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From Real Life to Cyberspace (and Back Again): Bringing the Digital World of Your Clients Into Therapy
by Tobi Goldfus, LCSW-C, BCD

7 CE Hours - $104

Last revised: 03/19/2019

Course content © copyright 2019 by Tobi Goldfus, LCSW-C, BCD All rights reserved.


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Learning Objectives

This is an intermediate level course. After completing this course, mental health professionals will be able to:

The materials in this course are based on the most accurate information available to the author at the time of writing. The literature on the effects of online engagement on adolescents and young adults grows daily, and new information will likely emerge that may supersede certain aspects of these course materials. The present course material will equip clinicians with a basic understanding of how to work with adolescents and young adults to create balance between their online and real-life experience. This course is adapted from the following book: From Real Life to Cyberspace (and Back Again): Helping Our Young Clients Develop a Strong Inner Selfie, by Tobi Goldfus, ( Zeig, Tucker and Theisen, Publishers, 2017).

Outline

Introduction

The Importance of Bringing Your Client’s Online Presence Directly into Therapy

The purpose of this course is to present a selection of road-tested techniques and perspectives focused on working with adolescents and young adults. The course acknowledges technology as a central aspect of human development and relationship, and it explores a host of realistic ways both to use it in therapy and to approach it as a topic for therapy. As an author, I take my role as a teacher seriously, thus I have tried to offer content in an interesting way. The case excerpts identify certain client characteristics and circumstances, and the segments that follow them illustrate practical ways to attune to young clients and help them establish and strengthen the core self – the “inner selfie.” There is content in the course that will withstand the test of time and some that will need to be updated as technology continues to expand its reach into our private lives and social media increasingly becomes the platform through which people explore identity and developmental questions. Further, the studies coming out of brain research are clarifying the intricate connections between these threads every day.

The information and approaches that I have been exploring, developing, and teaching about integrating psychotherapy interventions with cyberspace experience are offered here. The framework includes views that I believe are essential as we attempt to understand and be with our young clients.

Digital life is a fact of life and it is here to stay. Many of our young clients have little idea of what came before or even that there was a “before.” What on earth did people do? How did they possibly manage? I almost don’t remember myself. So, our young clients are plugged in without question; it is now an “organic,” natural and, often, central aspect of their environment, education, socialization, exploration, communication – their normal daily life. Their parents are often as plugged in as they are and many of us are hearing a lot of complaints about that. Although cyberspace is a free space to go anywhere, the generation gap can be found in cyberspace too, with older adults going to digital neighborhoods or looking for things younger visitors don’t care about. We therapists are plugged in too: we are both therapy-anchored and digitally aware. The degree of our awareness depends on many factors, including age, tech savvy, comfort, and interest.

So if digital life is a fact of life, it must also be a factor in therapy. I want the digital realities of your younger client to be an integral part of your therapy, no matter what therapeutic blueprint or treatment modality/school of thought you use. We must recognize this digital online plugged-in life as part of who our clients are, as part of our therapy, from beginning to end. Without this view, we are worlds apart from our young clients and add to their feelings of isolation and not being understood.

This course focuses on how to integrate these worlds in our therapy. I have included both the adolescent and the young adult because this is life as they know it. Some of you might even fit that young adult profile.

The positives of the digital age are phenomenal; but there are also concerns and caveats. This course considers both in terms of their impact on the developing young person. We know that the brain continues to develop until around the age of 30. We know that being socially connected online can both reduce isolation and stimulate curiosity and learning. We also know that too much of anything can cause all kinds of problems. Internet compulsivity and addictions, and even other addictions that can be fueled online, are often a central aspect of the problem. The course also addresses and identifies healthy use, compulsive use, and addictive use; as well as how anxiety, depression, and other psychological problems can be impacted both positively or negatively.

Boundaries and confidentiality, and other old conceptual pillars with clear definitions, have given way to new ones. Some of these mirror what our clients are dealing with. What you would never do IRL (in real life) is a whole different ballgame online.

We also explore how our young clients are practicing and mastering developmental tasks online as well as offline. Because online engagement is so externally focused, a very interesting and creative question for me is how my clients’ digital interactions might be channeled more toward emotional and psychological growth.

Over the years, I have developed several ways to enlist the aid of electronic devices to help clients access and improve self-confidence and build strong internal states as they confront their many challenges. I refer to this as building their Inner Selfie. Trancework or hypnotherapy, both direct and indirect, and “parts” work or ego-state work, as well as other approaches that I have integrated over the years, are the focus of the treatment choices outlined here. They make sense and come alive with young people.

I describe the Inner Selfie as an immediate down-regulation tool. This image promotes the reflective, the contemplative, that inner pause. Inner Selfie awareness promotes self-confidence and strengthens inner resources. Here I describe how using ego-state or “parts” work begins to increase internal responsiveness and how combining trancework or mindfulness techniques with this will add to transformative emotional impact for change and Inner Selfie building. I show you how to use your client’s mobile devices to access a part of their Inner Selfie and provide a short trance for anchoring and strengthening their maturing resources.

Not bringing the digital world into therapy risks missing a large part of who younger clients are and what is defining them at any given moment. I have developed the Social Media Assessment Form (SMA), a tool for navigating and “seeing” their digital landscape, which will serve as a valuable resource from the beginning of therapy to the end. It moves seamlessly into the therapy hour, increasing the understanding of your client exponentially. This establishes an openness around both sometimes-tough questions about clients’ digital explorations and what digital experiences and interchanges they are having that impact them.

You will also learn about the Seven Stages of Smartphone Attachment, which you can use to determine where your clients are with theirs (as well as observing where you are yourself). This tool identifies the pulse and strength of attachment and can help you to target treatment goals.

Over time, I have studied the comparison of hypnotic phenomena that is happening when one is in digital time with that of therapeutic trance. These parallels are contrasted and discussed with a focus on utilizing these phenomena in therapeutic trance in the service of improving inner strengths and real-life relationships with others and with oneself.

Another tool I offer is how to pepper your dialogue with technology-friendly words in natural ways. I encourage and discuss the benefits of the “trancette” (a brief trance) designed specifically to appeal to the adolescent/young adult client, acknowledging his or her attention capacity while creating positive emotional impact.

Being connected and active online is essential in today’s world but we need to go “unplugged” at times. If offline time can be intentional, no matter how long or short it is, our clients will come to welcome it, as they experience lower anxiety and a surge of authenticity with themselves and others. This is where living in real community can flourish. It is a visceral, kinetic, warm sense and is felt deep within, perhaps touching into that Inner Selfie. We also look into when to unplug and when not to.

By the end of this course, you will have no question as to the importance of including the digital persona of your younger clients in every phase of your treatment and relationship with them. And you will have the tools to do it!

Glossary of Terms

The terms below are used by the author in this text and are not necessarily used in common parlance.

Cyberalert/Cybervigilant: Positioned on a continuum from being alert and focused on whatever and wherever the cyber attention is, to being hyper-focused, scanning, constantly checking and moving around cyberspace with increased speed and absorption.

Cyber-Egostates: The sides, “parts,” or ego states being expressed and/or being developed online.

Cyberpresence: Being online in a totally absorbed way. Being able to be CYPERPRESENT on many sites at once. Dissociated to some extent or to an extreme extent from “in real life” (IRL).

Cybersincerity: Senders know their own level of CYBERSINCERITY, but the receiver has to guess or assume where it is on the spectrum from sincere to embellished to completely false.

Cybertrust: The amount of trust one has in the sender(s) of the message. The receiver has to make a calculated guess as to trustworthiness.

Inner Selfie: The internal sense of self, healthy ego, or core. The play on words brings together the digital and real-life worlds to which adolescent/young adult clients respond positively.

Social Media Assessment Form (SMA): An assessment tool given to your clients at the beginning of therapy (or midway for current clients). This straightforward questionnaire asks about sites frequented, amount of time spent on them, etc. The information is highly useful and the invitation to fill the therapist in normalizes discussion from the start.

Trancette: The mini-trance. A shorter version (4-8 minutes) of a hypnotherapy direct trance designed to fit the digital pace of your client.

Context – Achieving Increased Effectiveness and Connection with Your Client

Learning to Navigate the Digital Landscape

Opening Scene: The late afternoon light sifts through the mini-blinds. Carrie, age 21, settles onto the leather love seat. Her goal in therapy is to get out of a “rut of aimlessness and long-term depression.” She rearranges her coat and positions the two pillows and her cell phone to her right. Behind me, where I sit in my comfortable chair, is my desk, turned at an angle, the PC on, my cell phone beside it. We are ready to begin.

Flashback: My cell phone was turned off and stowed away in my purse. I noticed her cell phone, felt some minor irritation – its presence like a bold, uninvited guest. If Carrie picked it up to text someone, I might have asked her to wait until the session was over. She might have responded with a somewhat annoyed look, slid it under a pillow and snuck a peek periodically. I felt the session to be slightly off balance.

Today: Our session begins. I know from the Social Media Assessment form (SMA) that Carrie uses texting and Twitter for up to three hours a day and that she has spent hundreds of hours since her early teens playing an online fantasy game. She now writes blogs and is at work on a fantasy novel. She also let me know via the SMA that she wants to spend less time on digital devices. We have agreed on a goal for her to be more “social” in real life (IRL).

Carrie responds to two or three texts during the session, her thumbs flying. She reads me part of one text to someone she is in a floundering relationship with and shares something from her fantasy novel. If we do a “trancette”(a short 4-8 minute trance) today, it may include a few of the traits from characters in her novel that I can weave into the dialogue with indirect suggestion. If either of our cell phones “dings” with an incoming text, I might use that sound to deepen her experience, like the ring of the Buddhist chime. I am totally cool with it. It seems perfectly normal.

Inviting Digital Personas into the Therapy Room

We know that what isn’t discussed becomes the elephant in the room. If ignored or just given a nod to, the digital life of your client is one of the biggest elephants you will ever miss. The welcome mat is out when you acknowledge and get to know their online profiles and activities as a natural part of who they are.

Constructs of ego states or internal state systems in therapy focus on all parts of a person, both internal and external. If the digital personas and experiences are not treated with equal respect, you may be encouraging the compartmentalization, fragmentation, and dissociation that young people so often describe in therapy today. We must address all parts of our younger clients, and that includes what they experience and act out online. When we do this, we demonstrate a level of respect for the total self of the client, which translates into the client feeling really seen.

When I was in social work graduate studies more than a few years ago, seeing the “whole” person was already a part of our training: familial, social, emotional, physical, spiritual, and systemic. Today, what constitutes the “whole” person has expanded. We accept that our clients will likely Google us and that their smartphones often actively join us in session (texts, pictures, YouTube). The therapeutic relationship between “us” and “them” now includes this “other.” This third entity is an alive and active part of our client’s whole being – part of their vital presence.

Using Your Therapy as a Search Engine

If your approach can embrace the electronic persona of the adolescent/young adult, you will find that your work together will be enriched and more effective.

Clearly, the digital world has become part of who we are. Almost all of us use our smartphones, iPads, and PCs as adaptive extensions of our physical selves, interacting with them most of the time. We have changed how we see ourselves, how we communicate, and how we spend much of our time. It’s all so automatic that we hardly pause to think about these changes, but our lifestyles are fully wired (or wireless) and it affects almost every aspect of interaction.

Automaticity has two sides: One is our growing adeptness in navigating the electronic social media world. It is like learning to drive a car or ride a bicycle – we get better and better and don’t think about each little skill that it involves. The other side is more akin to eating a bag of potato chips in front of the TV – two hours go by and the bag is empty and we don’t even know how it got that way. And sometimes when we do things mindlessly, absorbed in something else, the cost can be huge – far more than a few hundred calories.

As therapists, we are not immune to the call of the digital world. We parallel our clients’ digital engagement to a great extent. The fact is we should neither ignore the force and influence of cyber technology nor demonize it; we need to incorporate it. Our clients spend many hours of every day absorbed online and on social media sites. More and more studies are looking at increases in adolescent and young adult reports of anxiety, depression, and general malaise that seem to have a connection to time spent online. Physical impacts of prolonged use are reported to be on the rise too. I have a client whose teenage son has been diagnosed with “adolescent round back” from spending too much time hunched over his video games. I have read about “text neck” and “iposture.” Sleep problems among young people are also on the rise, as many simply can’t turn their minds off at night, their digital night-lights constantly calling out to them. They can’t turn off and they can’t tune out.

We can use psychotherapy as a “search engine” to help our clients who are engaged in cyberspace. I will introduce ways to effectively adjust and expand your therapy strategy to fit with the client’s digitized world. You will significantly improve your interventions for bolstering ego strengths and a solid inner locus of control.

You will learn about the Social Media Assessment form (SMA), a central tool that can help you find the common digital ground between you and your client. The SMA allows the client to share his or her online digital reality, or at least open the front door, in a straightforward way. The information provided will quickly form a cornerstone of your shared information gathering that invites clients’ digital experience into therapy, and will foster further exploration in all aspects of your treatment.

The SMA marks the beginning of the journey to help clients move more easily back and forth between online and real time (IRL). The goal is to match their technical savvy with richer, deeper possibilities for connection and a growing sense of self in a present, mindful way.

We need to redefine our view of what it means to see the whole person to include all aspects of the digital self. Updating our understanding will deepen our attunement to these wonderful young people who are often telling us they are lost, anxious, confused, and overwhelmed. Our ability to move with some grace through the digital landscape with them will help us refine and better tailor our therapy with them.

Therapeutic App: Expand your therapeutic lens, shift your focus slightly to embrace the total experiential world, online and off (internal and external), of your adolescent/young adult client.

The Great New Frontier: No Maps or Guides

Opening Scene: As a teenager, Dixie explored every place online that piqued her curiosity or that she knew would be forbidden by her parents. It was her private life, and not even her friends knew about her secret digital travels. Now 22 years old, and in college, Dixie is still probing unknown horizons and visiting unconventional sites. With her choppy blue hair, body piercings, and biker boots, she prides herself on being independent (though not economically) and a free spirit. She loves indie music, role playing, and sexual interactions that are “open” and gender adventurous.

Flashback: I loved how Dixie made her hair, clothes, and body a part of her artistic expression. She was cautious and careful in sharing her angst, insecurities, and depression. We proceeded slowly. I might not even have asked much about her social life online. We talked a lot about her friends and her sense of rejection when one withdrew or others were not responsive. I wondered what she was withholding from me and if she saw me as being aligned with older adults, a world she clearly had no interest in.

