A recent article on a study from the University of Zurich offered the headline, "Psychotherapy Via Internet as Good as If Not Better Than Face-To-Face Consultations." It does not surprise me when I think about many of my clients’ everyday lives in the Bay Area: technology tends to be seen for the most part as a fun, useful and normal part of life. It also makes sense when I think about the ways that technology, if wielded strategically, can sometimes make things simpler and more immediate. Grandkids and grandparents all over the world would agree (thanks Skype!), as would families with service members deployed in far-off countries.

Here's a quote from the article in Science Daily about the online psychotherapy study, "In the case of online therapy, the patients tended to use the therapy contacts and subsequent homework very intensively to progress personally. For instance, they indicated that they had re-read the correspondence with their therapist from time to time. ‘In the medium term, online psychotherapy even yields better results. Our study is evidence that psychotherapeutic services on the internet are an effective supplement to therapeutic care,’ concludes Maercker [one of the study’s authors].”

Skype therapy could improve outcomes while it lowered the barrier to accessing therapy. In one way of thinking about it, what was once a trip across town and a 2-hour commitment is now 50 minutes at one’s desk.

But I notice a conservatism and even a bit of prejudice against technology use among therapists: Skype, texting, online scheduling, and other things can be treated as if they are volatile substances when in fact they are more and more a part of everyday life, used by lots of people to great effect. Therapists can benefit from remembering the wisdom that often what seems unstable and jarring to an older generation is soon enough just “the telephone”—utterly banal and safe.

A few years ago a former Supervisor warned me against texting with clients about appointments and scheduling shifts. When I questioned him further, however, he admitted that email was ok for this, and that he emailed with clients about appointment times, though not clinical material. Most therapists under forty who I ask about texting with clients say it is the same thing—just a quicker form of email. I have even heard a client assert, “It’s rude to call someone on the phone now. You interrupt their day and make them say ‘how are you?’ Texting is more polite, faster, and doesn’t require needless formalities.”

I think that the obvious insight here, that technology changes and what seems outlandish today will soon be normal, can go one step further. What if therapists could harness the excitement and convenience of technology to improve our usefulness to clients and to improve our ability to help clients change their lives?

I've been thinking a lot about therapists and technology lately, as I have been part of a group testing out a new mood-tracking app called Senti. With Senti, users answer a few relevant questions about mood and emotion throughout the day and Senti keeps track of how they seem to be doing. The questions both track useful information (“Thursday tend to be a rough day for me”) and also function as a mini-intervention, just as if someone had texted you to say, "hey, put your feet on the floor, take a deep breath, and tell me how you're really feeling right now."

But when I described the app to another therapist she was skeptical. "It sounds great," she said, “but therapists are late adopters. You'll never get them to use it with clients." Similarly, The New York Times recently ran an article by therapist Lori Gottlieb with the headline, "What Brand is Your Therapist?" In it, she ponders whether therapy as we know it is a think of the past. "I hate to think that therapy is an outdated idea, too slow and too private to satisfy a population that has come to expect immediate responses and constant gratification."

I see people each day needing help coping with divorce, eating disorders, anxiety, depression, and other problems that cannot be repressed and forgotten and that need attention. There is a great need for inner work and for the relief of human suffering. Rather than thinking technology is a barrier to connection, we can ask what Darren Kuropatwa asks in his presentations about technology and learning: “What can I do now that I could not do before?”

What if instead of a necessary evil, technology could facilitate a different kind of depth—the depth of a therapy that can be held by a client in their hand; where self-support, self-inquiry, and a therapist at the other end of the wi-fi connection make transformative work more possible? After all, there is nothing about Skype or about an email exchange that is inherently glib or false. What matters is the content and the material and the depth to which the client can face themselves, with the powerful support of another person trained to be of use. Whether the therapist is on Facetime or tweeting reminders to followers to pause and breathe when angry feelings erupt, what matters is that people get better and the world gets better. And for that project we need every tool we can get.

File under: Musings and Reflections