
> > 4. Ambivalence about intimacy can be expressed as a preference for online text communication and its blend of openness and distance. (2.3)Quite true. I wonder how many will read/hear this statement as meaning its reverse?
> > 5. Saved text can reduce errors in recall -- or be taken out of context, distorting its meaning. (3.2, 3.3)Certainly. It "can" also be used to preserve valuable information for later use, or any number of other possibilities.
> > 6. With online text communication, others try to help more quickly by giving advice or problem-solving. (11.2)More quickly than what? Do you mean
"People with problems can find advice/support more quickly online than from other sources" or "People are more likely to respond quickly to an online call for help than to a similar request in "real life"?
> > 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)Most "groups" respond positively to a sense of direction and a certain minimum of structure. I believe that these are absolutely necessary for a support group to be experienced as supportive.
> > 2. Online support groups tend to be less cohesive. (10.3)This would seem to be a factor of membership stability--or lack of it.
> > 3. In online support groups, a person can explore and experiment with different "identities" at the same time. (10.7)I doubt that the personae of most are quite so "fluid." I believe that differences seen are more often reflections of a complex "true self."
> > 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)True. An online "group" has, almost by definition, only 2 levels--the moderator/administrator and the participants. Formal status is automatically conferred upon the first. Informal status may be awarded to those participants (and leaders) whose contributions are perceived as valuable.
General comments:
1) If these statements really are hypotheses, how are they to be proved or evaluated?
2) For me, "can" is a wishy-washy word--as difficult to disprove as to prove. Most things "can" be; I think that both descriptive and predictive value lie in more definitive verbs--i.e., "is" or "isn't", "does" or "doesn't".
3) You asked (I believe) one poster about online therapy groups. For me, an online therapy group would have to closely resemble an offline one: limited (max and min), closed membership; member commitment to a minimum posting requirement and an individual therapeutic goal for some agreed-upon minimum of time; and a potentially active leader who monitored all posts and was willing to intervene when necessary to facilitate therapeutic movement. I do agree that online communication could be a useful adjunct to traditional treatment--I just can't figure how one would bill for it!
Since I can't afford med tx, rxs and therapy, your online support groups are particularly valuable to me. Thanks much.---medlib
Posted by medlib on October 11, 2000, at 0:34:53
In reply to Re: Hypotheses about Online Text Communication » Pritzker, posted by medlib on October 11, 2000, at 0:24:47
Sorry--My earlier post was meant for Dr. Bob. Evidently I clicked on the wrong post to reply.
medlib
Posted by Dr. Bob on October 11, 2000, at 12:25:27
In reply to Re: Hypotheses about Online Text Communication » Pritzker, posted by medlib on October 11, 2000, at 0:24:47
> Abstract: A lengthy, useful, but not altogether accurate "first pass" at describing the nature of online support groups.
Well, you have to start somewhere! :-)
> > > [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)
>
> Anonymity can confer a sense of safety, but not necessarily a feeling of trust. Online communication without anonymity confers neither. I'm wondering how, and/or if, meeting f2f (as some Babblers have) affects this effect.My hypothesis would be that people feel safer online, even if they're not anonymous. Not necessarily completely safe, but safer than they'd feel in person. How about that?
I think trust is a great issue to consider. What goes into trust?
I'd also be curious what the effect of meeting in person has been, if anyone who's done that would like to comment...
> > > [D] 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)
>
> Well, if one is affected at all, s/he is likely to be one or the other, don't you think?Right. But do you think there's likely to be an effect? And, if so, which one? :-)
> > > 6. With online text communication, others try to help more quickly by giving advice or problem-solving. (11.2)
>
> More quickly than what? Do you mean "People with problems can find advice/support more quickly online than from other sources" or "People are more likely to respond quickly to an online call for help than to a similar request in "real life"?Sorry, that was poorly worded. I meant something more like: "With online text communication, others try to help more quickly, for example, by giving advice or problem-solving rather than by initially exploring the situation further."
> General comments:
>
> 1) If these statements really are hypotheses, how are they to be proved or evaluated?That's a good question. I think it's important that they be framed so that they could be tested. By comparing online and in-person groups, for example.
> 2) For me, "can" is a wishy-washy word--as difficult to disprove as to prove. Most things "can" be; I think that both descriptive and predictive value lie in more definitive verbs--i.e., "is" or "isn't", "does" or "doesn't".
I agree -- and did try to be definitive. As has been pointed out several times, however, these are generalizations that aren't going to apply to everyone. So if they're going to be tested, the results are bound to be along the lines of "tends to" (ie, more wishy-washy).
> 3) You asked (I believe) one poster about online therapy groups. For me, an online therapy group would have to closely resemble an offline one: limited (max and min), closed membership; member commitment to a minimum posting requirement and an individual therapeutic goal for some agreed-upon minimum of time; and a potentially active leader who monitored all posts and was willing to intervene when necessary to facilitate therapeutic movement.
Thanks, that's a nice set of parameters!
> Since I can't afford med tx, rxs and therapy, your online support groups are particularly valuable to me. Thanks much.
You're welcome, and thanks for all your contributions here.
