Monday, May 7, 2012

Face Time? Reflecting on Cell Phone Use in Treatment

We have interesting relationships with our phones these days. They keep us continuously connected to one another, least of all by phone calls, and more and more via text, email, social media, and even sometimes "facetime" (like a phone call with video). We live in a world where we expect instant access, instand information, to be constantly reachable, and to reach others constantly. It's almost an addiction.

An like an addiction, we may go through withdrawal if we have to be away from our phones and out of contact. I know that I, for one, get anxious and start to imagine what I might be missing. And I don't even use my phone that much (since it's web applications are too slow!).

Given the significance of the phone in our culture, what is its significance for treatment? Here, I'm setting aside the complex question of telephone calls between therapist and client, and simply thinking of the client's phone and what it represents.

There are layers to this question, as there seem to be layers to so many things in therapy. One interesting dynamic has to do with the role of phones in substance abuse treatment. If you've worked with this population, you know that they cannot have their own phones in treatment programs. The reason is that their phones represent a connection to the drug world. Not only do they most likely have contact information for deals and people they used with stored in the phone, but those people most likely also have the client's information, and may call to offer drugs, invite the person to "hang out" (and get high), or to ask the client to get drugs for them.

However, amputating people's phones doesn't really solve the problem. Not only can they still get drugs if they really want to, they also can't get in touch with supports for recovery. They can't call their sponsor, or other people from 12-step meetings, arrange rides to meetings, reach or be reached by their providers. It's always a frustration to me when I work with clients who are in a program and have no phone, because inevitably there is some occasion when they or I have to miss a session, and rescheduling is practically impossible.

Phones can also influence other kinds of treatment, particularly at any level of care other than standard outpatient individual therapy. People on inpatient units typically cannot keep their phones with them, and don't have phones in their rooms, with public payphones the only option. I understand the rationale. In medical facilities cell phones can disrupt certain medical devices, and in psychiatric facilities, there's always the risk that interacting with people from outside could be a stressor and lead to decompensation, or even aggression. However, as with substance abuse treatment, removing phones also isolates people from supports that could help the person stabilize and feel more hopeful about life outside the hospital. And more selfishly on my part, I'd like to be able to reach clients in the hospital, since all too often I'm not even notified if a client of mine is admitted.

In group treatment, phones take on a different role. Since most phones have cameras on them these days, phones represent a potential breach of confidentiality if people take any pictures during treatment. Texting and web access also open the possibility of breaking confidentiality, or even "subgrouping" - contacting other people in the group during or after group to talk about what is going on. However, in psychoeducational groups, phones with web access could be a way to check or gather related information. On the whole, however, phones seem to be at best a distraction, and at worst a way of derailing group process. However, with a large group it may be hard to always know if someone is texting, or just looking at their labs...particularly if the group is sitting around a table.

How do you see cell phones playing into treatment dynamics? Are there particular populations or settings where they seem most positive or negative to treatment?

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