Psychotherapy in a Hyperconnected World

"The cell phone has become the adult's transitional object, replacing the toddler's teddy bear for comfort and a sense of belonging."- Margaret Heffernan


Introduction

Witness the following scenes that are now standard fare in contemporary culture. A family of four composed of mother, father, and two children are out to dinner at a casual neighbourhood restaurant. Glance over at their table and what do you see? They are all on devices, either smartphones or tablets. There is little or no interaction among them as they are engaged elsewhere. This same scenario could just as readily be taking place in the privacy of their home. They are ‘alone, together’. Or are they?
The same kind of social scene could be observed amongst a group of adolescent or college friends. The only difference might be the presence of the camera function of the smartphone. Group pictures or selfies might be taken that would be immediately posted on apps, websites, or other places where they can be broadcast to both select and random others. News, if we call this news, travels fast in the digital world. Are they being hyper-social or anti-social?

These scenarios illustrate just part of the profound effect that the current technological revolution is having on contemporary culture. I want to be clear at the outset that I am not arguing that the technology revolution has only negative consequences in the arenas I am discussing. It is abundantly clear that social media offers much that is positive as well. There is ample data that millions of people are leveraging these technologies as a way to ‘connect with’ orders of magnitude more people than could ever have been imagined in the past. It’s much easier to find a group of similarly minded individuals in cyberspace than in one’s physical neighbourhood. It can also help develop a sense of personal validation and belonging. Finally Nancy Jo Sales, in her just-published book “American Girls: Social Media and the Secret Lives of Teenagers” (2016), notes the social activism that can be undertaken via social media with profound results. This same connectivity has enabled political revolutions, elected presidents, and is now responsible for 35% of today’s marriages, according to the National Science Foundation (2014).

But we must also recognize that these same technologies are increasingly used relationally to substitute for what we would consider ‘authentic’ connections, relationships and conversation. Where there was once conversation, there is now texting, Instagram and selfies. What could it mean that someone on Facebook has 300 “friends”? When face-to-face, real-time conversation is replaced with the asynchronous modes of communication in vogue with adolescents today, do these modes of communication fully gratify the same need, or is something of significance lost? How might our humanity be compromised?

A perhaps more concerning question, relates to the fact that these same technologies may, in fact, be increasingly interfering with the development of genuine, less superficial connections, and the conversation/intimacy that accompany them. As that takes hold, does it begin to change the very nature of relationships, what we need and want from others, and how we get it. This, in turn, affects our brain wiring and ultimately evolves us as a species.

Ray Kurzweil, an internationally respected inventor and ‘futurist’, made the observation that technology IS the evolution of human biology and that we are headed towards a phenomenon called the ‘singularity’ – when there is a blurring of the boundary between human biology and technology. Kurzweil predicts that technological advances will irreversibly transform people as they augment their minds and bodies with genetic alterations, nanotechnology, and artificial intelligence. Whether you agree with his theory or not, technology’s impact is undeniable and it follows that it is important to consider its impact on the way people relate with one another.

The idea for this paper began with a question about how people/patients would be changed by this technological revolution and how these changes would potentially affect the psychotherapeutic process between adolescents and their talk therapists. I hope to share some observations and raise some questions about the psychological effects of technology and social media on the shaping of individual development, the nature of the conversation, and the therapeutic encounter between psychodynamic therapists and their patients.


People as Fundamentally Relational

That the group scenarios described at the beginning of this paper exist and are not unusual is both irrefutable and noteworthy. It seems clear that something important is being changed - perhaps lost - when people are disengaged from one another while in each other’s presence. Divided attention, a feature of our current human condition, is having an effect. But let’s consider these scenarios from the context of the following statement from Steve Mitchell’s Relational Concepts in Psychoanalysis p. 24:

“The evidence seems overwhelming that the human infant does not become social through learning or conditioning, or through an adaptation to reality, but the infant is programmed to be social. Relatedness is not a means to some other end (tension reduction, pleasure, or security); the very nature of the infant draws him into a relationship. In addition, relatedness seems to be rewarding in itself…. it becomes the psychological reality of primary importance.” (Mitchell, 1988)
But to go one step further Mitchell notes: p. 29:

“The overwhelming motivational priority is entry into human community, intense ties with others, and these are established and preserved at all costs”.

