500-600words

O R I G I N A L P A P E R

Technology, Relationships and Culture: Clinical
and Theoretical Implications

Karen Zilberstein

Published online: 27 August 2013

� Springer Science+Business Media New York 2013

Abstract The increasing popularity of the Internet and

social media has generated concerns and disputes about

their effects on brain, behavior, and relationships. While

many positive outcomes are associated with cybercom-

munication, some individuals experience negative conse-

quences. This, in turn, has roused theoretical and clinical

debates about the impact of technology on psychotherapy

and the stances therapists should take in their own work

with clients. Understanding the emerging digital culture,

which includes how the Internet, social media, video

games, reality, identity, relationships, and the self are

experienced and managed, is thus important if clinicians

are

to carefully consider and understand the modern rele-

vancy, patterns, and meanings of clients’ communications

with and about technology, as well as the possible use of

social media as a therapeutic tool. This paper considers

those questions by evaluating research on the effects of

technology use and the implications of that research for

psychotherapeutic practice and theory, with a particular

emphasis on how psychoanalytic therapists have approa-

ched the topic.

Keywords Psychotherapy � Technology �
Relationships � Culture � Theory

The Internet and social media are increasingly used in daily

life, changing, in some ways, how people communicate and

relate. While Internet use remains high amongst many

demographic groups, youth constitute the one most digi-

tally connected. According to the Pew Research Center and

The Berkman Center (2013), 78 % of teens have a cell

phone and 95 % use the Internet. In contrast, 83 % of

young adults aged 18–29 use the internet, 77 % of those

aged 30–49, 52 % of those aged 50–62, and only 32 % of

older adults (Pew Research Center 2012). As youths’ pat-

terns of technology use often persist and stimulate similar

changes in adult populations, social media and the Internet

are likely to increase in popularity over the coming years

(Pew Research Center and The Berkman Center 2013).

This has stirred dispute and concern about the impact of

those practices on brain, behavior, and relationships, par-

ticularly because youth are both most exposed and vul-

nerable to technology’s effects (Small and Vorgan

2008).

An abundance of cautionary books and articles now exist

about these new media and the possible devolution of

relationships through diminishing face-to-face contact, the

impact of multitasking on attention and brain development,

and the creation of false identities and relationships

(Akhtar 2011; Turkle 2011; Small and Vorgan 2008). It has

also roused theoretical and clinical debates about the

impact on psychotherapy and the stances therapists should

take in their own work with clients. Therapists of some

orientations have embraced the digital world as a means to

augment treatments and increase compliance with inter-

ventions, while others worry about the effect on boundaries

and traditional modes of interaction. This paper considers

those questions by evaluating research on the effects of
technology use and the implications of that research for

psychotherapeutic practice and theory. It focuses primarily

on how psychoanalytic practitioners have addressed these

issues, as that sub-discipline has been most involved in

exploring this topic, and then provides some contrasts with

other approaches.

K. Zilberstein (&)
A Home Within, 8 Trumbull Rd #205, Northampton, MA 01060,

USA

e-mail: eKaren@me.com

123

Clin Soc Work J (2015) 43:151–158

DOI 10.1007/s10615-013-0461-2

Research on Technology’s Usage

Impact of Technology on Relationships

Researchers from a variety of disciplines now study both

social media usage and their effects on relationships with

consistent results. According to that research, individuals

create personal networks and use media in various ways to

enhance social needs and lifestyles (Boase 2008). Texting

and other means of briefly connecting may appear to

constitute superficial relationships, but in fact act as a

means to continue existing friendships (Campbell and

Russo 2003; Miyata and Kobayashi 2008). Studies show

that social media are generally not used to establish new

friendships or romantic associations, but to connect with

friends and family members (Gross 2004; Pew 2011a). Nor

do they replace closer contact (Szekely and Nagy 2011).

Those who text more also call others more (Pew 2011b).

Despite high media usage, particularly for young adults, in-

person meetings and intimate contacts still dominate

closeness in relationships (Boase 2008; Jin and Park 2010).

Furthermore, social networking and media based connec-

tions tend to parallel and augment real-life interactions

rather than replace them (Chen 2011; Gross 2004). Today’s

youth appear to develop complex and multi-faceted sys-

tems of associations based on a mixture of various types of

contact (Boase 2008; Szekely and Nagy 2011). Youth

engaging in such combinations of online and offline rela-

tionships also report an increased sense of wellbeing and

enhanced self-esteem (Obst and Starfurik 2010; Chen

2011; Walsh et al. 2010).