Today: My younger “self” resonates with Dixie’s self-expression through fashion. I get that language. The SMA shows me a rudimentary map of her online travels. In our intake, I am comfortable interacting with her about being plugged in 24/7 on various sites. She is forthcoming about her gender openness based on questions I can now ask, as she has provided permission. She seems relieved. The guard is down as Dixie continues to share complex and painful struggles that often have a genus online and seem to feed her fear of being alone.

Uncharted Territories

The digital galaxy is as vast as the real universe. With every second that passes, it becomes more complex as it is experienced, explored, and exploited by billions of people. It is the connector for most of the world’s population, no matter how remote. It has changed our lives profoundly and forever.

The Internet is its own wild kingdom. When people head their digital off-road vehicle deep into the electronic jungle, there are no passports, no vaccines, no antibiotics to take if they get sick or infected, and no licensing boards or speed limits. There are no danger signs, no U-turns, and sometimes there is a digitally fueled reconfiguring to a place that is even more unknown than anticipated. GPS is for physical spaces, not for cyberspace travel. Safety nets and controls are limited. Remember maps? They offer a picture of where we are going, an estimate of the distance between points, and an image of where we are setting out from. They provide a clear reference, a sense of spatiality. Using maps, we can find detours and choose alternate routes should something unexpected arise. We have time to consider our options and perhaps even decide not to go. But online, there are almost no objective indicators, nothing to tell you whether you are heading into an isolated back road of disaster, a vortex of shame, or a mountain of material that might be way beyond what you can handle.

Our maturing adolescents or young adults may be masters at traversing the digital landscape, but they could use our help in developing reliable maps that keep them true to their internal compass. By understanding more about what “territories” they frequent and what their visible digital profiles look like, we can begin to be that guide who is in the unique position to show them ways to strengthen their Inner Selfie and fine-tune that compass.

Dixie, from the vignette above, had been navigating the electronic world without being able to chart where she was for a long time. She was not alert or particularly conscious to its seductive danger potential, and she was unschooled in how to withdraw from it anyway. As she moved into her 20s, what would be pretty intimidating for most people was feeling pretty normal to her, and her appetite and curiosity for more had her traveling deeper and deeper into the underworld. I could sense her suffering because I entered that world with her and she took me along.

A couple of years ago, I visited South Africa where I was presenting at a hypnotherapy congress on the subject of this course. The plane landed in the middle of the night to refuel in Dakar, Senegal. As I stared out into the darkness, I saw very little light. The uniformed men who came on board to search our luggage and then bizarrely spray us with an anti-yellow fever agent made me feel unworldly, lost, and out of control. For a moment this was my own “uncharted frontier.”

Two colleagues and I stayed a couple of days at a gorgeous inn close to Kruger National Park. We had to land and orient ourselves to that beautiful foreign country I knew nothing about. Our driver, Mandela, became our guide and “GPS” as we took in a couple of safaris and forays into the mountains. Mandela, a warm friendly father of three daughters, owned a Nokia and a Blackberry. His family still carried water from the river to their home. He was saving for a small water tank. His wife’s dowry at marriage was 12 cows that he was still paying off and he had already calculated how many cows his daughters’ dowries would be.

Simultaneously, he was a member of the global digital world, emailing and texting. I wondered where this would take his daughters as they grew into adolescence and young adulthood. Would there be the equivalent of a “digital” cow, as these ancient cultural systems intersected with contemporary digital operating systems?

I kept thinking about the striking contrast between young people all over the world who live with so much less economically than many of us in highly industrialized countries. Cyberspace becomes then the grand master of equality. Age, gender, country of origin, economics, social strata, you name it, in the digital universe there is no differentiation. Navigating skills may vary greatly, but your presence is made known immediately – and you are on your own. You connect with others in that universe, but you travel alone.

Even the wild animals I observed on safari, who roamed with no visible boundaries, have primitive biological survival skills. The young learn from the mature about danger and about where and how to find food, how to survive. They are guided and have an innate loyalty to their tribe, which gives them that reference point and sense of membership and belonging.

Social networks are the closest thing to that belonging in the vast digital landscape. Online memberships permeate the digital world, but joining them usually only takes a click or a quick fee. Loyalty is also only as thick as the click.

Thus, therapy with young people navigating this great frontier has to rise to the occasion. Our own internal compasses may be intact, or still evolving, but it is our responsibility as therapists to redefine therapeutic attunement for today’s all-inclusive online, IRL, and internal landscape. For the sake of our developing young clients, who are still finding their way toward healthy ego maturation, we must join them in their world. As their world becomes ever more focused online, including large and always active social networks, their life offline is often getting shortchanged. There’s no precedent for it.

The title of Robert A. Heinlein’s classic 1961 sci-fi novel, Stranger in a Strange Land, can help describe each of our entries into the land of cyberspace as we begin to assimilate, with our digital backpacks becoming lighter as the landscape becomes more familiar. And yet there lurks many still unknown and strange lands where we will likely feel alone. When Heinlein’s alien characters landed on earth they used the now well-known term “grok” to describe being understood and having felt empathy from earthlings with whom they felt attunement. As therapists, we have to increase our “attunement;” we have to grok our younger clients, be part of the mother country and real-life presence that helps them acclimate to their true selves.

Our younger clients often describe being more comfortable online than off, or wanting to get back on when real-life interactions or being alone raises anxiety. They also love a good adventure, practicing cyberspace skills, and having their own space. So many online interactions take place simultaneously: never “alone” there.

Most of these young people also describe strong longings to have that comfort within themselves and with others in real time: often “alone” there.

Therapeutic App: So put on your therapeutic guide hat, grab your cyberspace walking stick, fold the Inner Selfie roadmap into your pocket, and join your client on a pilgrimage of self-discovery. The journey promises vital experiential change. It is an honor to accompany them on their unique paths.

Using Mobile Devices with Ease for Change within the Therapeutic Framework

Opening Scene: Randee is an 18-year-old, dark-haired beauty with a gorgeous smile and open friendly presentation. She always has her smartphone by her side but is too polite to look at it during session. She is the pride of her South American family who came to the states when she was young. Both her mother and her father work two low-paying jobs with long hours to support their children.

Randee is a competitive cheerleader and an A-student. Her family is counting on her to get a full scholarship to college, which means she has to get on the university team. She is their American dream. Her applications are in and she is feeling the pressure to audition well, be accepted into the cheerleading program, and not let her family down. She feels that she has no option but to “make it.”

Flashback: We explored other viable options for attending college if she were not accepted into the program and we considered her internal self-worth beyond being the star athlete. Trance work for optimal sports performance under pressure and integration of all parts of her were our therapeutic path. All was good, and I appreciated her manners regarding staying in session and not veering off into “cyberland.

Today: The goals are the same. Her SMA reports using social media solely for friends in real life and family. Now she shows me her smartphone videos of competitions she has been in, including one where she fumbled. I use her phone to record trancettes that focus on concentration, alertness, and confidence; one made specifically for before she auditions. She shows me the program she is trying to get into on my PC. She plays some music she likes.

She does make it into the program, though not with a full scholarship. She works out the balance with loans. She talks with her parents and finds out they will love and support her no matter what. She can now talk about the different parts of herself and how if staying on the squad gets to be too much, she is okay with resigning. I film her on her smartphone using the Inner Selfie technique. She can return to that when she needs her internal strength to talk to her less secure side. She emails me in the fall to say that this has been very helpful.

Your Ally in Session, Not Your Enemy

I know that most of you have accepted your client’s smartphone and mobile devices as a real presence in your therapy sessions. Whether you have embraced this change slowly or quickly, I will assume you have made some kind of peace with it. Perhaps you are already taking clinical notes on your computer or iPad during session. Truthfully, I still find this idea difficult. I don’t even like my own doctors doing it. Something feels as though it is missing in the relationship and their attentiveness. I choose at this point to still make handwritten notes during session. For me, I can be fully present and attentive this way. The use of the computer or other device would demand too much given my current technical skill level. You may find that it doesn’t interfere with your ability to be present at all, and as long as it’s okay with your client, it will work. It is our job to be present, of course. Anything that interferes with that needs to be cleared out from that space between you and the client.

When it comes to the smartphones and other mobile devices that come into the office with your young client, relax! You are going to be inclusive. These devices will be recognized and welcomed. You don’t ignore anything else about your client, so it doesn’t make sense to ignore or banish what is a central aspect of life for most adolescent/young adult clients. Now you can see this device as a gateway of knowledge to different parts and experiences of them. The SMA has also given you a big leg up insofar as being able to glimpse inside their digital world.

The give-and-take that now happens with our clients and their smartphones is like the old “show-and-tell.” We get to see their “selfies” (how they present themselves), pictures of their friends and family (both those who are known IRL and those cyber-only interactions), videos from YouTube they want to share, music they like, and text after text they may read out loud or show us (how they interact socially). They may show you their Tumblr site (journal entries or postings of interest) or share a poem or written work on a fan fiction site. The fact is, now that you have invited them to share this digital part of their lives, you are in this world with them.

Being accessible and transparent in terms of your own digital electronics is important too. This might include looking something up on your computer that is relevant to the session. Your young client may use your computer to show you something poignant. I’ve been asked to share a picture from a trip I’ve been on, which seemed to add to our bonding in a certain context. “Easy flow, easy go” makes for a more natural interchange.

Many of you already record trances and guided imagery for your client in different ways. I prefer to record them directly onto clients’ smartphones so they are accessible at any time. If I think a trance is one I want to save for any reason, like they want me to have a copy they particularly resonate with and don’t want to lose it, I have them send it to me via email. This method has worked well for me.

I use their mobile device for the Inner Selfie technique (or ego-strengthening resource technique). You will learn how this technique utilizes trance work, ego-state therapy, and integration of self. In short, I film my clients talking into the device from the perspective of their Inner Selfie strengths to other parts that are struggling or need a pep talk. This technique of using the mobile device to access one’s inner strengths is bit contradictory to the idea of “unplugging,” but it works in a paradoxical way. It is an integration technique for digging deep into core beliefs for support of the wavering parts (requiring the “pause,” the reflection, the juice of self-understanding that gives that organic push) – all using the mobile device as a vehicle. And our younger clients are listening and watching themselves, which is a hypnotic hook for them.

Randee, our conscientious high-achieving athlete, found that listening to herself support her inner strengths was like giving herself a cheer. At times, her anxiety around disappointing her family or wondering about her self-worth ambushed her. If she took a few breaths and watched and listened to her Inner Selfie speaking to her from her smartphone, she was able to return to her more confident and relaxed self.

Therapeutic App: Your ease in recognizing, using, and utilizing smartphones and mobile devices as part of your therapy will allow your clients to be comfortable sharing this large part of their world; their digital persona and experience. Your allowance and interest have validated this part of their life. This shared comfort will increase attunement, the “yes-set” for mobilizing change, and techniques that foster many defining moments. Your clients can use their smartphones as an anchor to step off the digital plane and reclaim their Inner Selfie when feeling unsure and a little lost.

Assessment Tools to be Used Throughout Therapy

Opening Scene: Fifteen years old with a thick mop of chestnut hair and blue eyes, Emma is going on about a five-hour fight and breakup she just had with one of her “best friends” (of eight months). Verbal beyond her years, she is angry and distraught. She whips her long hair with a defiant snap, like an impatient colt, as tears spill out. She has had a couple of episodes of minor cutting in the recent past, which is what prompted her mother to seek therapy for her. I ask her to tell me where she is feeling it in her body. She stands in front of a window, tense, her smartphone in her clenched hand and describes wanting to “bust out” of her body. She denies cutting this time but admits to having wanted to.

Flashback: We spent time talking about how to deal with her feelings and the resources she has to address her bad feelings rather than going to self-injury. We discussed a homework assignment for breaking a pattern she often finds herself in with friends when angry, and did a short trance (“trancette”) to help her down-regulate or de-stress and future-pace practicing new behaviors. Her mother joined us at the end of the session so we could enlist her support when Emma loses it. She was worried about all the time Emma spends in her room alone. Her cell phone interactions were noted by me but probably not addressed. Something seemed to be missing and it nagged at me.

Today: Emma’s smartphone is a very active part of our therapy. I know from the SMA that she is on a minimum of four social media sites and counting. I know she has 200-plus friends from school and over l,000 followers on her posts about a movie trilogy she loves. She writes on fan fiction sites. She also engages in many daily online dramas that fade from one day to the next. I double check that the fight with the friend, whom she met on a fan fiction site and has never met in real life (IRL), was entirely on Instagram. Since she reads me her fight texts, I know she can sometimes be aggressive and mean online. She insists she is never like that in IRL, and that in live interactions, she is a faithful and loyal friend.

Emma loves to be alone in her room, which is humming and active with her online life. Although Mom is learning, she still encourages her daughter to spend less time there. Three stars for Mom. Fast forward two weeks: today Emma dismisses her “best friend” and doesn’t expect to contact her again. Another drama emerges. Emma has a new crush in school. She reads me a poetic post – filled with longing and a desire to be noticed – that she has offered up to her large fan fiction following. Ageless adolescent scenario. New age tapestry of online and offline experiences. She does not share this post on the social media site her friends from school use. “Too embarrassing,” she says. “Too private.” She’s in love!

The Social Media Assessment Form (SMA): An Essential Tool for Effective Therapy Today

Over time, I found myself asking more and more questions about my adolescent/young adult clients’ online life. As social media sites have become an extension of our lives and the place where so many of our young people engage for hours every day, I knew I needed to have much better information. I had to expand those office intake forms and my blueprint in the initial assessment to include this central aspect of clients as a natural and normal way of information gathering. So I developed the Social Media Assessment form (SMA). It can be used for all clients, but it is the young online-immersed clients I am specifically focusing on in this course.

All new clients 14 to 29 years of age, as well as current clients in the same age range, are invited to fill it out. It’s a gold mine. It seems so simple and yet the SMA has accomplished several things at once. It tells me immediately what social media sites are being used the most, how much time is being spent on them each day, how much time is devoted to role-playing or gaming sites, and which ones have my clients’ attention. The SMA also lets me know of clients’ general satisfaction/dissatisfaction with their digital engagement and what they like or don’t like. Direct, no big explanation. Wow!

The SMA is shared here to help you focus on the growing impact that the digital world has on your young client’s world and experience of self. This form will, of course, change as new sites and other techno realities emerge. And our clients will always answer it in a current up-to-date way. Yes! We don’t have to be tech whizzes for this. If you are old school, you may still have a flip-top phone; on the other hand, you may be ahead of or on par with your clients. It doesn’t matter. The SMA will help you keep current with their digital realities.