From this perspective, we might consider social networking as a ‘technologically augmented’ next step in the evolution of human sociability and the fulfilment of the individual’s longing to be part of a broader community. If this is so, the question then turns to what kinds of attachments will these be? Are relationships that are increasingly mediated by technology fundamentally different?

The 2014 movie “Her” illustrates the complexity of this question. In this film, the protagonist begins a relationship with an operating system, enacted by the voice of Scarlett Johansson. It learns his likes, dislikes, habits, verbal expressions and his feelings. He falls in love with her/it only to discover that she is engaged in similar relationships with thousands of others at the same time. He is wounded and his sense of intimacy has been turned upside down. Is this the direction intimacy is headed?
To consider this question one must turn to ways of knowing oneself and another in relationships.


Early Childhood Development: Knowing the Other

We learn much about others and ourselves in the earliest attachment, typically between mother and child. It is through the exquisite dance between the developing infant and his/her responsive mother that the infant comes to learn about himself and the world. This includes his underlying sense of self and sense of the other as a person in their own right. These very early experiences have a lasting effect.

Both Intersubjectivity Theory and Theory of Mind suggests that if things go well during early development, the infant will learn not only about the world at large but about him/herself, his inner life, and the ‘other’. Included here is the notion that the other is not merely a need-satisfying ‘object’ but that the ‘other’ has an internal life that includes wishes, motivations, ideas, feelings and needs.

Mentalization, as it is referred to, is essential to the development of the capacity to hold the other in mind. That is, one must be able to recognize the other, internalize a version of the other, and ultimately put oneself in the other’s shoes. In my mind, this is akin to the earlier conception of empathy.

What happens during this critical developmental process when it is disrupted by technology and divided attention? What happens when children can swipe a screen before they can walk? Or when mother’s attention is elsewhere? Mothers have been observed during breastfeeding, and other times, to be more engaged with their tablets than with their child. Tablets cannot be passively engaged but demand one’s attention and are intended to be interactive. What happens to empathy and recognition when relationships are increasingly mediated by/through devices or compromised by divided attention?

The recent phenomenon we all know as ‘helicopter parenting’ is, in fact, both encouraged and enabled by these technological ‘innovations’. Mothers texting their children to find out how they did on the math test, children being watched by cameras, fathers saying goodnight via Facetime. How about the separation that sleepaway camp provided; a necessary time for children to experience independence. What happens to that necessary separation when technology allows parents to, in a virtual way, see their children daily, and exchange texts and emails? No more ‘out of sight, out of mind’. How do young children experience separation in a state of hyper-connectivity? More insidiously, how is the way that others are being ‘held in mind’ impacted by these technologically mediated relationships? Can a developing child learn about how their parent moves, talks, expresses affect with technology intermediating their experiences? Psychologists, neurobiologists, and philosophers of mind can speculate about the changing nature and form of internalized objects – in this case parents.


The Hyperconnected Adolescent

Today’s teens are the first generation to have grown up wired. That is, technology is an embedded part of their lives. They are often referred to as ‘digital natives’. What effect is that having on them? For example, we know from recent neurological advances that brain wiring for ‘empathy’ exists and like many other neurological functions must be exercised to remain intact (Schore). The expression ‘use it or lose it’ applies. Is it possible that the actual capacity for empathy may decline during adolescence if it is less utilized during these years? What evidence is there that the phenomena of social networking and hyperconnectivity are, in fact, having an impact, neurologically or otherwise, on the behaviour of developing young adults?

To begin with, there is ample historical evidence to illustrate the power of the social milieu (in this case technology) to affect individual and group development. Each generation seems to have its own specific ‘pathology’ that corresponds to the social/cultural forces at play during its time. In Freud’s time, it was sexual repression leading to hysterical symptomatology. Fromm identified the marketing character type as a response to prevailing American capitalist forces. ‘The last twenty years have seen the overexpansion of the ADHD diagnosis, which has become a garbage pail’ term. But from the vantage point of this paper, the diagnosis seems directly correlated to a sped-up culture with its many simultaneous demands for people’s attention. It is not surprising that this co-created environment is a breeding ground for distractibility and impulsiveness that has coalesced into a diagnostic entity.