Studies of youth’s communications through texting and

chat rooms, or informal online discussion groups, suggest

similar findings. Chat rooms allow for anonymity when

conversing about various issues, which has both benefits

and drawbacks. On the one hand, anonymity gives teens

the space and opportunity to discuss embarrassing topics, at

times sexual in nature, and to practice different types of

relationships (Subrahmanyan et al. 2004). Teens and youth

engaged in chat rooms often show support and sensitivity

to each other, which includes allowing free expressions of

feelings (Subrahmanyan et al. 2004). On the other hand,

when unsupervised, chat rooms can deteriorate into forums

for propagating inappropriate and harmful racist, aggres-

sive, and sexual views (Greenfield 2004). A similar finding

has emerged in a study looking at the content of youth’s

text messaging: ‘‘Our archive is replete with examples of

youths using text messaging to be wonderfully supportive

of each other, terribly mean, and surprisingly intimate with

parents as well as peers’’ (Underwood et al. 2012, p. 299).

Researchers conclude that the behaviors and sentiments

adolescents demonstrate online do not really differ from

those conveyed offline (Greenfield 2004). Concerns about

identity, sexuality, aggression, and social contact are not

unique to those engaged in social media, nor is the ten-

dency for adolescents to push the boundaries of acceptable

behavior when unsupervised: ‘‘the medium is not doing

something to adolescents—they, instead, are doing some-

thing with the medium. Teen chat provides new affor-

dances for old adolescent issues’’ (Subrahmanyan et al.

2004, p. 663).

The Internet and social media thus do not seem to rad-

ically alter or simplify close social bonds or behaviors,

although they allow new and different opportunities for

their expression. Relationships facilitated by technology

appear to provide the same sense of wellbeing as is asso-

ciated with other types of close associations. The Internet

may elicit some changes in how people communicate, but

not why they do so (Hartman 2011). Although digital

communication does favor brief, frequent contacts, it does

not destroy the value put on social associations or dis-

courage people’s willingness to communicate deeply in-

person. In fact, the evidence suggests that it more likely

facilitates both, at least amongst that portion of the popu-

lation that functions typically.

Effects of Technology on Brain and Behavior

Social media and texting do not work equally well for

everyone and they do contain risks. Extroverts and those

with better social skills flourish both in person and online

(Chen 2011; Nadkarni and Hofmann 2012). Negative

psychological effects, including depression and addictive

qualities, have been seen in those who play long hours of

video games or as time on the Internet or mobile phones

increases excessively (Angster et al. 2010; Longman et al.

2009; Lu et al. 2011; Walsh et al. 2010). However, the

nature of this association remains unknown. It is not clear

whether excessive phone, video, and Internet use leads to

difficulties or whether individuals with pre-existing social

or other difficulties tend to use such media poorly. Nadk-

arni and Hofmann (2012) suggest that introverts and nar-

cissists simply exhibit their various offline behavioral and

psychological styles online. According to this argument,

technology enables and extends pre-existing social, emo-

tional, and behavioral difficulties rather than creating those

deficits.

Some argue that the most pervasive, negative impact of

technology lies not just in the way it affects relationships,

but the very core of our neurological wiring. Because the

brain is plastic and changes with experience, digital use

strengthens some cognitive abilities while weakening those

that are used less. In a recent neuroimaging study, the

brains of older subjects were monitored while they con-

ducted Internet searches. Results showed that Internet tasks

led to more brain activation, particularly in visual areas,

152 Clin Soc Work J (2015) 43:151–158

123

than did reading (Small et al. 2009). Cognitive gains from

digital use have been noted in areas of visual attention, the

ability to swiftly sift through and analyze information, and

improved aptitude and accuracy when multi-tasking (Small

and Vorgan 2008). Studies also indicate that excessive

multi-tasking with various media diminishes productivity

and leads to inattention (Small and Vorgan 2008; Watson

and Strayer 2010), although what constitutes ‘‘excessive

multi-tasking’’ may vary according to the individual. Evi-

dence also exists that a small percentage of individuals can

multi-task effectively with no negative consequences

(Chen 2011). In addition, the research does not definitively

answer whether technology, per se, causes either inatten-

tion or reduced productivity. It is possible both that effi-

cient multi-taskers engage most in multi-tasking and/or that

those with insufficient focus are most susceptible to

engaging in that behavior (Chen 2011). Without more data,

it is impossible to know whether multi-tasking causes

changes and difficulties, attracts those best or least able to

cope, or a combination of the two. Pre-existing difficulties

or propensities towards inattention and addiction may lure

some individuals to overuse media, which may then per-

petuate further problems.