Every single young person to whom I have given the SMA has been cooperative and open about their digital realities. In one easy step, I now have information that helps me from the beginning of therapy to the end of treatment. I can explore the complexities of their online/offline relationships and move with them between their virtual and their IRL experiences with ease.

I find that my clients are actually very appreciative, always cooperative, usually relieved, and that they seem to be more open about their digitized experience. I feel a unique attunement with them that starts at their smartphone. We are less far apart, less divided in our understanding; no longer do they have to keep hidden such a big part of their lives. They can still have their secrets, part of healthy individuation, but they are much more likely to share them in the context of acceptance and acknowledgment. Resistance will most likely be lower.

I have learned to ask more digital-specific questions too, which adds to greater mutual comfort. By joining them in this way, the connection is strengthened, and with it my therapeutic effectiveness! For example, “When you tweeted that to your online friends, what kind of response did you get?”

The SMA offers a key to their digital world. Then when you begin your intake, your understanding is more contextually filled in as you learn to ask about how interactions are taking place: Was the argument IRL or via text or post? You can easily find out more about clients’ digital profiles as they show you their “selfies” or their “likes” and “friends.” They will read you relational texts and tell you about their characters (or avatars). All you have to do is ask as if it is the most natural thing in the world. It is.

Another thing the SMA provides is a rich arena for developing your clients’ awareness of different parts of themselves or ego states. Those of us who have worked with parts/ego states/hypnotherapy know how creating awareness of all parts of a person can lower defensiveness and open the way to more self-reflection. Welcome, digital “states”!

The SMA is also a key to increasing the experiential moment and emotional impact for change. Adding cyber-friendly and familiar language to your interventions, perhaps through indirect or direct inductions, or a “trancette” that you sprinkle with digital spice, or a therapeutic anchor you give for a future-paced directive, helps the “yes set” (orienting toward sense of openness to change) begin to percolate.

With the SMA to allow you access to the digital galaxy of your client, you can be confident that you are listening better, and hearing what is really being said. As a result, you will have what you need to tailor your therapeutic interventions to the client’s uniqueness.

I will show you how using the “Inner Selfie” approach can lead to common therapeutic goals with young people for improving down-regulation, contemplation, resiliency and self-awareness.

Therapeutic App: Open your imagination as you better understand the reality of the digital impact on our clients. Each of our clients has quite a story to tell, so let’s not miss big clues to what could be the defining moment for change! The Social Media Assessment (SMA) will help ensure that you and your client are on the same page.

SOCIAL MEDIA ASSESSMENT FORM

Click here for the printable Social Media Assessment Form

Name_____________________ Age________ Date___________

Which social media sites do you use most frequently? Which do you use the least? Please answer on a scale of 1 to 10 with 1 being “Not at All” and 10 being “Very Often”:

Facebook ______

Twitter ______

Instagram ______

Snapchat ______

Tumblr ______

Other: ______

What other forms of virtual communication do you use? Please answer on a scale of 1 to 10 with 1 being “Not at All” and 10 being “Very Often”:

Email ______

Texting ______

WhatsApp, Viber, etc. ______

Video Calling (Oovoo, Skype, FaceTime, Google Hangouts, etc.) ______

What times of the day or night, if ever, do you turn off access to social media sites? _______

If you are a gamer, what games do you play online? __________________________________________

About how many hours daily? 1_____ 1-3_____ 4-6_____ 7 or more_____

What do you like the most about social media sites? ________________________________________

______________________________________________________________________________

What, if anything, do you not like about social media sites? _________________________________________________

______________________________________________________________________________

Are you satisfied with the amount of time you spend on social media sites? Yes_____ No_____

Or, would you like to spend more time? Yes____ No____

Or, would you like to spend less time? Yes___ No_____

Tobi B. Goldfus, LCSW-C, BCD tobibgoldfus@therapyischange.com

Copyright © 2015 Tobi Goldfus

 

The Phantom Appendage We Can’t Live Without

Opening Scene: His smartphone, earplugs, and computer are lying on the love seat across from me. He walked into the room five minutes earlier, moving to some music, and he didn’t hear me say hello. He opens his computer, moves his fingers at breakneck speed, a couple of quick clicks, and then pulls off his earphones, and there it is … a great smile and a hello!

Flashback: “Hey, I’m your shrink, not an app!” This might be my first thought as I follow him into the office. I wait for that smile and greeting. Then we begin to talk about his week in school, how he did his homework but didn’t turn it in, yada yada yada. We are both a little bored. His legs are moving up and down; his t-shirt is wrinkled, his Pumas scuffed and worn. He wants to tell me about what happened last night on his role-playing game. He looks tired. I ask what time he went to bed. He tells me at about 3 am because he was trying to reach a certain level. He is a junior in high school. His cell phone pings. He responds. “Patience, girl,” I tell myself.

Today: In the waiting room, his earphones are on. I smile and offer a thumbs up. He follows me into the office, his computer and smartphone humming. We spend an easy five minutes talking about his favorite iTunes, the last character development and interactions on his role-play. When he checks his computer, he shows me a funny YouTube clip. It is funny! Mentally, I am gathering metaphors, inductions, and trances for the upcoming therapy. Humor and interest in his digital world unites us. Whether it will be direct or indirect hypnotherapy today, there is cooperation and open collaboration. The SMA told me early on that this kid is online 10-12 hours a day and that this may include school days. He needs help putting some digital brakes on.

In her book Alone Together (2011), Sherrie Turkle writes about how our smartphones and devices have become an extension of ourselves. If we are honest, many of us know exactly what this means. Our smartphones are like an extra part of the body that really feels physically missing when it is not with us.

As I mentioned in the introduction, I was a late-comer to smartphones. My 20-something son taught me the basics and continues to clean up and lead me home when I’ve lost my way. I admit that at first I didn’t get the obsession with this device that the world seemed so taken by. A personal experience led me to humility.

I was at a Master Class in Ericksonian Hypnotherapy in NYC. I had owned my smartphone for only six months. Some minutes into the class, I realized that I had left it in the hotel room. To my surprise, and with some disappointment in myself, I felt as though a part of me was missing. I felt a little anxious. Two colleagues offered to let me use theirs that day, but all I could focus on was getting my own phone back. At the first break, I fled, flagged a cab, and grabbed that little sucker off the bedside table where it was peacefully recharging. When I got back, I was relieved and “whole” again. Whew! I barely looked at it for the rest of the day but knowing it was accessible provided that relief.

It was a humbling experience. I now understood my younger clients’ connection to their own phones or computers in a complex visceral and physical way. It was a valuable field trip into their attachment to it. It is a relationship! Epiphany! But in order for my clients to unplug, or for any of us to, for that matter, it has to be intentional and time-oriented. This was a new order of empathy – one that recognized that relationship.

In my workshops, I often open with a joke. “Can you please tape your smartphone to your forehead so I can at least pretend that you are looking at me?” I don’t know where I heard it, but it always gets a chuckle. Everyone knows and can relate.

If it is a relationship, then our attachment to it is like any relationship – it has stages. As you read the following stages of smartphone attachment, ask yourself two questions: What stage is my young client in right now? What stage am I in right now?

Keep in mind that we move back and forth between these stages, just like we do in our other relationships. Knowing where they are, and where you are, at any given time will help you in your assessment and treatment planning. For example, if a client is considering upgrading to a new smartphone, he or she is likely to be back in the attraction stage.

Seven Stages of Smartphone Attachment

1. Attraction Stage

I’ve been eyeing you for a time, yeah! There are others, sure, but something about your style, looks, appeal, and skills separates you from the rest of the crowd. There’s some chemistry here.

2. Honeymoon Stage

Love at first thumb press. Wow! This is fantastic! You are a wonder, over the top, and the surprises just keep on coming! I want to learn everything about you. I can’t wait to get to know you even better. Show me more. Yes! You can do that too? Awesome. I am totally into you.

3. In Love Stage

I am not myself if you are not with me – in my bag, in my pocket, turned on and charged up. Those cute little dings, the adorable ring tones, all those sweet sounds that make me feel so good and attended to. I can’t imagine you not being around or accessible. I want to wake up with you, eat with you, hang out with you, go to bed with you. We were meant for each other. Yes, there are just a few things, very little though, that bug me about you. Sometimes you don’t answer back fast enough or you freeze up on me. What’s that about, anyway? Okay, you can get a little demanding. But life is so much better with you than without you. Nothing we can’t get through.

4. Co-Dependence and Addiction Stage

I think about you 24/7. You are on and with me 24/7. The more you give me, the more I want. I would rather be with you than not. If I have to be with someone in “real time,” I cheat and look at you without a thought or at least caress you with my thumbs in response to your messages. People get annoyed with me and I don’t care. Just leave me alone. Don’t they understand? I want to be with you as much as is humanly possible.

5. Disillusionment Stage

I’ve had enough. I’m done. You are so getting on my nerves. Every time I turn around or try to breathe, you’re dinging away, texting, trying to FaceTime, whatever. What used to attract me to you is now bugging the s*** out of me. I feel out of sorts. Where is everyone? Oh yeah, they’re with someone like you, so I can’t even get their attention for more than a glance or a grunt. I have a headache, my neck and shoulders hurt, I feel nervous. I feel far away from everyone in “real time” because I have spent all of my time with you. And you know what? I’m sick of you. That’s the truth. I think we need to take a break.

6. Time Off Stage

I turned you off. I didn’t charge you. I turned my back. I went for a walk. It felt weird, like something was missing. It seemed so quiet. Almost too quiet. I liked it for a while. But everywhere I went, and I mean everywhere, everyone had a you. I tried to reach out but sooner or later they all went back to that you of theirs. I was lonely. I began to wonder what was happening with all the social media connections we had made together and all the places you had taken me to. I began to feel isolated and not myself. I missed you. A lot.

7. Rapprochement and Acceptance Stage

I decided to give you another chance. I knew you would take me back without question. I charged you up, turned you on, and we were off, like nothing had ever happened. It kind of felt like when we just met, going everywhere and connecting with everyone online again. Responding to and being responded to. Felt so good. Except this time, I knew you weren’t perfect and I wasn’t either. You are what you are and I am me, and time away does not have to mean we are finished, it’s just some time off. And time off is good. If I plan it right. I have learned to feel alive, relaxed, and creative. I can feel connected to both myself and others in those chosen times off. My Inner Selfie is feeling strong and secure. I am grateful for that. I know I can stand on my own without you when I choose to. But having you there, always ready to connect with me and take me where I want to go, means the world! This “we” is interdependent, not our old co-dependent.

How to Use the Stages in Therapy

This is easy. After you determine what stage your client is in, you will know how to estimate how high the resistance will be to shifting to a more balanced use of devices. Apply this to what stage you are in, too! When you think about these stages of smartphone attachment you will be able to add this “relationship” to an expanded picture of digital living. Knowing your stage of attachment will also help you understand your own responses to where clients are with theirs.

For example, when I was in the pink cloud with my own smartphone, discovering for myself the love affair so many others were having, I wondered what messages were coming in to me when my clients were checking theirs. In a flash of insight, I was more understanding and tolerant.

If your client is in the co-dependent and addiction stage, you will want to tailor your approach to acknowledge that stage, intervening to encourage less time but in a tolerable way. The client who had taken so long to be present in my office though physically sitting on the couch for several minutes, definitely needed some electronic detox.

You get the picture. The smartphone, and our relationship with it, are here to stay. The body just feels something missing when we are not in relationship to it. But this relationship doesn’t have to haunt us like a phantom appendage once we make it a conscious visible part of our environs. Awareness helps us to take control of this relationship rather than it controlling us!

Therapeutic App: Accept that you and your young client both have close relationships with your mobile devices. The quality of the relationship differs depending on the stage of attachment and the level of empowerment we feel with regard to our use of these devices. How is that relationship interfering or contributing to your therapeutic goals?

The Digital Self and the Real-Time Self: Developmental Tasks

Mastering Developmental Tasks

As we look at the mastery of developmental tasks that our adolescents and young adults need to move through, Erik Erikson’s (1950, 1968) classic components of these tasks have held up over time. The shape may shift gradually, but the form and elements still remain. These tasks help us evaluate where our client is. We can then consider the ways in which cyberspace has become the place where these developmental stages are simultaneously being practiced.

Adolescent and young adult maturation often blend together as mastery of developmental tasks today may not be completed until the late 20s or even the early 30s. In the United States, the 20s are often looked at as extended adolescence, sometimes called the Odyssey years or Floating generation, before embracing all of the responsibilities of the maturing adult. This is partly our changing US culture (40%-plus of adults in their 20s now move in and out of their parents’ home, whereas young people left home permanently at a much younger age in previous decades). The economy in the United States has an influence, as college graduates are having more difficulty finding jobs and their parents are working until much later in life than in the past. American parents can now keep their adult children on their medical plans until they are 26 years old since without a job or one that offers benefits, a young person will likely be without medical coverage. These and other trends in the US contribute to an extended period of adolescence and a slower pace of mastery for many young adults.

Tara, age 24, with an MA in psychology and a first job in an inpatient hospital for adolescents, doesn’t look much older than her clients. Although she does not live at her parents’ house, she continues to binge drink with friends on weekends, to use drugs to enhance concert experiences, and has random hook-ups. She knows she has to clean up her act and wants a more stable intimate relationship. She says she is careful online and posting, and really believes she keeps her private life and professional life separate, no conflict. Although she realizes the risks to both herself and the ethics of her profession, she insists (her rebellious adolescent side) that she is too young to give up her lifestyle.

This is a fairly common example of a 20-something adult who is in the process of still mastering significant developmental skills. In Tara’s case, the search for and practicing for an intimate relationship still mirrors almost an adolescent level of maturity – and the gulf between her professional and personal life is wide.

Rites of Passage and Developmental Tasks in the Digital World

Since most young people from their teens through young adulthood report spending many hours per day online and on social media sites, we should assume that these developmental tasks are being practiced, experimented with, and perhaps being formed at the same time as real-life developmental tasks and internal states.

When Erik Erikson talked about the young developing persons’ need for “time out” or “free space” to experiment without consequence, he was foreshadowing cyberspace as the dream playground! “Time out” and “free space” have become more unrestricted and for longer periods than Erikson could have ever imagined. And talk about no visible consequences! The young person’s perceived sense of “nothing will happen to me” and “no one has to know” is unchecked in the digital space. The young person is left to his or her own devices when it comes to monitoring behavior, meaning having to rely on internal controls that are still maturing or are easily ignored via a “who cares, no harm done” attitude.