There is evidence that social networking and its sequelae have begun to degrade the ways in which relationships are formed and valued. Tur kle (2015), for one, has documented a decline in empathy observed in middle schoolers. When asked, as part of an extensive, qualitative research project, teachers reported the following changes:

• Students don’t make eye contact.

• They don’t respond to body language.

• T hey have trouble listening.

• T hey don’t seem to recognize when they have hurt each others’ feelings ( p. 163)

It seems that one’s capacity for empathy may become compromised by the manner in which relationships are conducted over ‘technology-intermediated’ channels in which communication typically takes place in a non-face-to-face, asynchronous way. Body language, tone of voice, facial expression, and pauses are excluded. It is easy to be crude, rude, and abrupt when the target of communication is not present. Relationships can be terminated at the drop of an impulsive text.

But it is not the case that mediated relationships are conducted as if in the wild, wild west - without rules and guidelines. According to Turkle’s research, there are apparently well-understood rules and new social norms that guide how devices can be used in real time social situations. Time today doesn’t permit my going into those details but norms exist to govern social situations.

To extend this idea, are these digital natives learning a different set of rules not just about ‘texting’ etiquette but about the fundamental nature of relationship as well? In light of the fact that people’s innate drive to be related is so fundamental, it is unlikely that technology and social media will be undermining that drive directly. However as the mode and manner in which relationships are conducted changes significantly, what will be the ultimate effect on the way relationships are formed, maintained and valued.


Implications for Therapy

The therapeutic encounter, as I conceptualize it, is all about talk. Talk psychotherapy , especially psychoanalytic psychotherapy, relies on conversation (albeit a very special kind of conversation) as the fundamental medium in the way that thoughts, feelings and experiences are communicated between patient and therapist. It is both the vehicle through which we come to understand our patients and the road to therapeutic action.

I don’t think it’s alarmist to be concerned that the pervasiveness of social media and social networking is having an influence on individual development, conversation, empathy, and finally on people’s interest in talk psychotherapy and the kind of talking they want to engage in. Have we/are we creating a generation of less reflective, less empathic adolescents who approach psychotherapy with a different mindset? We have certainly seen much of this in the psychotherapy practice world already so it’s not entirely novel. People want shorter-term therapy, ‘tools for their toolbox’, medication, and they just want to feel better. They want to be ‘fixed’.

I recently read an article in the NY Times which reported on a psychotherapy app in which ‘patients’ pay a monthly fee (approximately $20) to have access to a therapist who they can text, who will text back quickly. They can use this service for a certain number of texts and then have to pay extra. This arrangement is not unlike regular smartphone service plans. Millions have already signed up in China and are actively using it.

So having said all this, what are today’s adolescents actually like in practice. Let me mention two current patients in my practice who present clinically very differently and also approach technology use in my office very differently. These very brief descriptions are intended to illustrate what today’s therapist is up against in terms of incorporating technology in their office. It is certainly true that some ‘digital natives’ seems to have retained all the needs, desires and capability for authentic connectedness that we think of as typical.

Dylan is listening to music on headphones when I retrieve him in the waiting room. I might ask about what he’s listening to, and the beginning of our session might be his talking about what he’s listening to, why he likes it, and even include his playing it for me. I like to connect with patients around their musical tastes. When he is filling me in on his week, he might show me pictures of what he did and who he did it with. I should say just as a matter of course that when I work with adolescents I sometimes feel the need to be flexible and ‘looser’ with the treatment frame than I may be with adults. While I may appreciate the way in which Dylan uses his device to share his life with me, it feels like something is inadvertently lost when pictures replace words. Pictures can bring a kind of closeness to the experience - but what is lost at the same time is the conversation about the experience. And the conversation is one of the outcomes of his having to organize and formulate his subjective experience and the meaning of the event. Dylan’s interdependence with his device has become a substitute for conversation – and it seems that his capacity to organize and report his experience could become compromised in the process.

