17-year-old Ellie and her mother sat on my office couch ready to discuss how Ellie’s mood had been since starting on an antidepressant medication. Before getting started, Ellie’s mom handed me her credit card to pay for the visit. Again, my phone’s app wouldn’t respond but after some fiddling, finally accepted the payment. Forgetting to mute my phone for this first appointment of the day, I set my phone on the table next to my chair. As soon as Ellie began sharing about her first few days of school, my phone beeped alerting me to a call waiting on my office line. I apologized to Ellie and her mother, muting my phone and moving it behind my chair. After briefly discussing how Ellie was feeling, I asked her mom to leave so that Ellie and I could talk privately. Before I could begin to explore Ellie’s mood in more depth, she excitedly pulled out her phone and showed me Instagram posts of several cheesecakes she had created from her own recipes. Beaming, she told me that she hoped to one day become a chef. I praised Ellie for her creativity and work. I was pleased to see such excitement from a girl who, a couple of months ago, couldn’t name anything that she did for fun.

One of the earliest lessons I learned in residency was the importance of tuning into the emotional and physical cues of everyone in my office. Lectures described personality types, relational dynamics and defense mechanisms such as transference and countertransference, all issues important in understanding patients’ complex lives. Now years out of training, I have become comfortable integrating all these concepts into my patient interactions. However, recently I have become aware of a surreptitious invader into the safe space that I have created in my office: technology.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

Technology has become ubiquitous in our personal and professional lives. Before I have arrived in my office in the morning, I have used my phone and often my computer. Both have become integral in my work used to communicate with patients, track visits, collect payment and carry through a variety of medically necessary tasks. It is the third entity in the room during every patient visit. However, I have always felt uneasy about the presence of my devices in my space, especially when they creep into my patient encounters. Experimenting with my laptop placement, I tried resting it on my lap as I attempted to simultaneously type and listen to patients as they discussed their concerns. Uncomfortable with my computer’s interference, I returned to handwritten notes, dismissing my laptop to my desk. Not long after, my smart phone eased its way to my side table, an arm’s length away to collect payments and research medication questions. I wondered if my patients felt its intrusiveness as it sat waiting to alert me to some call, text or other notification. I quickly learned to not only turn off my phone off during patient visits, but to move it out of our direct line of sight when a patient is in the room.

All of this has left me wondering how we as mental health providers can invite technology into our practices with intention. While devices can be invasive and disruptive to my connection with my patients, I also realize that these digital instruments can be helpful, even mandatory, in our work. As professionals whose work depends on engaging in and modeling healthy relationships, understanding the presence of technology in our practices is critical.

The very physical presence of technology can have both a behavioral and emotional impact. A 2019 study by Glas and Kang showed that college students who were allowed to have their phones and computers during class scored lower on final exams than their peers. The proximity and intrusiveness of our devices can impact our work with patients. Turning devices off or placing them on mute, putting devices out of site or, at the very least, removing them from between us and our patients, can help reduce the disruption of the person-to-person interaction. Not only are we modeling prosocial behaviors for the people who we work with, we can use our own behaviors to highlight the impact of devices in our lives. I have placed a basket in my office for devices that prove too tempting and distracting for the youth and families that I see. It is kept near the door so that, physically and visually, it is removed from our interaction.

On the other hand, technology can be an important tool in our work. For my children and adolescent patients, using apps to track mood and sleep have yielded more cooperation than tracking those metrics on paper. Apps that track mood and anxiety symptoms can help individuals share their symptoms with their doctor or therapist. As professionals, we can guide our patients in choosing apps that best meet their needs. Apps are not regulated and there is little oversight into their creation or claims. We can help our patients become better equipped to choose apps that are helpful rather than harmful. The American Psychiatric Association has created guidelines to assist professionals in helping individuals choose the best mental health related apps. The APA has developed the App Evaluation Model that can help providers evaluate the appropriateness of an app with their patients. (see figure)

Technology can also help us learn more about our patient’s interests and can assist us in forming a better treatment alliance. Asking a teenager about his or her Instagram or Snapchat accounts can lead to discussions about personal interests, friendships and conflicts with peers.

Technology is not leaving anytime soon and is likely to gain a greater presence in our personal and professional lives. When we are proactive about recognizing where technology can enhance or interfere with our work and connection to the people we care for, we can become better equipped to optimize its presence and function in our professional lives.


Arnold L. Glass & Mengxue Kang (2019) Dividing attention in the classroom reduces exam performance, Educational Psychology, 39:3, 395-408

The American Psychiatric Association, https://www.psychiatry.org 

File under: Musings and Reflections