The SMA has given you the “wheres and whens” of clients’ online travel in brief form. You will observe significant parts of the client’s developmental tasks as well as which ego states are being practiced and activated there.

In her book Alone Together (2011), Sherrie Turkle describes how the digital world can help in these rites of passage – including navigating friendship stages; exploring religious, political, and other ideologies; participating in interactions that are outside of parents’ purview; having a parallel sense of independence and the ability to make contact with parents at any time; having long-term (forever) “friendships,” as online connection does not necessarily shift with changes in IRL.

Turkle points out the positives of young people exploring these multiple online identities, developing social communities, and serious play practice outside of “real life,” and reiterates cyberspace’s golden offering where one can always be de-marginalized through virtual groups. No one knows I am fat ... or shy ... or transgender ... or gay. I can be part of this group. I can be accepted here.

So far, so good. These parts being played out daily for hours can create “alter egos” that can feed internal ego states or confuse them. When individuals create a profile on a social media site or an avatar on a role-playing game site, they can create and then edit who they want to be. They can act and experiment with parts of themselves. They can also express their dark sides, such as anger, shame, aggressiveness, and sexual compulsions that may hinder healthy ego development.

Is this different from IRL? In cyberspace, there is more freedom and one can take more risks without consequence, at least on the surface. Any of us who has ever had a young client read texts that are being exchanged with someone they are in conflict with may agree that what is said online is often dramatically less restrained than what would have been said in person; most clients tell me they would never say IRL what they communicate in their texts. Welcome to a whole new meaning of free speech! The experimentation and exploration of sexual development, gender identity, and forming views that differ from family upbringing in belief, religion, and politics can be private and unchallenged. We must also be aware of hidden online ego states that can hold spaces of shame, despair, and hopelessness. Not so easily revealed, we can never assume the absence of this just because it is not discussed. There are telltale signs, though, such as stated self-disgust or low self-esteem, and these observations can open the door to specific and gentle discussion of how these ego states may show up online.

Practicing developmental tasks online can foster independence and self-esteem – or it can hinder it. Frequent texting to a parent, multiple “friends,” or feedback from unknown people might encourage a dependency and avoidance of self-regulation of mood and anxiety. The emotional charge of being an online “friend” is high, but expectations of others have been lowered, sometimes to where they become “objects” who are useful and comforting (Turkle, 2011). Because the relationships are so easily discarded, our younger clients can still feel isolated and lonely. Thus, young people (especially) may search for more and more response (always instant) and can end up feeling even more alone. I have also observed this “short friend life” to be repeated IRL. One of my high school clients changed her core group of friends at school over a semester at least five times, as was reflected in her contacts online. And I see my clients in their 20s struggle with finding good relationships that stick or practicing them IRL. They often have their “discussions” or “fights” via text when they could just as easily use the phone or be together in person. What a difference between the ease and editing of texting (being in control) and the more challenging and less secure characteristics of face-to-face encounters or even FaceTime or phone interactions and relationship negotiations.

Practicing developmental tasks IRL and practicing them in cyberspace are not the same thing. The quality, full-dimensional learning that comes with working out differences, thinking and reflecting, building trust, and creating attachments that last IRL far surpasses what is easily discarded, deleted, and forgotten. Although the digital emotional charge that we feel in connection and relationship to others is a felt reality, “cybersincerity” (how honest and authentic this self is online) can be circumspect. Never judge an online profile by its cover. But recognize it as a real part of your practicing client toward maturation.

Cybersincerity feels real when plugged in and may match the person’s sincerity IRL, but it may not. See it for what it is: a spin on truth and authenticity – and the stakes can be high.

Today, as the “genuine self” of our maturing young client is in the cooker; we look for a more “fluid” self over the more classical “stable” self (Lifton, 1993). Peering through this developmental lens matches our own requirement of fluidity and flexibility in meeting clients where they actually are, as we help them move from cyberspace realities to embracing themselves and others IRL.

I invite you to see the reality of your clients practicing these developmental tasks online and to discern where they are with mastering them – both online/offline. Ask yourself if what you are hearing from your client is promoting maturation or where they might be stuck or lost.

The Growing Brain: A Time of Independence, Desire for Knowledge, and Exploration

Most experts in the science of the brain agree that the adolescent and young adult brain doesn’t fully develop until the mid-20s or even later. Girls are often around two years ahead of their male peers. Let’s review a few simple facts about our client moving into adulthood.

Digital Impact on the Developing Brain

If someone is plugged in 24/7, higher levels of arousal can be triggered, which can increase emotional responsiveness. It may be that irritability, sadness, moodiness, or anger set in or that euphoria, giddiness, and positive feelings reign. Dopamine, a neurotransmitter associated with pleasure (also associated with addictive behaviors), also gets fired up with unexpected and/or frequent responses in texting, gaming, and social media activity. “Hey, that ding that signals someone has responded or has sent me a text makes me feel good!” The lure of responsiveness and the subsequent dopamine rush create a compelling invitation to return to cyberspace, no pause, no question.

Being plugged in so often and for so long, and interacting on multiple sites with multiple people (group messages, threads, blogs, tweets), can decrease our clients’ comfort in being alone IRL. And we know that it is the time alone, when one is still with and within oneself, that is required for developing the reliable sense of self, the Inner Selfie.

Creativity needs ideas and reflection to incubate below the awareness level and then to be developed. If online input and information never stops, the natural talents and creativity of our clients may be underserved. This APP generation (Gardner & Davis, 2013) especially needs encouragement for this creativity and reflection in their identity formation. Online, people can either create or borrow from other sources to fill in the blanks. A type of laziness can seep into an imagination that only uses mix-and-match methods (Gardner & Davis, 2013).

This necessary space for developing intimacy skills can be practiced in online relationships and communications. They can also be superficial and non-binding, which gives that connection in online time and place the illusion of being within one’s control. Of course, hours of texting are often taking the place of IRL conversation where relationships can be negotiated, built up, or torn down and where long arguments can occur. This one-dimensional communication pathway leaves what happens in face-to-face contact out, such as visual, physical, and tonal cues, and it leaves a lot of room for misinterpretation. And these limits in understanding and perceiving online are also still maturing in our young person’s brain. Apology and conflict resolution online takes less work – much less since one can edit and control messages and responses. The closing of the digital door requires no exertion, little introspection. In IRL negotiations, the conversation cannot just be turned off, at least not so easily; working things out is more natural. So much can be muted or avoided online. One cannot plan or anticipate outcomes when relating in real space. One has to put in an effort and take the risk, something the young client may not relish, whether because of discomfort, lack of skill, or not finding the other person willing to be in that real space too.

When it comes to imagination, we can be lazy online, just mixing and remixing. Gardner and Davis (2013) give us another helpful assessment tool: observing whether clients’ apps or sites are “app enabling” (where they are constructing and challenging themselves to create) or “app dependent” (where the work is being done for them).

With too much information overload, the part of the brain responsible for decision making and control of emotions shuts down. Frustration and anxiety may soar. This is when bad choices and mistakes increase and the self-regulators in the developing brain act according to where the client is. The constant input of information encourages them to make immediate decisions, when more thought would be warranted; overload makes discrimination skills – which are still being developed – difficult (Newsweek, 2012).

The Impact of Cyberspace on Anxiety and Depression

We hear it every day, how our excessive digital engagement is negatively impacting our well-being. The champions of human interaction research and neuroscience help us keep current with ongoing updates on new discoveries about digital influences. Scholars and researchers such as Dan Siegel, who has written and studied the precious interactions among relationship, attachment, and the brain, bolster our resolve to help our younger clients find their Inner Selfie and stay connected in real-time relationships. We know today how vital our human connection is in helping our brain make new synapses and release good chemicals (such as oxytocin, which gets released when people connect with each other) and neurotransmitters related to attachment and sharing with other human beings. The ongoing discoveries about neuroplasticity – our brain’s capacity to make new connections in learning and behavior– provide us with an energized sense of hope and efficacy-based certainty as we begin to understand how change continues over time. We can teach our clients – no matter how old they are – to transform and grow, no matter how stuck or hopeless they may feel in a given situation or stage.

Thirty-eight hours a week online is now a low norm for all adults (Newsweek, 2012). Multiple studies show that anxiety and depression in young people are on the rise and link the pervasive or excessive time spent and pressure from social media sites to this trend (Michigan State University, 2012). On the other hand, internet use can lessen loneliness and depression in youth as they engage with others online in many positive ways.

In the past, admiration for technological expertise may have trumped concerns about use. Now the effects of being constantly plugged in are being reported almost weekly on radio, TV, and internet. This accentuates how important it is for us to enter our clients’ world fully in order to help them learn to navigate their travels back and forth between cyberspace and full and present living IRL. The magnetic draw of cyberspace is that the rewards are instant and easily attained, whereas the rewards in real life are more elusive. Research (Turkle, 2011) shows that although hanging out online doesn’t necessarily make one feel any better, real-life interactions may be experienced as so awkward that the younger client returns to cyberspace anyway.

The “empty” feeling, irritability, and constricted behaviors described by many clients following hours of looking at a screen tell us a lot about the problem and its circular nature. We need to be alert to the distinctions among what is healthy, what is compulsive, and what is addictive use of the Internet.

Prolonged use, where one goes, what happens there, and what relationships and connections exist IRL all influence the anxiety and depressive symptoms in our clients. The vicious cycle of getting offline, coming up empty or dissatisfied, and then returning to the online dopamine theme park often interferes with the ability to fully engage in life.

Therapeutic App: Your clients are practicing the developmental tasks that need to be mastered online as well as in real life. These rites of passage are carried out unchecked in cyberspace. As the brain develops into the mid-20s and beyond, the influences of cyberspace can lead to increased anxiety and despair. On the positive side, there is the common experience of affirmative social interaction and practice, from sharing secrets to exchanging ideas, emerging beliefs, and values. Your goal is to help clients find balance and authenticity in relationship to themselves and to others so that the Inner Selfie has the space and support it needs to grow.

Developing a Strong Inner Selfie

Opening Scene: “I’m so confused. I have no idea what I want to be or who I am. Am I totally f***d, or what?” Hannah, age 18, looks at me, her shoulders bent forward. Heading for college in a few months and with her anxiety mounting, Hannah would describe herself as uptight, driven, and full of fun. She is one of the fastest texters I had ever seen and she has many friends online and off.

She is a confidant to scads of these friends and she gives great advice. She also dislikes herself and how she looks. She feels like a “nobody” despite the positive feedback from her high digital profile and her popularity in school.

Flashback: Hannah was very likable and open in our sessions. She was not shy about sharing the details of her life. I watched myself chase her dialogue as I tried to figure out which of her interactions were IRL and which were online. We counted 30-plus texts in an early session. She agreed to put her smartphone under a pillow after the fifth session. I was relieved, but could sense how uncomfortable this made her feel. Did it really help our sessions?

Today: A year after first meeting with Hannah, I give her the SMA. Her social media sites are vast, including Tumblr, an online journal where she vents her deepest and darkest thoughts. She has 200 followers on this site alone. She meets boyfriends, girlfriends, and older men (though she insists she has stopped this) on various sites and she admits to sexting for “fun.” She is swinging back and forth between newly minted self-confidence and old self-doubt.

Hannah likes the short “trancette,” and we spend the summer before she heads off to school processing her internal ego states, external states, and online parts in dialogue, in a psychodrama in different chairs, and during trances. I have introduced the Inner Selfie as her beautiful, strong and resourceful inner self. We use her mobile device to give her quick access to this ego strengthening whenever she needs it.

What Is the Inner Selfie?

The Inner Selfie is the internal sense of self, our core, our “inner strength,” our “inner wisdom,” our unblemished and pure self. It is the healthy ego, the strengths and resources that we have and that we rely on when our deficits, insecurities, anxieties, and self-destructiveness get in our way. It is the sacred part of who we are. It is the part of our client that is sometimes unfamiliar and unexplored, vague, and definitely in the process of developing.

“Selfies” are the universal cyberspace fingerprint. Documenting and/or preening, they are the digital mirror, the reflecting pool of Narcissus. Who hasn’t taken a selfie? Selfies are fun; they tell stories about us. We are sharing in a vast collective archive. Adolescents/young adults have grown up crafting images of themselves, as they endlessly create and edit online personas. What or whom should they look like? How do they want to see themselves reflected online? The Inner Selfie is a term they respond to; it represents a thread between their external experience and their inner strengths and resources.

Inner Selfie resonates; everyone seems to know what it means. My younger clients immediately get it and even if they have no solid relationship with that Inner Selfie, it is a place to start. Offline, it is a deeply internal ecosphere. It is within. This is a place many young people are not used to spending much time. It is a place that is easy to ignore or avoid, a place to fill up with all kinds of distractions. You are most likely not accessing your Inner Selfie when deeply engaged on social media sites.

There are many and diverse approaches for building strong ego states and internal strengths. The “inner sage” or “true self” has a prolific place in literature, education, theology, and therapy. The Inner Selfie can lead your client there. It will help your client down-regulate. It can guide them to inhabit their body and teach them self-reflection. Being still, knowing your own voice, being comfortable with it – these are usually foreign concepts to our young “cyberspaced-out” clients! “Huh?” they respond.

“To thine own self be true,” Socrates wrote. “Huh?” a developing self may wonder. “True to what?” One of our tasks as therapists is to help guide the journey to self-discovery, ask the necessary questions, and hear the depth of the answers however they come to us. The Inner Selfie gives clients a clue, a glimpse into a part of them that invites more exploration. We hope that this is a place they will want to return to again and again, like returning to a spring of fresh water.

Five Ways to Introduce the Inner Selfie to Young People

Teach them the relaxation response.

You may have a way that works well for you. I teach all of my clients a version of the way I learned years ago when training at the Mind-Body Institute of the Harvard Medical School (Herbert Bensen, MD, director and founder, who actually coined the term, “relaxation response,” in the l960s).

“On your in-breath, fill your stomach up slowly like a balloon, slowly counting mentally 5… 4…; deflate slowly on your out-breath, slowly counting mentally 3… 2… 1… Bring your thoughts back to the counting when they drift off – and they will.”

It doesn’t matter whether the breath is through the nose or the mouth, whatever is the most comfortable for the client. Work with them, even for as little as five minutes, with their eyes closed. Check in on their experience, how it is for them being in their body, what it feels like, what sensations and images they have. For many, this is not a familiar place!