Finally, Max, a 10-year-old boy with Asperger’s Syndrome, cannot tolerate being without technology for more than 15 minutes at a time. In his case, it is not an INTER-dependency but rather a device- dependency. He insists rather firmly that he has to play Minecraft, download a gun app, or show me a video of Beyonce. It’s almost impossible to restrict his device use without feeling like I have to play the role of ‘policeman’ the whole session. He is hyperactive and impulsive and has great trouble in relationships. He lacks an understanding of others and their internal lives and we work on this a great deal. I try to do this in short segments of every session. We sometimes trade off; he shows me his app and then we work on having conversation. It is unclear in Max’s case whether technology-mediated relatedness is an assistive-device enabling him to connect with me at least minimally – or whether it is a crutch, an easy way out, that is preventing him from making progress.


Conclusion

Today’s children and adolescents are the first generation to have grown up with technology as an embedded part of their lives. Therapists who are over fifty vary quite a bit in their comfort levels with current technology. Younger patients have grown up in such a different world than many of us that thinking of them as culturally different, and all that entails, is often a useful vantage point. The generation gap can feel quite wide.

The constant turning to devices, asynchronous ‘conversations’, and technology-mediated relationships is a reality - and like everything else related to technology – the only certainty is ‘more of it’. And as with any cultural force that drives societal change, our responsibility as psychologists is to appreciate, confront, understand and respond to it.

It is a dangerous and slippery slope to simply declare that ‘everything was better in the old days’ – and yet some things undoubtedly were.

It is almost certainly the case that the ability to connect to a broader community - to find people you would never have found before – who can appreciate the things you appreciate and validate that there are others like you – giving you a sense of identity and relatedness – can be a profoundly comforting and psychologically beneficial impact of the ‘social network’. But at the same time, one has to ask what the very nature of these new connections is? How do these new ‘friends’ really ‘know’ each other? What does it mean to feel a sense of relatedness with someone who wouldn’t recognize you if they passed you on the street? Will anyone from this new ‘community’ be at your door when you get sick? Is the illusion of ‘company’ a poor substitute for real companionship and intimacy and the psychological benefits of being truly ‘known’ by another? And much more importantly, will the pervasiveness of these new kinds of relationships actually interfere with this generation’s ability to psychologically tolerate the feelings that come along with the pain and the passions which are an inherent part of true intimacy and vulnerability. We will have to understand this as we work with this generation of patients who tell us about their 300 ‘friends’ and yet feel profoundly lonely.

When the “Dear John” letter turns into the “Dear John” text, it will be our job to try to understand whether the patient who sends that message actually feels empathy towards the recipient – and if so how that patient internalizes the other when they are unable to share that person’s real-time reactions, facial expressions, and gestures.

Being able to establish a virtual identity opens entirely new opportunities to experiment with an aspirational identity but then what is the relation between these virtual identities and our ongoing sense of self?

In the world of hyperconnectedness – adolescents know what their friends are doing at all times – and a new and very real source of anxiety – the ‘fear of missing out’ is brought up in session. How do we as therapists address the patient whose sense of self-worth is determined by the number of ‘likes’ they get on a picture they posted? Could this be the new currency of relatedness?

Perhaps most importantly, the concern of this author is that psychotherapy , which depends on the relationship as the medium through which change occurs, may become more difficult to navigate or less desirable as the basic skills of listening, reflecting and witnessing become either expendable or unrecognizably transformed. It will be our job to navigate the waters of change and determine how we can come to both understand the experience of these digital natives and at the same time connect them back to the power of ‘authentic’ conversations, ‘authentic’ relationships’ and ‘authentic’ connections .

Dr Steven Spitz, has been practising privately for over thirty years treating children, adolescents and adults. He works in New York City with individuals of all ages and is actively engaged in training other psychiatrists, psychologists and social workers.


References

Ensink, K. and Mayes, L. (2010) The Development of Mentalization in Children from a Theory of Mind Perspective, Psychoanalytic Inquiry, 301-337.
Mitchell, S. (1988) Relational Psychoanalysis.National Science Foundation (2014).
Sales, M. (2016). American Girls: Social Media and the Secret Lives of Teenagers. Deckler Press.
Schorr, A. (2011). The Right Brain Implicit Self Lies at the Core of Psychoanalysis. Psychoanalytic Dialogues. 21, 1.
Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist
Turkle, S. (2015). Reclaiming Conversation. The Power of Talk in a Digital Age. Penguin Press. New York, NY.