More threads by David Baxter PhD

David Baxter PhD

Late Founder
Texting in Therapy
by Ryan Howes, Ph.D., Psychology Today
June 18, 2011

Getting five bars of connection in therapy

Jane sits down and unloads her accessories. She hands me her check, drops her water bottle on the end table and plops her purse on the floor. Her phone sits on the couch next to her, three inches from her leg, oriented so she can read it. A text comes in during the session and it moves inconspicuously to her lap, one thumb effortlessly tapping a reply while she interrupts her story about a fight with a coworker. She hits send, looks up and says: "Uh, where was I?" "I'm not sure," I say, "you tell me."

To be clear, I'm not talking about texting as therapy, as this article and many others promote as part of the gold rush of non-face-to-face psychotherapy. I'm also not talking about the phone as photo album, calendar, journal or record of past texts, which can serve a clear purpose in session. I'm talking about clients sending and receiving texts or phone calls during their 50 minute appointment. As phones have become our electronic appendage, this happens all the time. It used to be just teens, now it's everyone. And I've decided to roll with it.

Cell phones interrupt. I appreciate the convenience, but immediate access has it's down side, particularly in a therapy session. Phones make noise. They derail a train of thought. They yank a person out of their feelings and into their head. I think we can all agree on that even the coolest ringtone is annoying unless we're the one receiving the message. In therapy, however, my job is to observe words, behaviors and even interruptions and comment based on my training. If this means listening to a cell phone beep, a trumpet blast, or even country music, so be it. (My buzzing phone sits across the room, I check it between sessions.)

Some therapists have a strict no phone/text policy during sessions (kind of like movie theaters). I can understand their wish to keep the hour free from outside distraction. They want to maintain the sanctity of the space, keep the focus and hold the frame, so they ban the cell. I get that, but I have no such rules. If a client wants to read the phone, check facebook, return a text, even answer or place a call, that's fine by me.

I believe in Yalom's idea of "therapy as a social microcosm" (2002, p. 47), meaning the relational issues clients experience outside the office will eventually enter into our therapy. And cell phone habits are a relational issue. I want to facilitate that principle, not restrict it (within reason, of course). If I impose a rule that shields us from a major facet of a client's experience, we could miss some insight into their life. If a client regularly has her phone and feels the urgency to send and receive texts immediately, let's experience it together in session.

I have one caveat: we're going to talk about it. We'll discuss what the communication was, why it's taking place now, how it feels to do this during therapy and what impact it has on our connection. That's what we do in therapy, talk about the here-and-now, and if the here-and-now includes interruption from a buddy's "whazzup?" or a "hold on, I need to take this" from the client, that's our topic. If the texting disrupts the flow of our session, or prevents the client from going as deep as they'd like, I want them to experience and discuss it. If I feel like the texts prevent me from connecting with the client, I'm going to share that, too. We may have a discussion of why it's hard to resist the wireless umbilical to their friends on facebook, how that separation, even for 50 minutes can feel unbearable, which brings us to the topic of individuation and boundaries. Maybe we'll even explore how the phone is a safe buffer, a third object of convenient distraction that provides a sanctuary from uncomfortable conversations or fears of rejection. But I'm not going to tell clients to turn off their phone or leave it in the car. Maybe they'll decide to do this, but it won't come from me. That's empowering me, not the client. And why would I, when we can uncover some rich material?

Honestly, the above discussions do happen, but rarely. Clients usually ignore their beeping phone unless they're expecting something important, and many will turn it off of their own volition when they're interrupted. But when it does become an issue, it raises some important questions regarding the therapeutic process, boundaries and power. My still-evolving approach is based on some underlying beliefs: we're meeting to understand together why you do what you do and help you make informed, conscious decisions about it, and these decisions will mean more if they come from you than if I give a directive. I don't want clients to be on their best behavior, I want to see what they're really like. So answer your phone or don't, and we'll explore together how that choice is working for you.

A quick side note: I'm not Jungian, but I'm often amazed at the synchronicity facilitated by the phone-on policy. On more than one occasion the person we're discussing sends a text. Or the potential employer calls with a job offer. Or the long-awaited email response finally comes. It's almost enough to get me to tackle the Red Book.
wow i can't believe someone would actually do that what about politeness common curtsy It is very upsetting when the phone rings constantly when therapy is on it is not only distracting it is startling keeps one on the edge of their seats i wish i had the nerve to ask Therapist to turn off all phones while i am there i turn off mine. I can see you take on it though still one is raised to have consideration for others. Texting is rude when you are talking to someone whether in therapy or not.
I turn mine off completely , I remember one time I forgot to and of course it rang!, I was embarrased because of this, though my T wasn't and just asked if I wanted to take the call. )
There's a reason for voicemail isn't there?? times like this maybe? text or voicemail can be attended to afterwards. IMHO of course. :)
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