Normalize any sense of dizziness as good oxygen to the brain. I talk with my clients about how when we are anxious or occupied we are usually using shallow breath through the chest. So their brain is absorbing this healthier dose of oxygen as their body and mind slow down with abdominal breathing and focused mind. I reiterate the importance of the mind taking a break along with the body. If our mind is still racing, our body has difficulty really relaxing.

This simple relaxation piece gives your client a super-easy tool to practice after their first session. Most report that they use it with good results. Most describe a sense of relief, a feeling of calmness. Pick up on that. Talk about what that is like. You have already provided a beginning sense of mastery in this easy way to learn to down-regulate.

Therapeutic App: Think of the Inner Selfie as the image for loving one’s self, thinking for one’s self, trusting one’s self, listening to one’s self, and being able to be in authentic relationship with one’s self. Being able to embrace this position allows for true connection with others.

Redefining Boundaries and Confidentiality

Opening Scene: Megan was in her late 20s. A confessed “borderline,” she was determined to find out everything she could about me – and she did. She looked up where I lived, how much I paid for my house, and the age of our son. She even found a poem I had written and read at my mother’s funeral (many years before), which had been published. She drove past my house and knew exactly where I parked during the work day.

Flashback: I believed my boundaries had been violated and I felt exposed. Where was my privacy? We discussed it in session and worked it through, although it took a while. We found a good place, one that respected boundaries and privacy. I have always guarded my private life, keeping my online presence very low key. It didn’t seem totally wrong, just brazen; a part of me was impressed with her research skills and I could recognize this resource in her.

Today: I expect that Megan will find this personal information and more. Par for the course. Based on her SMA, I know she finds many sites that feed her feelings of emptiness and her abandonment issues. It just seems to me now that she is simply trying to connect with me in an anonymous online way. But she has told me about it. This pseudo boundary-crossing feels more fluid and not really so intrusive. My work with Megan is to help her create a world that keeps her safe from herself and energized toward discovering a more solid sense of self. The trolling of dating sites, and the profiles she sends out, versus how she really feels about herself, add to her sense of depression. She has vented on the electronic “wailing wall” to total strangers about her intimate thoughts and feelings. She receives both encouragement and horrible negative responses. But at least she gets something.

From “No Boundaries” to “Know Boundaries”

The Webster Dictionary defines a boundary as “that which indicates or fixes a limit or extent or marks a bound, as of a territory, bounding or separating line, a real or imaginary limit.”

In cyberspace, that boundary line is usually constructed by the user. We freely go to any site. Sites recognize us and store all kinds of information about us. We pick familiar places and move carefully through new ones. Or we don’t. We tend to dissociate from all that is out there about us. Dissociation then has developed and become a new boundary of protection.

If adolescents and young adults are still maturing, still developing their personal boundaries, how do they learn how to create good boundaries online and on social media sites? Yes, they are practicing, through trial and error, just as they do IRL. But the real world has social restraints, acceptable ways of being, and checks and balances. Parents begin by teaching and modeling boundaries to their children. Boundaries are also drawn and reinforced by laws, religion, teachers, and mentors. These parameters are built into any society. The experimentation that begins in the teens and continues through the 20s is a natural part of development. Limits are stretched in real time, but the limits are there. In cyberspace, limits are few, and thus the ability to safeguard oneself is tenuous at best; learning to protect oneself becomes paramount.

External boundaries are delineated by those in authority to protect people from the consequences of certain behaviors. This is rarely the case online. Thus, internal boundaries are essential in the open space of the digital world; they arise from being able to listen to a strong Inner Selfie, that part of the self that has a sense of knowing when something is good, productive, and nurturing. Healthy internal boundaries equate with self-care. Patrick Carnes (2001) describes the presence of internal boundaries as reflecting a relationship to oneself (pp. 141-143, 153).

As therapists, we need to help our clients develop internal boundaries that are both firm and flexible. This is a central paradox in our work with them. First, they are creating their own space and they are practicing their developmental tasks for mastery as mature adults, separate from their parents and other adults in the world. And second, these internal boundaries are just beginning to take shape and are highly vulnerable and easily influenced. Young clients by nature are also at an “anything goes” stage and are reluctant to judge something or turn away from it just because it is off the beaten path. They are also often suggestible. We have to help our clients to come into themselves and to self-regulate, especially as they interact in the digital world.

Further, the feeling of unreality that goes with keeping a digital presence can blur boundaries. The digital possibilities for being bullied or for bullying, for being manipulated or controlled in some way, are rampant. Uncensored verbal attacks on others that would never happen in real time, or deeply personal confessions that would not be made face to face, occur a thousand times a minute in cyberspace. Being online highlights every kind of boundary issue and whatever challenges there are in being able to self-regulate. Online relationships can exacerbate unhealthy real-time ones and can cause great dissonance for our clients’ internal states.

Good boundaries are more about paying attention to one’s conscience, and that willingness and ability to learn from and listen to the Inner Selfie. Pausing, breathing, making contact with the self – these are essential to beginning to establish internal boundaries.

Megan, the client whom you met at the start of this section, eventually chose to block self-destructive sites and stop a digital interaction if it didn’t make her feel good. She learned to ask herself if what was happening online was hurting or helping how she felt about herself.

I tell my clients who are struggling with how to decide where to go and with whom to interact that there are no rules to turn to, but that if they learn to listen to themselves and take the pause to ask the right questions, they will stay on a good track.

Besides boundaries regarding online behavior and where one travels, there is another important boundary to consider: how much time to spend plugged in. When I bring up with young clients that they can be in charge of their time online, they seemed surprised. Many of them have indicated on their SMA that they want to be on social media sites less but that they don’t know how.

I ask them about their beliefs and values. They usually don’t offer up this information on their own, but their responses give me the keys to tap into their conscience and ways they might be guided to own a sense of responsibility both online and off. I know, for example, that one young client values trust but is “cheating on her boyfriend” with online meetup encounters. I talk with her about where she is drawing her “boundary” line. At first, she says that they feel like two different worlds (which they are) and that one doesn’t affect the other. When she was in high school, talking to lots of guys online and dating in real time didn’t cause her too much stress. Now she says she is serious with her boyfriend. As we talk, she begins to realize that maybe she has crossed a boundary of trust with him within the parameters of her own value system. She says she definitely wouldn’t want it the other way around. Boundary-building in the making!

“Flaming,” as Sherrie Turkle describes in Alone Together, is a way of uncensored ranting toward someone online, whether you know the person in real life or not. I hear these rants quite often in my office as some of my clients read them to me off their smartphones. There is a bravado and self-righteousness in their tone. Sometimes, young clients (and others) feel their anger as a way of “drawing a line.” But this is a false boundary. It is not the “working things out” kind of process so crucial to navigating the world. Cyberspace is an open forum that gives us all a voice, but it can mute the conscience and dull the discernment naturally guided by it. We are here to help our clients develop their own moral yardstick. We invite them to reach deep down and get to know that Inner Selfie.

Impulsive Acts

Who is your adolescent or young adult client? Untethered, curious, both delighting in and at the mercy of a developing brain, acting at times without thinking, and “living” on social networks, while having what has often been the young person’s nemesis – PISS: Problems Interpreting Social Situations!

Imagine the misinterpretations that happen hundreds of times online for our adolescent/young adult clients every day as they edit, project, absorb, and distort. How can they tell what is “real”? Even FaceTime lacks real eye contact. In cyberspace you can’t touch or read emotions. Yet most young people are choosing to text or email rather than talk on the phone or hang out in person. So much goes missing. And the margin of error for projection, misinterpretation, and emotional distress goes way up as human contact goes down.

Growing up connected to the digital world is like driving without brakes for many young clients. Those in their 20s may report that they were “addicted” when they were younger and went places and did things on the internet that they would never let their children do. It’s a mixed message though, as they also admit continuing to do things and go places they feel some question about, even if a bit “wiser” now. Why do they do it? Well, many of them simply find it difficult to stop. Others don’t really even think about it. It is what they have done ever since their fingers discovered the keyboard.

Spontaneity

Distinct from impulsivity, spontaneity is understood as “proceeding from natural feeling, temperament or disposition, or from a native internal proneness, readiness or tendency, without constraint as, a spontaneous gift or proposition” (Webster).

I like to talk with my clients about the difference between impulsivity and spontaneity, providing them with examples to help them differentiate. Spontaneity may look like a flash mob where everyone converges to dance or sing, or sending a friend a text that is loving and kind, or posting a funny picture and getting a thumbs up. No harm done. I encourage these clients to think of a time when they have been spontaneous or to imagine something in the future that could be. And I ask them to think about how that spontaneous action may differ from something they have done impulsively or could see themselves doing. Most of them have not really thought about the difference before.

The “native internal proneness” that is part of the definition of spontaneity ...yes, it’s that Inner Selfie!

The New Confidentiality

A lot has been written about the changing face of confidentiality in recent years. What is personal and private today can look unrecognizable from when some of us were young. What I find interesting is that my clients often share their “private and secret” selves on sites with people they don’t know IRL. There in that digital space are places and people they can vent to, get support from, or rant with. “Sharing” with online-only associations is often described as less risky than confiding in their friends or family IRL. Journals online come in many forms today, and most private journals have followers reading them and posting responses. These responses can be kind or cruel, which can tip a client’s mood toward despair or euphoria. Take the example of 15-year-old Shari, whose school friend “accidentally” caught a confidential feed sent to her many online-only “friends” about an upset at school. Her school friend sent it to others and Shari was soon very distraught as messages started coming in criticizing what she had shared, which had been meant only for those online. Her response outwardly was angry bravado but she admitted that her inside part was hurt and that she had cried in her room for hours.

If you have a personal profile and threads to it, you have an outed self. The more of your information that is out there, the more you are out there. Even some of my younger clients who are developing therapists have posted more than others of us would ever dream of sharing on Facebook and other sites. This new “confidentiality” is perfectly normal to them.

Ask yourself how you view confidentiality today compared with a few years ago. Does it affect how you practice or how you view your client’s sense of privacy and what it means to honor it?

Four Steps Toward Helping Your Clients with Online Boundaries

Step One: Start with easy external boundary decisions tailored to the client’s circumstance. (A couple of examples: “I will play X game online before 11pm and then put my device in a place I can’t reach or see when I am going to bed.“ Or, “I will not send any more sexting or compromising pictures of myself.”) Have clients only carry out one or two decisions at a time. Invite them to make an intentional statement in your office, directing it to themselves. Encourage clients to say it out loud when needed (their own verbal anchor) and to visualize doing it as they state it. You might do a “trancette” to give it emotional impact and weight. This will help them keep to their resolve. Ask them “how” they feel on certain sites? How does being there help them have a positive sense of being? If it doesn’t, and being somewhere that is perhaps secret, makes them feel a sense of shame or discomfort, discuss how this could be a boundary crossing that is contributing to the depression or anxiety they may be experiencing. Discuss how feelings of shame can be telling them it may be a place to stay clear of.

These ideas mark the foundation of building Inner Selfie awareness, the consolidation of inner strength, and the forming of an internal boundary.

Step Two: Encourage your clients to practice the relaxation response (stop, deeply inhale and exhale slowly, maintaining other focus, i.e., counting down slowing from 5 to 1) and to visualize changing their course online when something negative about it bubbles up for them. Picturing what they want to do is part of indirect post-hypnotic suggestion and encourages the success of one’s intention. Invite them to listen to where that feeling resides in their body. Remind them that a decision, one they have made, just takes a simple click and that it could free them up in such a positive way. Follow up in future sessions and chart their progress. Give lots of support as they experience both successes and difficulties. The discussion alone gets them thinking. Aha! Some offline reflection!

Step Three: Do a “trancette” using metaphors of boundaries and allow these images to deepen with post-hypnotic suggestion. For example, I remind young Shari: “.. just like you enjoy closing the door to your room, YOUR room, when you are ready to be away from your brother and all the noise downstairs, you can shut the door on a post … knowing that in a day or two … you won’t care as much and that by taking that break, just a short one, like being in your room alone for a while with your door closed, you will ride the tide and the next wave will be much smoother ...” (This is a bit of tailoring based on Shari’s enjoyment of surfing.)

Step Four: Talk about maps and travel guides that they can develop for their online life. For example, the young client who has decided to stay off of meetup sites with other guys now that she is in a serious relationship, puts a stop sign in her head and takes a “route” to a social media site where she has plenty of “friends.” Discuss how and why making decisions like these represents a positive internal shift. The inner resources that you are nurturing in clients will help build their resiliency and resolve.

Therapeutic App: You have joined your client by witnessing the changing definitions of boundaries and confidentiality in the digital world with them. You are spearheading the trek to help them tune into their internal self, the Inner Selfie, and to develop digital resiliency, which includes the ability to recognize unhealthy triggers and to willfully change course!

Application

Using Trance, Mindfulness, Somatic Experiencing, and Ego State/Parts Work for Effective Integration of Digital Life with Real Life in Your Clients

Hypnotherapy Can Be Your Lens

The masters and great teachers of hypnotherapy have provided us with an incredible way to look through the digital keyhole. The chorus of those who stand behind me – which includes Jeffrey Zeig, Ph.D and Michael Yapko, Ph.D., both brilliant sages of the wise pioneer Milton H. Erickson and both profound contributors to the field – has given me my own wings and flight mapping. Very briefly, Ericksonian approaches are based in and evolved from the work of Dr. Milton H. Erickson. They encompass a tailored, individualized, strategic yet nonlinear focus, which can include both direct and indirect trance and interventions for optimal emotional impact.

You, the clinician, have your own chorus of voices behind you and I encourage you to keep using and growing from what you know. I will lay out some basic ideas from hypnotherapy that you can apply in helping you work with the social-media-filled life of your clients. Whether you are a novice, an experienced, or a seasoned hypnotherapist, using the hypnotherapy lens encourages the therapeutic goals of being fully present, flexible, and moving from being stuck in old patterns to creating more positive new ones that access inner resources and allow for more effective resolutions.

When you go into trance in a natural way, you are focused on something (like looking at a gorgeous landscape) or absorbed in an experience (like floating on your back in water feeling the sun above and the water around you) that is elsewhere. You are absorbed here, not there. Or there, not here. Watching a good movie, reading a compelling novel, driving to work while thinking about what you are going make for a friend’s dinner party tonight, waiting in line at the grocery store completely lost in thought – these are all examples of being in indirect trance. Part of you is dissociated by the very nature of your dual experience.