The question of digital media’s effects on brain and

behavior is particularly salient when it comes to children.

Younger children’s brains are less developed, growing

faster, and more vulnerable to various effects than more

mature brains (Small and Vorgan 2008). Research shows

that sensory and relational, face-to-face experiences are

important in shaping young children’s brains and providing

needed scaffolding for later social and emotional compe-

tencies (Beebe and Lachmann 2003; Schore 2009; Small

and Vorgan 2008; Stern 2004). Through their impact on

brain structures, social experiences play a crucial role in

neurologically shaping the child’s ability to regulate and

understand affects, cognitions, and behaviors and develop a

coherent and integrated sense of self (Schore 2009).

Excessive media use by children, especially if it diminishes

opportunities for in-person interactions, could thus inter-

fere with crucial learning, although studies do not yet exist

to confirm or dispute whether or to what extent that may be

occurring (Small and Vorgan 2008). In addition, children

are more susceptible to other aspects of the Internet

because of their inexperience and suggestibility. In par-

ticular, they are less able to decipher and resist some of the

more commercialized and destructive messages that

accompany heavy Internet use in the form of advertise-

ments, pop-ups, links, or contact with unknown people

(Greenfield 2004). This has led many to recommend lim-

iting and supervising Internet and social media use by

children and teens in terms of time spent on various

devices, the Internet sites visited, and messages sent to and

received from others (Greenfield 2004). Guidelines on how

to approach social media use appear consistent with rec-

ommendations for parental monitoring and restriction of

youths’ behaviors in general (Keijsers et al. 2009; Kerr

et al. 2012).

A solid understanding of the opportunities, benefits,

limitations, and risks of cybertechnology is important for

therapists who need to translate this knowledge into ther-

apeutic practice. The following section will compare,

contrast, and evaluate various emerging therapeutic stances

towards digital media.

Technology in the Consulting Room: Impact

on Psychotherapy

As therapy and therapeutic theories have always been

influenced by cultural trends and ideas, it is hardly sur-

prising that technology and social media have slipped into

the therapeutic arena. Clinicians debate whether and how

to embrace this new cultural artifact and the type of impact

it might have on therapeutic practice. Clearly, theoretical

orientation influences how therapists frame that debate.

Psychoanalytic and relational therapists tend to feel the

most uneasy about technology’s presence because the idea

of digital media conflicts more with underlying theories

and trends. The current analytic focus on nonverbal com-

munication that consists of gestures, facial expressions, and

important moments of face-to-face affective regulation

(Beebe and Lachmann 2003; Fonagy et al. 2002; Schore

2009; Stern 2004) renders cybertechnology a somewhat

suspect form of communication. However, the recognition

also exists that technology’s sheer cultural popularity and

widespread use all but guarantees its inevitable creep into

the therapist’s office (Brottman 2012; Hartman 2011;

Mishna et al. 2012). While it is impossible to discuss all of

the controversies, questions, and implications of the

Internet and social media on therapeutic practice, a few of

the most salient will be discussed below.

Psychoanalytic Concerns: The Impact on Relationships,

the Self and the Therapeutic Endeavor

The psychoanalytic writers who worry most about the

effects of digitalization express concerns about the impact

on the self and relationships, as well as how to address such

issues therapeutically. Those center on the intrapsychic and

social reverberations of social media and the culture they

create: the ways in which technology alters experience,

merges offline reality with online fantasy, discourages

thought and reflection, and creates detachment from bod-

ies, feelings, and friends (Akhtar 2011; Goren 2003;