BTW, although I'm jumping in all the time on this thread, everyone doesn't have to direct their comments just to me. Maybe I should be quiet for a while...
Bob
Posted by medlib on October 11, 2000, at 18:03:02
In reply to Re: Hypotheses » medlib, posted by Dr. Bob on October 11, 2000, at 12:25:27
Dr. Bob--
Re A.1.-- I can't generalize about others--I'm just not enough like them. Without anonymity, online communication would feel *less* safe to me than f2f; I would be unwilling to communicate in writing about personal matters to someone I did not know and trust. Any form of writing can be saved and come back to haunt. F2f communication, whatever its content, is ephemeral.
For me, "safe" is a real-time feeling generated by the experience of acceptance. "Trust" is the expectation of future reliability and consistency. It is generated in part by early experiences of consistent caring and in part by recent repeated experiences of feeling understood and valued. Some people's early experiences innoculate them against having such expectations of others.
D. 2/3.-- People who join either an online or offline group do so because of some need to communicate with others. There *are* communication differences between the two group types. However, they seem to me to be perceived differences in timing rather than in style or content. An online member may seem to reveal more sooner, but that may be because they have been a "virtual" member (lurker--an unfairly derogatory epithet, IMO) long before they became active (visible) by posting. Factoring out timing, I suspect that communication style and content are pretty similar across group types. They are for me, at least.
G.C. 2--To me, "tends to" is a big improvement over "can." It specifies direction and can be operationally defined as "observed at a rate/level >50%." It's measurable.
BTW...etc.-- Hey, it's your thread! Reading, reacting and writing about the hypotheses takes a long time. I, for one, appreciate the feedback. I suspect that your participation has a measurable effect on the quality and quantity of responses you receive.
I'll be interested in what these hypotheses lead to. Please keep us informed.--medlib
Posted by pullmarine on October 12, 2000, at 1:48:13
In reply to Hypotheses about Online Text Communication, posted by Dr. Bob on October 5, 2000, at 10:09:11
> 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)Overall True. but people might also not write things they feel guilty about, since it leaves a permanent document.
>
> 2. A person's writing style reflects aspects of their personality, and changes in it reflect changes in their thoughts and feelings. (6.1)
>
Possibly. But I think you're on a slippery slope. people may change style on purpose without a change in mood or thoughts. How will you distinguishh the two.?> 3. The "handle" a person chooses reflects aspects of their personality. (6.4)
>
not sure what you mean> 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)
part a. I don't agree.
part b. definitly. In fact, i think hospital patients should be given access to the net.
>
> B. Positive aspects
>
> 1. The act of writing fosters self-expression, self-reflection, and cognitive restructuring. (1.2)
>
Definatly yes for the first two. in some for the 3rd point.> 2. Online text communication that does not take place in "real time" enhances impulse control, self-reflection, and cognitive assimilation. (4.1)
>
Agreed.> 3. Receiving online text communications from others can promote the development of steady, supportive, reality-testing, ego-building "internal voices". (1.7, 4.4)
>
Not always true. for instance. I've seen some responses to suicidal people which I consider to be criminal. People with no training in suicide prevention can do a great deal of damage.> 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)
>
yes, but it also helps knowing that you can be of help to others.> 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)
Only for outliers, but they should be removed from your sample.
>
> 6. Online text communication can desensitize a person to social interaction and build social skills. (7.4, 7.5)
>online communication can also isolate people from real social interaction.
> 7. Access to online information tends to be empowering and transformative. (7.10)
Depends on the information. Overall, i would say no. Besides. the info on the net is not always reliable.
> C. Negative aspects
>
> 1. Online text communication is more subject to "simple" misunderstandings and conscious and unconscious distortions of meaning or intent. (2.1)
>
Disagree. because it's written, the cognitive and emotional processes at hand reduce the likelyhood of misunderstandings,and this, despite the absence of tones and facial expressions, body language, etc.> 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)
>
true and not true. the permanace of these records and the possibility of being identified will reduce this for many taboo issues.> 2. With online text communication, a person can be less inhibited and -- deliberately or not -- more likely to act out. (2.2)
>
not clear.> 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)
>
in some respects, yes. in other respects, no.
>
4. Ambivalence about intimacy can be expressed as a preference for online text communication and its blend of openness and distance. (2.3)
definitly. But it does not replace intimacy. in some ways, it's better.
> 5. Saved text can reduce errors in recall -- or be taken out of context, distorting its meaning. (3.2, 3.3)mostly yes >
> 6. With online text communication, others try to help more quickly by giving advice or problem-solving. (11.2)depends. other can also add fuel toa fire.
>
> 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)I disagree. what would be usefull would be MH workers checking some of the info, and providing feedback regarding the accuracy of some of the statements.
what would be useful, if not a necessity, would be a list of suicide prevention do's and don'ts at the begining of such web-sites.
>
> 2. Online support groups tend to be less cohesive. (10.3)
>
no shit!> 3. In online support groups, a person can explore and experiment with different "identities" at the same time. (10.7)
>
absolutly! but is it healthy?> 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)does not apply.
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