Being in the digital wonderland is the mother lode of a natural trance. You are absorbed by whatever you are looking at or communicating with in that little box. Your body is somewhere else, perhaps on your couch, in the car, on your bed, while you’re walking, and so on. You may be aware of the TV in the background, people chatting, people talking to you, music playing, the sounds of traffic, and even silence. You are dissociated. You are in a trance.

And when you are online, you are probably on more than one site, perhaps many simultaneously. There is information; there are dialogues, pictures, sounds, and more that you are negotiating in a competent and seamless way. Can someone be “cyberpresent” on ten sites at once? I think so.

Cyberpresence

Being “cyberpresent,” which is my word for being online in a totally absorbed way, means responding and resonating with whatever is happening to you online. You are there. You react and respond simultaneously. Upon receiving a communication, you react (whether it is a cognitive, emotional, or even physical reaction) almost immediately. So even though you are not present in your body IRL, your body releases dopamine (the chemical associated with both pleasure and addiction) each time you hear the ping of someone responding to you. So you feel good about the response and then you filter your response depending on the perceived tone and content of the message. Your body’s muscular system is responding both to the physical constrictions of your prolonged online use and to what you may be experiencing online. You are dissociated from IRL, but completely cyberpresent.

So, if our teens and young adults have been cyberpresent for huge chunks of their days, months, and years, they are going to be dissociated from experiencing IRL. They are dissociated from being IRL-present, from what’s in the moment, in the body, from deep breath, reflection, and the ability to meditate, create offline, and connect with themselves and others. And when they are offline, they are often hyper-focused, ready to bounce back to their digital world when the first ping comes in. Immediately.

Pay attention to the bodily behaviors you observe in your clients, and make connections, for example if they are holding their breath or breathing in a shallow way. This can be as simple as knowing that they sit for long hours (info from the SMA and self-report) and move very little while being cyberpresent.

Moving from “Cyberpresence” to “Being Present”

Cyberpresence has some interesting parallels to hypnotic phenomena experienced in a direct or indirect trance in hypnotherapy. Here the hypnotherapy lens assists us in our work when we take in the digital personas and experiences of our young client. Being mindful of themselves and others, being present and in the “now,” and being in the body, are therapeutic goals no matter what the issues being brought into therapy are. Look at some components of hypnotic phenomena that echo the online experience.

Comparing Components of Hypnotic Phenomena with the Experience of “Cyberpresence”

Dissociation

In therapeutic trance and induction, we bring our client back into the body. Through ratifying (or underlining their physical experience and awareness while going into trance), we help them land softly into themselves. Just a quick example for folks who aren’t familiar with trance: “… and you can notice how warm the sun through the window feels on your head and shoulders, how comfortable it makes you feel, how you might be aware of your body beginning to unwind and slow down ...you can notice how the cool air of the air conditioner compares to the warmth of the sun, you may feel a growing lack of tension from your head … to your shoulders … down your back … from your thighs down to your feet … as you enter this experience of being totally focused and alert in your mind’s eye while your body’s emerging comfort settles in …”

It is then (now that they are dissociated from your office and more present in their body and internally oriented) that we can help them deepen this absorption and move in the direction and toward the goal you are collaborating with them on reaching. They are now dissociated from the therapy room and from online distractions even though they are aware of those dimensions and others, like the sound of your voice. They have left the familiar place where they are usually immersed. So it is similar on one level, but they are organically connected to their body and going inward as compared to being online, dissociated from their body and focused in cyberspace.

Time Distortion

In therapeutic trance, one experiences time distortion (that is, time often seems shorter than it actually is). My young clients often experience a trance that is 5-10 minutes as being longer. They are not used to slowing down and being present IRL for long periods of time without checking in online. I find that the briefer time in trance seems to be tolerated well and will often become something they look forward to in their therapy. Online time distortion happens to all of us constantly. Time goes by without our noticing. Teens and young adults spend countless hours online and often report being surprised by how much time has passed. You can point this out as well as how long periods of unconscious time can create the opposite effect of therapeutic trance or time spent relaxing offline, including muscle tightness, feelings of sluggishness, or of being wired, etc.

Automatic Behavior

When therapeutic induction flows into deepening trance, automatic behaviors such as swallowing, readjusting one’s position, or scratching an itch, are done with a semi-awareness while focus goes inward. Just as when your client is online while sipping a soda, or hears a parent calling and answers absent-mindedly, or drives while texting (yikes!), automatic behaviors come from habit or self-absorption somewhere else.

Positive or Negative Hallucinations

As we use metaphors or create possibilities in trance, our clients will “hallucinate” them in their own imagination. This is a part of giving your client the gift of creating, experiencing, and foreshadowing where they may like to go with their goals. Our younger clients do this multiple times daily in digital space; they fill in or project what is not fully available to them. Think texting. You don’t see the emotion or hear the tone; you make calculated guesses as to meaning. A message may feel more challenging or caring than it is meant to be. Since this guessing game and projection happens among all human beings to some extent, especially when someone is not forthcoming about a feeling or position, it is not hard to imagine how this occurs at a greatly accelerated pace online. Lots of room for error and misunderstanding. And we see this up front and personal with our clients frequently. For example, they may be very excited when they feel that someone is expressing interest in them, or they may be very hurt by a message they interpret as a rejection.

In therapeutic trance, positive or negative hallucinations (something one wants to add or subtract from one’s experience) are your young client’s own creations, which are being “seeded” by you.

Age Regression or Age Progression

In trance work, we may go back in time to access a client’s memory for positive recall and resource-strengthening or go forward in time to suggest the possibility of what can be. These processes are used as a kind of time travel for growth and responsiveness. Age regression can also be used for reparation and healing to lower the emotional charge and reactiveness with trauma.

Many examples of age regression and age progression can be found being practiced online. Role-playing games, for instance, have characters of all ages, and your clients’ characters may reflect their developmental stage and parameters of imagination as well as different parts of their ego states; what traits they would like to have, what they hate in themselves, or emotions that are easier put into characters. (Released in 2015, the movie Inside Out is a terrific film that portrays the rich inner world of ego states. I recommend it highly to clients as well as to clinicians.) You will want to know about such characters and digital personas for your trance work and interventions. A client may project a different age than his or her own biological one or may be interacting with others who are far younger or a great deal older. Of course, since others online may also be projecting a created self, age differentiation and how it is perceived can become almost psychedelic. Who knows what is what and who is who!

In your trance work with your clients, the experience of age regression or age progression is one that serves to promote health and well-being.

Amnesia

In trance work, a therapist may work in tandem with a client to forget about something when cued. This happens in different ways and for different reasons. Many people who go into therapeutic trance don’t remember parts of the trance experience and some people recall very little, even though while they are in trance they are aware of being in trance, of what is being said, and of the clinician’s voice. This is more automatic and unconscious. The advanced hypnotherapist can use amnesia to minimize a traumatic event. For example, when working with a 28-year-old client who couldn’t stop thinking about or being flooded by a traumatic event – a severe bullying incident that had happened to her when she was 7 years old – we talked about how she was much more than that event as a child. Then we had her put the event in a balloon that she could let go of – from time to time she could look at the sky and wonder where that balloon had gone. This work freed her from remembering it constantly. In fact, the details began to fade. Amnesia, even as part of an induction to encourage a client to “forget about it” with a metaphor to forget a letter of the alphabet or the first lines to a favorite song, can encourage clients to be creative in filling in the blanks.

Online, the hypnotic phenomenon of amnesia occurs often. When one is cyberpresent, memory loss for behaviors or experiences IRL while online happen frequently. An adolescent client may literally tell her mother three or four times that she will start her homework in the next half-hour but when confronted about it, have no recollection of the promise. Appointments and commitments can be “forgotten” until well past the time they were to take place. Amnesia can happen as part of the dissociative process such as when your client has behaved or experienced something online in a way she would rather not remember and so quickly moves on, erasing the evidence as much as possible both online and in her mind. When a teenager in my practice had been outed by so-called “friends” for her behavior at a party, she unfriended them (not a bad idea in this instance) and a year later was so immersed with her new social life online and off that she barely “remembered” the incident.

Catalepsy and Ideomotor Behavior States

I choose these two states to mention here because in trance work, catalepsy (the restriction of movement) and ideomotor behavior (semi-conscious physical movement) hypnotic phenomena are often present. If you ask your client to signal to you with a finger, your client may remember raising a finger in a vague way later. The client may describe the sensation of being glued to the seat, but in a relaxed, comfortable way. Simultaneously, internally the client is alert and awake, absorbed, and focused.

When people are deeply absorbed online, we know their physical movements are often constricted and slowed down, even for hours at a time. And they may dimly remember some ideomotor behavior. Kyle, a 27-year-old married client with a young son, is quite positive that as he is role-playing for hours, he reaches out and pats the little guy’s head and murmurs something, but it is very foggy since he is absorbed in the drama of his role play. (He is not proud of the amount of time he spends there, although it is one way he is able to relax after a long day at work at his … yes, computer tech job!) Our trance work is brief, whereas cyberpresence is often extended for long periods.

Post-Hypnotic Suggestion

One of the gifts both direct and indirect hypnotherapy gives us is the possibility and hope for change in the future. Whether it is when the client leaves our office or it happens in different ways in the next weeks, months, or years, we seed that idea for future change from the very beginning of our interaction to the end of treatment. In the Ericksonian world, every step of your interventions and interactions is a seed for change, and moves in the post-hypnotic suggestion direction.

Online, suggestions given to and made by our clients can be either supportive or negative. We know these “post-hypnotic” suggestions have weight because clients bring the stories to us. Sometimes they get locked into the scripts they are hearing online or are contributing to. If Megan, our “confessed” borderline, has poured out her negative self-talk on a post, we hope she gets the “cheer up, mate, you’re beautiful inside and out” talk, but she could get the “you are a piece of s***t, you always will be” tirade. We need to know what feedback our clients are getting and giving. These messages have so much power, especially when people are young and impressionable. If the negative response appears to underline their own poor self-image, they buy into believing the prophecy given them, a dangerous post-hypnotic belief. Being aware of these negative self-messages built up from online interactions, therapists can help shift clients to more self-affirming beliefs with post-hypnotic suggestions that move into a positive sense of self, the healthy Inner Selfie.

Thus, with the lens of hypnotherapy you can provide a reliable map and the real-life CPR that is sometimes necessary for clients who are caught in the maze of cyberspace and are unsteady in the here-and-now. Hypnotherapy can help them navigate back and forth in a healthy way, using therapeutic hypnotic phenomena for building positive experiences and growth.

Looking for Responsiveness with the Hypnotherapy Lens

Positive responsiveness or emotional impact, that defining moment of change, begins at the hypnotherapy door. The information imparted to you in the SMA is key to creating responsiveness, as your interest and awareness allow you to walk into your client’s cyberpresence. Whether you use direct or indirect inductions and trance work, guided imagery, the relaxation response, a meditation, whatever your style and intervention approach, you have opened responsiveness, the “yes-set,” the receptive floodgates. Your own style of magic and artistry with your young clients will resonate with them.

You can now recognize how hypnotic phenomena are alive and well in cyberpresence and how a therapeutic hypnotherapy lens can capture and harness that reality and bring it into the therapy hour for the IRL presence that will help build and maintain those strong Inner Selfies.

Now let’s look at how parts work and ego-state work can add to this alchemy of success with your teens and young adult clients.

Parts Work and Ego-State Therapy as the Home Page

If hypnotherapy is our lens, integrating the different parts of your client can be an effective “home page” – one you can return to, is easy to find, and is comfortable to access.

So many extraordinary people contribute to my home page: there’s Virginia Satir, Murray Bowen, as well as a most brilliant graduate school teacher, who introduced me to the work of John G. Howells. There’s Maggie Phillips and Claire Frederick, pioneers of ego-state therapy, and other contemporary contributors such as Gordon Emmerson. I count my training blessings. Martha Stark’s unique sensitivity training for really “getting” clients with organic empathy is an essential addition to the mix as is Dan Short’s work on transformational relationships. Psychodrama, psychodynamic, CBT therapy and gestalt chair work give parts work flair and movement in expression.

Whatever background you bring to your therapy, attention to your client’s developing parts and ego states will lower resistance, open up sharing, and allow for the “observer” self to begin to stir.

All of us essentially have multiple personalities; we all have different sides that either blend together in harmony or do not blend easily and can be dissonant from each other. Some parts of us are dissociated from other parts. Other parts are close friends, great playmates. We have internal voices from our past: parent, child, adult, caretaker. Are these voices supportive, punitive, loving, or withholding? We have the critical voice, the funny part, the shameful self, the executive mode, the creative self, the quiet reflective side, the strong and bold part, the sexual self, the intelligent self, the dumbed-down self, the talented self, and the list goes on.

A wonderful aspect of ego-state and parts therapy is the implicit acceptance that these are just parts of us. It is like sitting in an AA meeting, listening to “everyone” (all of one’s ego states and parts) with curiosity, respect, and acknowledgment. No judgment.

Introducing parts is easy because the SMA is already in place. You are aware of the digital places and personas your clients express as well as their parts IRL; cognizant of their internal landscape as well as sides of them that they play and feel on a daily basis.

You will find how this segues to a willingness to reveal themselves early in your treatment with little hesitancy and resistance. When you are looking at this new whole person constellation, one that includes all the parts that are operating and expressing in digital space, clients feel more comfortable sharing these parts of themselves with openness and transparency. You have given them permission and invited those digital parts into the therapy room as well.

Once these digital parts are in the room, along with their other ego states, they can be explored in the context of the canvas that showcases every color and hue of your client’s individual uniqueness. The process of integration of self becomes more viable and supported.

Somatic Deepening

The goal is for the client to move from their daily digitized dissociation to a felt experience that resonates in a deep organic way. This felt experience, which can be elicited through different mind-body techniques, such as hypnotherapy, somatic experiencing, and mindfulness and meditation training, emphasizes the intense internal changes that occur when someone goes into his or her body and becomes aware of sensations and feelings. The observer self is able to take the front row seat in a more neutral non-judging, non-critical way. And from an ego-state therapy or parts work perspective, the awareness of which part is being triggered, and where it is in the body, along with what emotion or thought, creates a synthesis that can be a defining moment for change.