Hanlon 2001; Turkle 2004, 2011). According to this

argument, relating to others through email, texting, and

Clin Soc Work J (2015) 43:151–158 153

123

online chats provides at best the illusion of a real rela-

tionship and at worst an attachment to a machine rather

than a person. Digital communication and its lack of

prominent face-to-face contact (although Skype and other

virtual media do allow some such contact), fast pace of

online communication, brief responses, and dangers of

information overload discourage fundamental components

of close associations. These include deep thought, reflec-

tion, and emotional demands (Turkle 2004, 2011). Online

communication also allows for playing with altered and

false identities at the same time that robots and computers

entice with the promise of easy, cyber-based rather than

bodily-based connections (Goren 2003; Hanlon 2001;

Turkle 2004, 2011). These relationships with inanimate

objects lack true intimacy and encourage shallowness and

detachment from self, others, and experience (Goren 2003;

Turkle 2011). The Internet and emails have also been

explored as transference displacements and as transitional

objects or spaces that require therapeutic interpretation to

dispel (Gibbs 2011; Lingiardi 2008). In this way, a number

of psychoanalytic writers suggest that technology allows

for defensive and altered perceptions of self, relationships,

and reality that are detrimental. In fact, research only partly

bears out these associations. As discussed above, digital

technology offers many opportunities for intimacy, reflec-

tion, and identity formation. However, for more disturbed

individuals, perhaps those more often seen in therapeutic

settings, misuse of technology can also result from and

subsequently exacerbate pre-existing difficulties. However,

it likely also confers many of the same benefits and

opportunities for relationships and connection to that

population and, as will be discussed later, even holds some

advantages for therapeutic work with some types of diffi-

culties (Brottman 2012; Nadkarni and Hofmann 2012; Roy

and Gillett 2008).

Essig (2012) warns against the propensity for psycho-

analysts to formulate negative judgments about digital

usage and worries that such assumptions block deeper

understanding of the relevance of technology to modern

culture and the positive meanings and experiences digital

media can provide: ‘‘Information technologies are finally

growing up, so we can interact with them in our world,

instead of theirs…. Ours is a culture fully remade by
information technologies’’ (p. 441). Hartman (2011) con-

curs: ‘‘We need to rethink certain concepts that hedged bets

on reality so that we don’t make the mistake that a number

of psychoanalytic writers have already made of rushing to

judge the new reality on old terms’’ (p. 474). Part of the

difficulty may lie in what could be characterized as a newly

created digital culture gap. Youth, as the largest consumers

of the Internet and social media, are creating cyber cultures

that may be less well understood by older therapists

(Akhtar 2011; Essig 2012; Greenfield 2004). For instance,

Lingiardi (2008) describes his reaction to a client’s email

this way:

I had never before got an e-mail from a patient in

analysis, and I confess that my first reaction was a

sense that I had been ‘‘tracked down’’ and ambushed

in my own private place…. This unexpected e-mail
seemed exotic, erotic and hazardous. A phone call

from a patient is different: it’s more urgent and

there’s usually a question involved. The patient is

physically there, with the tone of his real voice. But

an e-mail pops onto your screen, flashing there amid

the other thousand things in your life (pp. 112–113).

One can imagine that today’s youth might have an

opposite response, finding phone calls more exotic,

demanding, intrusive, and less private than the use of email

or texting, in that voice messages and phone calls can

potentially be overheard. In addition, while the outlines of

this new digital culture are still being formed, they have, to

some extent, altered traditional notions of boundaries and

accessibility and with them, perhaps, client expectations.

Hartman (2011) characterizes it this way:

The person inhabiting this reality doesn’t become a

subject through the ambivalent acceptance of others’

reality. This is a reality of ultimate access and diz-

zying multiplicity where a person becomes a subject

regardless of others’ reality…. In Reality 2.0, access
trumps the need to accept limits as a tool to self

discovery. Networking replaces containment as the

bulwark of meaning (p. 474).

A better understanding of that emerging culture,

which includes how the Internet, social media, video
games, reality, identity, relationships, and the self are

experienced and managed, is important if clinicians are

to carefully consider and understand the modern rele-

vancy, patterns, and meanings of clients’ communica-

tions with and about technology (Dini 2012; Essig 2012;

Hartman 2011).

