Can the future of psychotherapy be found in an iPad?

As I read Dr. Allen’s recent blog post “What’s Next? Psychotherapy by iPad?,” I had a few thoughts. I was reminded of the seemingly natural gradiosity that we humans possess in believing that there are certain behaviors that only we can do, or that we do best. I recall reading When Elephants Weep: The Emotional Lives of Animals and having that same thought: Is it not grandiose to believe that, as a species, we have the corner on the market of complex emotional worlds? As an avowed middle-aged geek, I was also reminded of Data from Star Trek: The Next Generation and his quest to be human. In one episode, the wise Captain Picard mused that perhaps humans ought to aspire to be more like Data.

Attachment and machines

In all seriousness, I think one question that begs to be answered is whether or not computers can simulate mentalization. I have a pleasant memory of the old computer program ELIZA that was created in the 1960s and programmed to give Rogerian-type responses to “clients” who chatted with it. Many people found ELIZA to “feel” strikingly human and some reported feeling helped by “her.” A more modern version of ELIZA can be found in MindMentor, a computer-programmed “chat therapy” developed by a pair of Dutch psychologists. According to one survey, 47 percent of individuals who used the program reported that they had been helped by it. Did they feel heard? Did the program mentalize them? Is it possible to attach to a computer in the same way that persons attach to other non humans such as family pets?

Though I realize I am straying away from the topic of mentalization and attachment, as Dr. Allen alluded to in his post, there are other, non-human modes of treating people out there. There are CBT sites, for example, that purport to help people with depression and OCD. Also, as he mentioned, thousands (millions?) of self-help books exists that presumably have helped individuals in their recovery. Did the individuals reading these books feel “heard” or “understood” when they turned the pages? Did the books “speak” to them?

In the future

The most recent Monitor on Psychology, a publication of the American Psychological Association, just arrive in my inbox, and on the front page, it says “Beyond one-on-one psychotherapy.” In Dr Allen’s post, he rightfully mentioned recent thinking by psychologists that we need to try to reach more clients. We ought to be able to provide services in many modalities, and to people who are geographically, financially and mobility challenged. It seems to me that ongoing debate and study regarding alternative delivery methods is inevitable. It’s conceivable to me that, in the future, I might pull out my smartphone and utilize an “app” that helps me think about an interpersonal problem I might be having. Will I feel “attached” to my smartphone? Well, I already am. (Just a little textual cue so that you might better mentalize me and the playful spirit with which this post was submitted.)

Once I decided I was going to try to quit using diagnostic language. My head was swimming with diagnostic labels and, when I started working at Menninger, I came to find out that there were new labels to be learned! For example, I found out that one can be addicted to “love.” Who knew?

I became convinced that I stopped seeing “people” at some point, and started seeing boxes and symptom lists and other forms of academic short cuts that are often used to describe a  complex human who sits across the room from us.

In my role as a psychologist, I often get called upon to use diagnostic language when describing people. I’ve been trained in psychopathology and assessment, and there have been times when, within 15 minutes, I had to come up with a formulation about a person’s innermost self. I knew it was too much when I went home and started thinking of my dog as “avoidant” and “masochistic.” She deserved better, I thought.

A new viewpoint

I became determined to look at people contextually. At this time, I started wearing a rubber band on my wrist, and every time I uttered a diagnosis (or defense mechanism or similar psychobabble) in a meeting, I would snap it. I found that I was snapping it every five minutes or so!

It seemed that diagnostic language was everywhere and that even patients were hungry for a word, or set of words, that pulled their experience together into a cohesive and unified idea. For about two weeks, I succeeded.  Interestingly, I found my thoughts to be more poetic and my stream of consciousness about the folks I was working with to read, on paper, more like a rich and detailed novel. My patients were coming to life!

And then I forgot the rubber band and sank back into my old habits. Perhaps I’m a “label addict.”

What happened to mentalizing?

It struck me that in forming a diagnosis we were doing the opposite of mentalizing. Instead of staying curious and continuing to ask questions, we were arriving at conclusions — sometimes far too soon in a person’s treatment. I believed that a diagnosis was an end point and could lead, quite possibly, to the cessation of curiosity. However, in a poignant moment dealing with a relative who was struggling with a mental illness, it dawned on me that the diagnosis gave the family, at least, a community. It allowed them to look online and join groups for relatives of people struggling with bipolar illness, for example. It simplified complexities in an already demanding world.

In sum, I’m back to my old habits. I like what I discovered, however, when attempting to let go of a world view that was instilled in me many years ago:  that human problems can be distilled and diluted into medical terms. In doing so, I discovered a richer language in myself, and I find that I’m thankfully still able to access that language.

I also learned something about some peoples’ quest for meaning and understanding, and how diagnostic language can assist in that quest and can even help people form supportive networks. As always, the answer is not an “either/or” but a “both/and.” Or, perhaps I’m just projecting.