As an example: Kyle, our 27-year-old father whose excessive online role playing illustrated ideomotor, or constricted movement as part of online hypnotic phenomena, can begin to label his “parts” – father, provider, husband, gamer, lazy part, angry part, guilty part, loving part, responsible part, compulsive part, among others – and then be willing to sit with each part. We go into a short indirect trance with each part as he feels its location in his body and he speaks the “voice” of that part. Angry part: “I just want to be left alone, I love him (son) so much but he won’t let me alone and all I want to do is relax and get into my game” (feels it in his stomach). Guilty part: “I should want to be with him and not my game” (feels it in his chest). Responsible part: “I have to figure out how to do both and not short-change him” (feels it in his neck). As we move toward recognizing all the parts that are triggered as legitimate, and elicit their help in new ways, Kyle is less self-punishing and seems relieved. The “chill” part can inform him of where to relax in a kinetic way. Being more physically active helps Kyle stay with his resolve to find more balance. Even though it may seem insignificant, taking 5-10 minutes to walk, play a physical game with his son, or go up and down the stairs a few times, refreshes his circulation and interrupts his compulsion machine.

Harmony: Working in Trance and with Ego States in Full Color

Whether you use direct or indirect trance, your hypnotherapy lens now recognizes those parts of your client expressed and experienced in their digital landscape. You are now including them in the therapy hour.

You can deepen these parts for integration with your client’s other issues and parts through trance as well as with physical and vocal parts work. I often find that moving a client to another chair or standing up and taking the posture of the part that is working something out with another part can have a deep emotional impact, just as it did with Kyle.

These techniques are used in many schools of training, including gestalt therapy, family systems work, psychodrama, transactional analysis, and others. This psychodrama allows you to focus on how a given part of the client looks, how it sounds, and, most important, how the experience feels in the client’s body. Remember that this allows clients to view these parts of themselves with less judgment, more acceptance, and less defensiveness.

Tom, a 27-year-old man with severe OCD, learning disabilities, and no meaningful or sustained work, could only tolerate short evocative trances. He had developed avatars online that had great superhero powers. He learned to ask for chair work and engaged enthusiastically after I played out two sides of his conflicted self. He wanted to be able to turn the volume down on his, “You’re not able to do anything because you’re a loser” part and turn up the part that felt too small and undeveloped: “You are kind, a good friend and want to do something with your life, and you can.” I moved from one chair to the other and asked for his feedback on voice, volume, expression, and physical posture. Then he cautiously took one part, his positive side, and sat across from me as I was representing the “loser” side. I helped him turn up the volume and sit tall. The loser voice got smaller. Later, he played both sides himself – with gusto.

Tom could then sit for short “trancettes” that used his ego-state work in psychodrama, creating images that integrated a more realistic avatar with deep internal strengths. I knew from his avatars – their superpowers masking his insecurities through the magical thinking and posturing that fueled his creativity while playing – that his Inner Selfie needed boosting.

Therapeutic App: From digital to IRL, hypnotherapy points its lens and invites the celebration and integration of parts and ego states onto the “home page.” You can utilize hypnotic phenomena experienced online by transferring to IRL those phenomena in deeply felt and kinesthetic trance work, both direct and indirect. As you bring your clients from cyberpresent to being present, you will help them explore all the parts of themselves. Creativity and self-awareness begin to percolate. The Inner Selfie is supported!

Make the Therapy Fit: The Fine-Tuning of Attunement

Step One: Not a Cookie Cutter Approach

Your younger clients have been galloping over the digital range for most of their lives. They search, select, edit, and constantly update both the technology and direction they are taking. They are in constant flux and they are a fluid force, like the wind moving over the prairie. They are “cybervigilant” (meaning being alert, aware, and focused on whatever and wherever their cyber attention is).

If something doesn’t fit or their interests shift, young people instantly change it with a click and a series of rapid adjustments to find what they want. Remember those thumbs that speed across the keyboards in a blur of dexterity.

As therapists, we need to practice this flexibility and movement to meet their pace. This doesn’t mean we abandon our professional areas of practice and skill to peddle a mishmash of lightweight therapy. But we do need to become adept at employing various treatment modalities when it becomes necessary. With an eagle’s eye toward your treatment goals, using the myriad tools and skills that you have will allow you to keep up with and guide your clients.

The SMA helps you individualize your interventions because you know where clients are and how empty and lonely, or full and vibrant, their territory is. When they realize your response to the information they initially share with you is not to pathologize it but rather that you are interested in and actually understand something of their cyberspace realities, they are much more likely to help you help them.

Step Two: Be Yourself. Let Your Inner Selfie Shine

A skilled and competent therapist has many strategic interventions up her or his sleeve. The responsible therapist is always evolving as a professional, developing more skill and exploring further education; their wisdom is always expanding. And it shows when the therapist continues to evolve and grow personally. The self of the therapist shines.

Many leaders in psychology have written about the self of therapist and attunement. As mentioned, I have been so fortunate to learn from great presenters on the topic, including Dan Short, Dan Siegel, Martha Stark, and my Ericksonian mentors, Jeff Zeig and Michael Yapko. The Ericksonian model shows how the evolving self of the therapist joins the evolving professional self with the evolving client in order to both be the best and encourage the best. Whatever your own study and practice, you can integrate this approach to be the best that you can be. In a million ways, this is your way of letting your own Inner Selfie come through!

So keep learning about yourself and your own vulnerabilities, strengths, and areas that can be enriched. Your degree of self-awareness is integral to allowing a good therapy fit. In other words, if you are feeling like a “deadbeat” therapist, doing the same thing over and over again in the very same way every day, you need an Inner Selfie overhaul! Of course, I know, this does not apply to you! But just in case you find yourself in a slump, be responsible and find ways to “un-slump.” In his wise book, Oh, the Places Youll Go!, Dr. Seuss points out that, “un-slumping yourself is not easily done” – and so we might need to do some pruning and revamping.

You will always be checking your own reactions, responses and any countertransference with your young clients. This clears the space for you to work at your best.

We have to stay out of our own way. Me to me: “Her clothes are so provocative.” Reframe: “Uh, lose your critical parent and admire her sense of freedom.” Me to me: “I feel like a fool; I forgot to check in with him about that big drama he was in last week, He’ll think I don’t care.” Reframe: “You remember now, admit it and move on, get over yourself.” Me to me: “I really want to do a trance with her about that, but she has switched to a new issue that seems less pressing.” Reframe: “Hmm, it’s not about what you were set on doing, it’s about her, so jump in and join her there.” And so it goes with our continuous internal checks and balances – our own parts being triggered here and there with the mission to heal ourselves and “do no harm” – we provide the rich uncontaminated soil in which to germinate a strong Inner Selfie!

You can tune in and attune with your clients only if you are tuned in and attuned to yourself!

Step Three: Clear the Room of Your Agenda and Listen

Empathy is built upon listening and the taking in of the other person in a deep and soulful way. You can put yourself in their shoes and really “feel” what they are describing. If you have cleared the room of your agenda and gotten out of your own way, you can be present and listening with your “psychotherapy ear” to the ground. You are authentic and your young clients will feel your sincerity.

Listening to a young client begins in the waiting room, with how you interact and what you take in about the person. The SMA offers you another “waiting room” for listening. Just as observing a client’s manner of dress, demeanor, and presence before he or she settles in gives you some idea of his or her way in the real world, the SMA provides glimpses into what and where your client has been in their digital world. I read a book years ago on the Aborigines in Australia who were so tuned in to members of their tribe that on their walkabouts they could put their ear to the ground and “hear” complex and multi-level messages through the vibrations from many miles away. Now that is attunement. Our “ear” is multidimensional (including the digital one) and the more we “listen” the more tuned in we will be. In the walkabout with our clients we keep adjusting to whatever vibrations are signaled and shared with us.

Listening and staying with the client is a discipline. I guarantee that when your clients have the deeply felt sense of you “seeing, hearing, and getting” them, you will have already carved out with them an important position of caring.

Step Four: The Therapeutic Toolkit

We have the skills and the knowledge. With hypnotherapy and parts and ego-state work we can help guide our clients from the digital world to being present IRL. We may pull in a variety of techniques or modalities toward that end. I might use the Daily Mood Log from the cognitive behavioral therapy of David Burns (1995) with a bright, anxious, “awfulizing” young client who can’t talk her way out of the box she is in. I might use it as a down-regulation tool that we later bring back in trance. Her negative thoughts might be acted out against her more realistic thoughts to deepen the experience. This will include somatic experiencing with her parts. You get the picture – incorporation, tailoring, a weave of trusted skills.

By moving from one modality or technique to another with ease and flexibility, you confidently stay with the complexity and uniqueness of your clients. You plant the appropriate seeds, encourage them to take root, and stay alert and mobile as defining moments of transformation take shape. You tune into the winds of change, climate, or mood experienced by your clients and chart the direction that you have set together with them. The clients define the journey; you help them navigate it.

Your particular expertise and treatments of choice (for me, Ericksonian hypnotherapy and parts and ego-state work) meted out in accord with your clients’ receptivity enables the therapy to reach the mutually agreed-upon destination.

What you use depends on what is in the room with your client. Your therapeutic toolbox is organized and ready to be utilized to match with your clients’ offering for change.

Therapeutic App: To meet your digitized client in a heartfelt way, you will dump the “it has to be done this way because it is the way I work” and embrace “it will be done as you lead me because this is the way I work.” To attune and tune in, you begin to listen immediately, in the waiting room and with the SMA, as you quickly become fluent in the client’s language. Your empathy toward your client increases as you clear the room of your own agenda and get out of your own way. Your Inner Selfie is shining like the harvest moon because you are taking care of yourself. This brings you and your client together, connecting and authentic. You are attuned.

Spotlight on Online Identities and Ego States

Cyberspace Realities

Is there an interpreter in the house?

The answer is yes. Your clients are the interpreters of their digital identity and digital ego states or parts. Unless they share with you, you remain in the dark. The SMA contains the initial clues.

Do we need a translator?

The answer to this question is also yes. We need two translators. Your clients will tell you what some of their digital identity means to them and what parts of themselves they share online and with whom and when and how. You will translate back to them what you hear and make sure it is accurate. The next step is to translate what you have understood into real life (IRL) treatment goals and strategic interventions.

You are moving back and forth between their online digital profiles and experience and what they are living in their real life, as well as their internal experience and states. If you are, say, over 30 years old, you have a bigger task than in the old days. You are juggling and synthesizing while you form interventions that you want to weave into a tapestry that combines all three of these realities – cyberspace, IRL, and internal states.

Who is asking these questions?

The answer to this question is that both of you are asking the questions. Your clients have implicit questions of you: “Do you really know what my life is like? My digital life is just as or almost as important as the rest of my life in many ways. Do you understand any aspect of my experience of this part of me? Do you have any clue? Are you judging my online life because you don’t understand it?”

You, the therapist, are asking clients to share this huge part of their daily life, to teach you what you do not know in order to understand them better. You are asking that they trust that together you will find the way. By being alert to this part of their landscape, you offer the message: “I know some of your language. Invite me in; I am so honored as you open up this world of yours to me, and I am eager to learn.”

The universal language of online identities, profiles and experience is that of understanding and acceptance. The different grammar, new vocabulary, and unfamiliar “persons, places, and things” (media sites, postings, games, research, etc.) will be interesting, fun, and, yes, sometimes alarming – and all of it serves as information you may draw from to work with the parts of this young and complex client coming to your office for help.

Online Identities and Ego States

You know from your own experience and life online that there are many facets of you out there. There are parts of you that you have shared with family, friends, colleagues, online communities, gaming sites, and many more. Your family members get a side of you, your professional contacts another; your friends know one side, and your clients another. Because it is a digital galaxy, these facets multiply and overlap with time and exposure.

I have my competitive word game side (my mother was a Scrabble devotee who taught her kids from early on to play it hard and well) that comes out when I play with my son, my niece, my sister, and some friends. Then there are many texts to husband, son, family, friends. There are the parts that I share in different professional online classes. I use texting/email as appointment reminders to some clients. When I am Skyping a friend in France, another part emerges, as our friendship feels as easy as if we are still living in the same town. There’s my six international/national “Sorrento” group of good friends/colleagues, who frequently share both deeply personal and professional journeys. These are just a few of my sides. I look up things online out of curiosity and there are some places I would never bring up in polite conversation. Is this my adolescent ego state still stretching a boundary?

At this point in my life, I do feel that my internal ego states are more congruent with ego states shared online. But I am still growing and learning. Yes, you can teach an old dog new tricks!

But your adolescent/young adult clients are still forming and developing their internal ego states, and many of their sides are occupying digital time in their formation. Sometimes they are in harmony with internal states but often they may be unaware of them; uneasy, dissonant, and compartmentalized, or cut off from each other.

As your client practices and experiments online, you will find out which “cyber-ego-states” (those sides being expressed online) are being manifested. They can be active or passive. For example, Lindsay, a 25-year-old client who struggled with compulsive overeating and body image, was able to find a community online where she could share her shame and get support. This was her cyber-ego-state being active. It helped her internal ego state IRL begin to believe she would be able to like and accept her shape and size a bit better. And there was the case of 15-year-old Maria who watched hours of YouTube videos of TV shows that showcased unpopular girls who found acceptance and triumphed. This triggered her ego state of feeling unattractive, yet she could dream of acceptance and friends who would like her for who she is (her cyber-ego-state). This was a passive cyber-ego-state because she was the observer, not interacting firsthand. In both of these examples, the online experience and profile helped to foster healthier ego-state development.

Adolescents, as well as many young adults, who mainly text – perhaps with some FaceTime – their romantic or platonic relationships, do experience positive feelings of closeness, which is part of practicing their developmental tasks. However, online exposure within these relationships can also bring out strong ego states of jealousy and possessiveness, and the acting out of those feelings, both online and off, are all part of the maturation process. Your understanding of how powerful these states are as they are triggered and acted out online increases your ability to help your clients understand what parts of them are being so activated and how other maturing parts can assist with better coping and down-regulation skills.

In other ways, the developing client may find cyber-ego-states that impede healthy development. As we know in our work with developing clients, different parts can experiment and practice with varying degrees of self-destructiveness at times. Early drug and alcohol use, sexual acting out and a “f**k you” to societal norms are among potentially destructive forays. Or there may be secret bingeing, or incidences of bullying or being bullied. Because online practice and acting out are also part of the developmental process, today we have to be as aware as possible of this in the digital life of our young clients. Some of their biggest dramas are being played on the digital stage. Often, the acts are short and short-lived, as the next act appears and quickly gets their attention.