Another important question concerns whether or to

what extent to interpret and manage technological phe-

nomena and themes via pre-existing theories and tech-

niques. The new technological terrain, which has emerged

from contemporary ways of thinking and relating, may

require adaptations of thought and methods, which

includes considering whether technology can serve a

legitimate and beneficial role in psychotherapeutic prac-

tice. As will be illustrated below, this could not be char-

acterized as a novel situation. Psychoanalytic practices and

concepts have regularly shifted over time in accordance

with changing scientific, philosophical, and cultural land-

scapes (Curtis2012; Mitchell and Harris 2004; Wachtel

2008).

154 Clin Soc Work J (2015) 43:151–158

123

The Historical Perspective

The evolution of psychoanalytic practice can be briefly

traced from its Freudian beginnings to current intersub-

jective and relational theories. Freudian and early psy-

choanalytic theories posited that instinctual drives and the

ego and superego’s ability to cope with them determined

the structure of the self and the extent of neuroticism or

pathology (Freud 1949). Therapy thus worked primarily

with individuals and strove to uncover underlying uncon-

scious mechanisms. The therapist functioned as an impar-

tial observer and authority figure, an interpreter of material,

rather than a shaper of experience (Geller 2011; Gelso

2010). However, as early as the 1920s, American psycho-

analysts began to look more closely at the interchange

between a person, others, and the environment, in part due

to the influence of Progressive Era ideologies about mod-

ernizing and improving the self, the political system, and

society (Cushman 1995). Harry Stack Sullivan (1953), who

began working as a psychiatrist in 1917, emphasized

interpersonal relationships over instinctual drives as orga-

nizing mechanisms for the self. Ego psychology, prevalent

in the 1940s, and self psychology, popularized in the

1970s, further developed in response to growing American

ideals of individualism that placed treatment and growth of

the ‘‘self’’ on center stage (Cushman 1995; Goren 2003;

Kohut 1977). Scientific interest in parent–child relation-

ships and attachment also helped shape self psychology

through explicating how individuals are influenced and

formed by relationships and empathic attunement (Ains-

worth et al. 1978; Bowlby 1988; Winnicott 1960). These

new conceptions about the origin of psychic difficulties

also lead to alterations in therapeutic techniques. The

therapeutic relationship acquired more scrutiny and

importance as it began to be characterized as a real rela-

tionship that provided the antidote to crucial, missed, early

relational experiences (Greenson 1967; Kohut 1977; Win-

nicott 1960).

In the 1960s, a cultural revolution began (spurred by

feelings of discontent around civil rights and anti-war

issues) that also influenced beliefs about relationships. As

‘‘question authority’’ became the dominant mantra of the

young and a profound distaste for the powers and inequities

that society engendered grew, interest in intimacy rocketed

(Jamieson 1998). Intimacy became associated with genu-

ineness, mutuality, equality, and closeness that included

deep and privileged knowledge and understanding of

another and emotional connection (Hatfield and Rapson

1993; Jamieson 1998). These ideas also found their way

into therapeutic techniques and theories. By the end of the

twentieth century, therapists tapped into postmodern and

social constructivist philosophies that reflected a growing

interest in the democratization of relationships and an

increasing distrust of authoritative theories of knowledge.

Relational and intersubjective theories gained ground.

According to those theories, knowledge, reality, and the

self are relative and multiple and become co-created

through various unique interactions (Curtis 2012; Wachtel

2008). Each therapist and client dyad creates a singular

pairing that allows them to work in an inimitable, distinct

way (Geller 2011; Stern 2004; Wachtel 2008). Moments of

change occur through deeply emotional experiences with

another, not merely through insight or interpretation,

although making meaning of those experiences remains

important (Curtis 2012; Stern 2004). While Freud’s ideal

analyst acted as a blank screen and authority figure on

which the patient grew dependent upon and then inde-

pendent of, the modern therapist allows the client more

space in joint decision making, provides less authoritative

comment on the meanings of a client’s communications,

gives wider berth to individual beliefs and values, and

favors interdependence over autonomy (Freud 1912;

Wachtel 2008).

These newer ways of characterizing the self, relation-

ships, and intimacy had already entered both society and

the consulting room when cybertechnology burst upon the

cultural scene. In fact, social media arose within and per-

haps best exemplify the ethos of less authoritative and

more democratic and accessible relationships and the

existence of multiply constructed selves. In this respect, the

pertinent question is not whether or not technology erodes

the self or close relationships, but how the self and rela-

tionships are expressed in a technological society and in

what ways psychotherapy can respond so as to be relevant

to and understanding of that cultural shift. This has begun

to occur as some psychoanalytic therapists look at the

context and content of cybercommunications in the same

way that other types of verbal and nonverbal communica-

tions are evaluated, to determine the function, purpose, and

proper reaction to such messages in any given therapeutic

interaction (including guidelines and boundaries on those

communications) and to help clients think through their

own online goals and behavior (Akhtar 2011; Brottman

2012; Hartman 2011; Lingiardi 2008). In fact, the psy-

choanalytic world has much to offer in this respect, as not

all sub-disciplines of therapy ask those compelling

questions.

Use of Technology in Psychotherapy

Some therapists and researchers seem less prone to ques-

tioning technology’s possible adverse effects and instead

view it as a resource that can be actively incorporated into

treatments. These clinicians base their opinions both on the

unique capabilities of technology and also on its cultural

fit: ‘‘Future widespread use of smartphone technology in

Clin Soc Work J (2015) 43:151–158 155

123

the behavioral health field can be expected. Our increas-

ingly mobile, tech-savvy, and health conscious society will

demand care delivery systems that expand beyond tradi-

tional office-based requirements to better fit diverse needs

and lifestyles’’ (Luxton et al. 2011, p. 6). As a conse-

quence, they recommend that clinicians stay educated

about such issues: ‘‘Given the central role of mobile, social,

and wearable computing in people’s lives, clinicians should

stay abreast of developments and look for ways to make

use of these technologies’’ (Morris and Aguilera 2012). As

suggested previously, those technologies are less often a

part of psychoanalytic work and more often integrated into

cognitive-behavioral therapies. Examples of digital media

in therapeutic use include phone apps that help clients track

symptoms and moods and reduce retrospective inaccura-

cies in reporting (Luxton et al. 2011; Morris and Aguilera

2012); text messaging clients to insure homework com-

pliance between sessions and to strengthen the therapeutic

alliance by showing clients that their therapists are con-

cerned about them (Aguilera and Muñoz 2011); using

smartphones to record coping skills that clients need to

practice and generalize outside of the office (Eonta et al.

2010); and the use of skype or video-conferencing to

conduct sessions (Luxton et al. 2011). In each of these

cases, these authors see technology as an important adjunct

to therapy that furthers specific goals. While they do note

possible concerns about privacy and boundaries, they

handle these rather matter-of-factly through informed

consent and clear policies about how and when they will

respond to text messages and/or email (Eonta et al. 2010;

Luxton et al. 2011). In keeping with their orientations, they

approach technology primarily as a tool rather than asking

how its use may affect or illuminate a client’s underlying

conflicts, desires, relationships, or sense of self. In fact, the

two are not mutually exclusive and contemporary thera-

peutic practice may need to consider many different

aspects of the digital world: the benefits technology can

provide, its meaning to clients, and its various effects on

therapy and the therapeutic relationship.

Technology may prove especially useful for those

unable or not ready to engage in deeper, more intimate

psychoanalytic treatment. Case studies suggest that email

communication can be helpful for severely anxious and

relationally limited clients (Brottman 2012; Roy and Gillett

2008; Lingiardi 2008). Email allows time and space for

sorting out thoughts and feelings, which may be beneficial

for those who are overwhelmed by the immediacy of

relational and emotional demands (Roy and Gillett 2008).

It sometimes also enables clients to share thoughts that they

view as too shameful or secretive to relate in person

(Brottman 2012; Roy and Gillett 2008). Skype and email

may also provide important therapeutic access to clients

who are disabled, out of town, live in a distant or remote

place, or are institutionalized (Akhtar 2011; Brottman

2012). They can also serve defensive purposes (Gibbs

2011; Lingiardi 2008). Therapists thus need to think

through how and with whom the use of technology

enhances treatment and how and with whom it may inter-

fere with deeper, more relational work.

Before using any form of cybercommunication, how-

ever, therapists need to be informed and thoughtful about

the ethical and professional boundaries inherent in the use

of this new media, and for which guidelines now exist

(Luxton et al. 2011; Mishna et al. 2012; The international

society for mental health online 2000). While considering

the new challenges social media introduce may seem

daunting for those unaccustomed to or inexperienced with

the digital world, it is not clear that negotiating those

boundaries and privacy issues are any more complex than

navigating other common therapeutic issues such as pay-

ment, scheduling, emergency access, and phone calls

(Brottman 2012). As Brottman (2012) notes:

Many anxieties surround this question, including the

worry that other computer users may obtain access to

e-mail conversations, or that text messages may

accidently get sent to the wrong person. While such

things are certainly possible, they are no more likely

than the risk of therapy notes falling into the wrong

hands, or voices being overheard in the waiting room.

Similar fears, no doubt, surrounded the possibility of

speaking to one’s analyst on the telephone in the

early years of the twentieth century. Although such

anxieties may seem absurd today, the telephone was

in fact once the locus of all kinds of apprehensions—

around loss of hearing, the electric current, and the

instrument’s erasure of class boundaries (pp. 21–22).

In thinking about the impact and use of technology on

therapeutic practice, it is important to distinguish between

unfamiliarity and anxiety with the tools and the real

strengths and weaknesses that they offer so as to be able to

use them in the most effective and ethical ways. That is

likely to be an evolving debate in the field and guidelines

are likely to become more explicit as therapeutic experi-

ences with this new media grow.

Conclusion

There is little scientific evidence that supports the view that

technology, per se, frays social bonds or decisively incu-

bates new conceptions of our selves. While social media

certainly alter how people relate in some areas, research

suggests that it has not revolutionized the value placed on

intimate relationships and people’s willingness to pursue

such affiliations, nor has it radically eroded a generation’s

156 Clin Soc Work J (2015) 43:151–158

123

sense of self (Chen 2011; Hartman 2011; Nadkarni and

Hofmann 2012; Subrahmanyan et al. 2004). The argument

that technology causes fundamental changes in who we are

omits an important other side: people do not simply live

passively at the mercy of powerful commercial and tech-

nological forces, but play a seminal and purposeful role in

fashioning and using digital objects (Boase 2008; Camp-

bell and Russo 2003). After all, humans create technology

and decide how to use it. Many of the trends and changes in

self, culture, and relationships impacted and perhaps

accelerated by technology predate its entry into daily life.

Cybertechnology’s attraction and rapid growth may in part

be due to the fact that it so easily fit into dominant cultural

ideas and norms about relationships and communication.

Yet there is no doubt that shifts have occurred, in part

enabled by digitalization, to which psychotherapy must

continue to respond (Essig 2012; Hartman 2011). This

includes the democratization of relationships by enhancing

connections to larger and more diverse social groups,

increased openness to considering the realities of others,

and more nimble and less hierarchical exchanges of ideas

(Hatfield and Rapson 1993; Jamieson 1998; Wachtel

2008). It also includes new and diverse online forums and

opportunities for individuals to explore identities, find new

realities, seek meaning, and establish intimate relationships

(Essig 2012; Greenfield 2004; Hartman, 2011; Subrahma-

nyan et al. 2004). Since psychotherapies always develop

within a cultural context, they must remain sensitive to

these changing norms and adapt expectations, under-

standings, and techniques accordingly.

The final chapter on technology and ourselves has not yet

been written. Rather, our relationship to technology and its

impact upon us will continue to evolve. Hopefully, as this

occurs, our theories will keep pace. Ideas, theories, tech-

nologies, and the way we use them as well as the way we

practice psychotherapy will inevitably influence and trans-

form each other, requiring us to alter those theories, ideas,

and practices to reflect these new circumstances. Such

changes are not lamentable or a sign of decline. Rather, they

represent the natural progression of science, culture, and

ideas. As Morawski (2001) notes about the spread of

anorexia nervosa, ‘‘Theory entered practice, altered prac-

tice, and left needs for further theorizing’’ (p. 438).

Acknowledgments The author would like to thank to Sheldon
Rothblatt and Sarah Abel for their suggestions and support for this paper.

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Author Biography

Karen Zilberstein LICSW is a child and family therapist and
Clinical Director of A Home Within in Northampton, MA. She is also

an Adjunct Associate Professor at Smith College School for Social

Work, where she teaches and coordinates the Child Development

Team.

158 Clin Soc Work J (2015) 43:151–158

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http://www.ismho.org/suggestions.asp

http://www.ismho.org/suggestions.asp

http://dx.doi.org/10.1037/a0028678

http://pewinternet.org/Reports/2011/Why-Americans-Use-Social-Media.aspx

http://pewinternet.org/Reports/2011/Why-Americans-Use-Social-Media.aspx

http://pewinternet.org/Reports/2011/Cell-Phone-Texting-2011.aspx

http://pewinternet.org/Reports/2011/Cell-Phone-Texting-2011.aspx

http://pewinternet.org/~/media//Files/Reports/2013/PIP_SocialMediaUsers

http://pewinternet.org/~/media//Files/Reports/2013/PIP_SocialMediaUsers

http://pewinternet.org/~/media//Files/Reports/2013/PIP_TeensandTechnology2013

http://pewinternet.org/~/media//Files/Reports/2013/PIP_TeensandTechnology2013

• Technology, Relationships and Culture: Clinical and Theoretical Implications

Abstract
Research on Technology’s Usage
Impact of Technology on Relationships
Effects of Technology on Brain and Behavior
Technology in the Consulting Room: Impact on Psychotherapy
Psychoanalytic Concerns: The Impact on Relationships, the Self and the Therapeutic Endeavor
The Historical Perspective
Use of Technology in Psychotherapy
Conclusion
Acknowledgments
References

Socialmedia such as Facebook and Twitter have obviously become a large part of our lives over the last decade or so. However, many feel that there is both good and bad in this. Questions arise about how the internet and social media might be affecting our brains, behaviors, and relationships. Are repetitive, short -term tasks affecting our brains? What are the psychological effects of communicating through a machine? And finally, perhaps the most important question; is it affecting us in negative ways that we might not even be aware of? After you have read the article Technology, Relationships, and Culture: Clinical and Theoretical Implications by Karen Zilberstein, please write a 500-word interdisciplinary critical analysis essay based on the article. You do not need to go online or to the library to find information about this topic. All the information you need is within the article that is provided. We want you to read, review, and critically analyze the information in this article. In your quiz for Unit 2, you learned about APA citation style, which is used for papers written in the social science disciplines. You will need to cite this one reference at the end of your paper and make in-text citations throughout your paper using APA citation style.

When you write a critical analysis essay, you do not need to be an expert on the topic. Your task is to evaluate what the author has written. For the essay to be interdisciplinary, it must include more than one discipline. Those disciplines are specified in the instructions below.

THE FIVE-PARAGRAPH ESSAY (INSTRUCTIONS)

When writing this essay, please use the five-paragraph approach. In this case, each paragraph should be approximately 100 words long. This is by no means the only formula for writing such essays, but for this assignment, it serves our purposes well. This method consists of:

1. Add a title page with all the information that is highlighted in yellow on the title page of the “APA Sample Paper” that is provided.

2. Do NOT include an “abstract” page. An abstract it not necessary for the purposes of this essay.

3. PARAGRAPH 1 (100 words) – An introductory paragraph

Clearly and concisely states the paper’s purpose, which is engaging, and thought provoking. Your introductory paragraph should answer these two questions: 1) What is the nature of the work (type, purpose) and what is the primary message(s) of this work?

2) What problems is the author trying to solve and what are the primary issues that the author is addressing?

4. Three evidentiary body paragraphs (paragraphs 2-4). Analyze the following disciplines and their role in the painting featured in the article.

a. PARAGRAPH 2 (100 words) – Analyze through the lens of the natural science discipline of physiology about how the internet and social media might be affecting the neurology of our brains.

b. PARAGRAPH 3 (100 words) – Analyze through the lens of the social sciences discipline of psychology about how the internet and social media might be affecting our interpersonal skills.

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c.
PARAGRAPH 4 (100 words) – Analyze through the lens of the social sciences discipline of sociology about how the internet and social media connects us.

WRITING TIP: Do NOT write a summary or “book report” of the article. That is NOT the purpose of a critical analysis essay.

5. PARAGRAPH 5 (100 words) – A conclusion paragraph

In your conclusion, describe what you have learned that you did not know before and perhaps what you can use in your personal and professional life based on your critical analysis of this article.

6. Add a “REFERENCES” page as formatted in the sample paper on page 9. In this case the only citation we have is the one article provided.

FORMATTING: Double spaced, Times New Roman font, 12 point text, and one-inch page margins. College-level writing is expected. The paper will be graded for content, grammar, spelling, punctuation, and sentence structure.

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