Remember fierce and lively 15-year-old Emma from earlier? By gaining entry to her digital life via the SMA and integrating her online persona in the therapy room, I could help her see that her cyber-ego-state of being mean and angry and fighting aggressively online when she felt betrayed by a friend was really a hurt part of her internal ego state, a still-active part of her from when she had been bullied when she was younger. Finding her voice online was exhilarating, but learning when to respond and when to shut up was a maturational task of discernment I could help her with, encouraging her to take that pause, to breathe, and to listen to another internal ego state, her developing Inner Selfie.

Leaders in online addiction research and treatment, such as Patrick Carnes, report a very high percentage of sexual behavior online starting as early as middle school or even earlier. You may think this can’t be true, or that young people would never disclose it if it were. Once you are able to enter their digital world within their comfort zone, by asking the right questions from a nonjudgmental, non-threatening stance, your young clients will be more willing to open doors to those cyber-ego-states that are operating under the radar and may be risky. And, by “risky,” I mean self-destructive and highly vulnerable.

I find that many teenagers will admit to sexting or going to porn sites and often regret later that they acted on impulse. Denise, a freshmen in high school, had sexted nude pictures to a boyfriend, a connection that lasted less than a week. She knew he had sent them to his friends and she felt terrible. Her impulsive cyber-ego-state now has a footprint in digital eternity. In real life, without using smartphones that record sexual experimentation, it stops there, still lingering in her memory as the years progress. Today, with its eternal digital footprint, unless she hears that her “here now and gone tomorrow” boyfriend has continued to send his friends “the evidence” or it shows up later in her life, she feels she can move on – cyberspace’s special gift of nurturing amnesia, compartmentalization, and dissociation.

As therapists, we must be aware that online and offline sexual behavior and intimacies have become the norm for many young people. Because the lines have blurred, it is important that you encourage your younger clients who may be expressing sexual ego states online to understand the permanency of sharing this decision. Many of my clients in their 20s report that this is part of their serious relationships or that they play around on provocative sites as part of their sexual activity. They tend to be quite comfortable with this. However, there are exceptions. There was 28-year-old Lisa, for example, who became quite worried when she and her partner of two years broke up and she realized that in his vindictiveness he might share intimate pictures. There are laws being written to make this a crime, but they will be difficult to enforce. The cyber-ego-state that Lisa shared with her fiance matched her sexually maturing internal ego state until the digital footprint she’d left threatened it and activated a long-term ego state of shame from her childhood.

Integration of Cyber-Ego-States and Internal Ego States

Cyber-ego-states are here to stay, operating in sync with internal ego states. This doesn’t mean they are in harmony and congruent, or that your client has an awareness of them or has even connected the dots. We now recognize them as vital parts of our clients and use our work to flush out the ones that impede healthy ego development and support those that are contributing to a new integrated whole. You can now discuss these ego states with your clients and move back and forth between their online and offline ego state parts as you work toward integration of self and building healthy ego boundaries.

You are the master magician and you now juggle at least three balls: the internal ego states of your clients, the real life (IRL) experiences they have, and their practicing cyber-ego-states. Once you embrace these, you will move among them easily as you strategize interventions and integration.

Therapeutic App: As you continue in your work with your adolescent/young adult clients, using the universal language of acceptance and understanding, you embrace their cyber-ego-states and interpret their digital language of expression, both positive and negative, active and passive. This recognition of and invitation to their online identities and experience allows the canvas of their internal ego states and real life to be painted with all the colors and depth that reflects who they are, how they are maturing, and how you can be most effective in your work with them. Their Inner Selfie invites you to see them in their entirety so that you can guide them to be the best that they can be!

Destination Psychotherapy: A Future-Paced Syntonic Approach

I was half listening to the radio on my commute to the office one morning when I heard a story about a “destination wedding” on some exotic island. The invited guests were sent their save-the-date postcards with the location, accommodations, and planned events. I imagined everyone trying to figure how they would get there, what they would bring, and how much time off they would need. They would be anticipating and visualizing what it would be like when they arrived and what a great experience it would be.

As I thought about it, I realized that what I practice with my clients is Destination Psychotherapy. Most of us, whether we are old-school or new-school practitioners, work in a goal-oriented way. We look down the road with our clients to a journey where change is made possible. We make strategic decisions that map our therapeutic travels for experiential change, with defining moments along the way. We use our therapeutic experience, training, and orientations, but most of all we bring ourselves, our being, into this space we share with our clients, who by sitting in our office, have invited us in.

When we are attuned to our clients in the deepest most organic way, we have really listened, paid attention, and resonated with their experience. The foundation of therapeutic and transformational change is empathy. When we feel “seen” or really paid attention to by another person, we experience them as taking in our stories and confidences, as forming a felt experience of who we are – and when this happens to us it feels good. Dan Siegel, MD, proposes that this mindfulness “involves a form of internal attunement that may harness the social circuits of mirroring and empathy to create a state of neural integration and flexible self-regulation” (2007, p.132). Once again, the hormone oxytocin that releases when two people are really connecting in relationship adds to the receptivity for change. Empathy, with its qualities of nonjudgment and acceptance, is the segue for you to begin your own Destination Psychotherapy. This “orienting toward” your client begins to lower resistance and defenses. Your empathy with them makes way for the “yes-set” (an openness to change and positive suggestion).

The words, “destination psychotherapy” imply and create a post-trance, post-therapeutic, post-hypnotic suggestion: How will it look when you get there? How will you get there? How do you want your experience (emotional, social, physical) to be when you arrive? How will it differ from where you are right now? When you can “see” it, how does it feel in your body? All that you know about your client – beginning the moment you meet him or her in your waiting room, from their SMA, their online personas and experiences, their internal ego states, their experiences, roles, and interaction in real life – allows you to be fully attuned to that person and to tailor those therapeutic destinations to meet their unique individual needs.

Intervention Apps: Tools of the Trade

To meet the pace and lifestyle of your adolescent and young adult client, your therapeutic approaches must be multidimensional and flexible. Think about it like the apps on the smartphone; apps we download tend to have a purpose, and we use plenty of them. Your therapeutic intervention apps will combine your training, experience, and approaches. Some of the following intervention apps can be incorporated into your work with these clients to help them make friends with their Inner Selfie and integrate their digital and real-world selves. Whatever your comfort level and expertise, use it as conceptual awareness and be open to using some of the following techniques to help frame how you look at your clients’ cyber-presence and cyber-ego-states alongside their real-life presence and internal states. Whether you use direct or indirect trance in your work, these can facilitate the mutual goals of building healthy ego strengths and boundaries.

The “intervention apps” I use all the time and in a synergetic way are unique to my training, experience, ease – and are rooted in who I am:

Hypnotherapy Lens App

Using this lens, I can observe, assess, and intervene in a strategic way (thinking forward with a target) that ties it all together. I can observe how the digital hypnotic phenomena experienced by my young clients can be utilized by absorbing them in real time within their internal states, as well as seeding what destination goals we are headed for with direct or indirect inductions. With this lens we can prepare our clients for being in a “readiness state” for experiential change. It helps me synthesize exploring their IRL parts, internal ego states, and those parts being practiced in cyberspace.

I can think in terms of Dr. Zeig’s structure (2006) of a strategic hypnotherapy intervention, for example. Stated simply – setup: induction (direct or indirect, coordinate with the therapy to follow, identify resistance, and elicit a related phenomenology and relationship); ratification: (underlining the phenomena a client is experiencing, i.e., increased circulation, lower heart beat); seeding the target: (planting themes and associations that connect to intervention goals); and tailoring: (making the therapy fit the client, not the client fit the therapy). Then finally, intervene (the defining experiential moment, the shift in experience, the meat of your goal); and follow through (post-hypnotic suggestion, future-pacing, helping the goals stick).

The use of metaphors, stories, destabilization, and humor all come from using this framework in my approach. The hypnotherapy lens is a big app and I offer just a hint here. The thing I love about it is that I see myself as an artist, using my own creativity and everything I have learned. I stand on my mentors’ shoulders, gratefully, and stand with my clients to offer what I know.

Discrimination Lens App

I look through the discrimination lens to ask: “Do clients lean more toward internal or external locus of control? Are they global or specific rigid? Are they future-paced or age regressed?” I use truisms, which connect to the goal. I might use the story of 9/11 and the community of support and rebuilding for an isolated client who needs to reach out as part of healing – and build strong “yes-sets,” the Ericksonian assumption, “of course you can!” that begins to initiate hope and receptivity. In my mind, Michael Yapko’s clear underscoring of the need to assess: HOW the client sees the world; HOW do they manage what they manage? HOW are they looking for change? HOW will they move from age regression to age progression? HOW will that specifically look? HOW, HOW, and more HOW! HOW this has helped me over the years!

Ego-State Therapy, Parts Work, Role-Playing App

The goal of ego-state work is integration, or “when the parts are in communication with each other and are working together harmoniously and cooperatively” (Frederick & Phillips, 2010). From this perspective, I can appeal to my clients’ “multiple personalities” (online and off) – parts of themselves that they can begin to grow their awareness of, and so develop an “observer self” and move toward greater self-acceptance. The reparative work that evolves from this view of ego states can heal conflicts among the parts, while beginning to use those that are ego-strengthening to de-amplify those that trample self-worth (a negative “inner voice,” for example, may reflect a punitive parent), and work toward harmony and growth. I love how this therapeutic app can legitimize the digital parts and cyber-ego-states of my clients in a way that feels authentic for them, helping them learn and acknowledge those parts of them IRL and their internal ego states. By both of us joining in the viewing of this whole gestalt, each part can be identified and processed. The ego-state and parts therapeutic app communicates and synergizes with the hypnotherapy therapeutic app very effectively.

Role-playing these parts in the office with “chairwork” (family sculpting, gestalt, and psychodrama methods) and exchanging the posture, tone, and voice of any of the client’s parts gives the experiential moment a gigantic boost. Since your client is profiling, role-playing, and posturing online, bringing this into your office in a felt way is freeing and significant for them. I can initially take on some of their parts if they are unsure or inhibited, but they soon become the sculptors of each of these parts; I am the clay, allowing them to mold this part of themselves. We can go back and forth with this. I find they engage deeply. Once they are playing one of their parts or ego states opposite another, they are simultaneously observing and experiencing. I can then use a very short “trancette” to help them land in their bodies and explore this part from a kinesthetic place, something that may be new for them. And it feels safe for them; it’s just a part of who they are, but often has huge emotional impact, the genus for transformational change.

When 27-year-old John, who is reserved and self-conscious, first agreed to talk from his young adult self to his “phobic fear of driving more than 10 miles from home part” (the “I don’t take risks” ego state), he told me what to say, what intonation to have, and how to sit. Soon he took one part and then the other too. He was surprised by the physical and emotional intensity of the experience. In the next session, he reported driving to a friend’s house, a good 100 miles away. His young adult ego state had been able to reassure the panicked dependent younger ego state. Although John had dated in his 20s, it became difficult as his anxiety about driving was an obstacle, but now he could follow through with a new energy and confidence.

Cognitive Behavioral App

Cognitive Behavioral Therapy (CBT) is known for its many effective tools for changing distorted thoughts such as those related to depression and anxiety. Having used The Therapist’s Toolkit (Burns, 1995/97) and its updated versions for years after training in Burns’ workshops, I find that connecting thoughts to emotions to somatic experience is often of great educational and concrete value for my younger clients. When they read his list of distorted thoughts (i.e., all-or-nothing thinking, jumping to conclusions, mind reading, emotional reasoning) and identify with them, a lightbulb goes off and they realize that having the thought or feeling doesn’t make it real. For example, Burns’ Daily Mood Log works with an upsetting event, moving from identifying the event with negative thoughts and feelings, seeing how those thoughts fit with which distorted thoughts, and then replacing them with more realistic responses. It is a very effective anxiety-lowering technique, especially for a highly anxious, obsessive client.

Eighteen-year-old Emily, a senior in high school, was experiencing performance anxiety in combination with feeling she has let her parents down in a competitive gymnastic tournament. She watched the stumble over and over on her smartphone. The Daily Mood Log allowed her to step outside herself as she labeled her distorted thoughts. Working through this exercise helped her down-regulate, which we later used as a positive reference experience with trancework.

Loretta LaRuche, a stress humorist on staff when I trained at the Harvard Mind/Body Institute for Continuing Education some years ago, called worry and anxiety “catastrophizing and awfulizing,” and encouraged us to stop “shoulding” (the “shoulds”) and “musterbating” (the “musts”). This way of labeling and identifying cognitive distortions has been highly effective in my work with adolescents/young adults, again giving them access to the “observer” self. Humor and laughter can grease the squeakiest, most jammed up wheel so that things can begin to flow. And the unstuck wheel begins to roll to places one may not have gotten to nearly as easily had it been left unattended. Laughter is one way of being present, of letting go, and it is an experiential basis for change.

Mindfulness/Relaxation Therapeutic App

There are many apps for smartphones that teach breathing techniques, relaxation skills, and mindfulness exercises. Even better, learning these skills in your office is personalized and tailored to the issues and uniqueness of your young clients, within the context of relationship and presence. You may have many ways to bring this to your clients, including through guided imagery and silence, meditation exercises, and trancework. This therapeutic app has effective practical value because clients can more easily access and practice what they have done experientially in your office. These tools overlap with our other therapeutic apps and exercises or homework that create targeted change.

Other Therapeutic Apps in Your Repertoire

You have so many tidbits of wisdom and knowledge tucked away in your lifetime of training and orientation to be the therapist you are today. There are so many other concepts I have picked up over the years that add to my therapeutic app screen or toolbox, and there are so many more to discover. Our work with this fast-paced digital generation of adolescents and young adults demands that we keep up, that we bring everything to the room. Yes, it takes energy and commitment! But if we aren’t energized by our work, the vital dynamic in the transformational relationship we have with clients will become stale and uninspiring. If we view ourselves as therapy “artists,” we remain open to constantly changing and evolving in what we bring to bear and how we do what we do.

Therapeutic App: Integration of hypnotherapy (being strategic and thinking forward with a target) and ego-state or parts work can move seamlessly with your clients’ external IRL experiences, internal states, and digital life. This is an approach that promotes an embodying experience in therapy, which then has emotional impact that fosters real change. If there are other approaches that you are more specifically trained in and comfortable with, they can easily be added, mixed, and matched, as you help your clients progress toward mastering their developmental tasks with an eye to all three of their life spheres: online, offline, and evolving internal states. Most importantly, what you bring to the table with your presence, empathy, and attunement will allow the therapeutic apps you use to be accepted in the trusting environment you have elicited with clients. You can have such a positive influence in helping them live in the real world and supporting the evolving Inner Selfie while helping them regulate, calibrate, and grow.

Finding Common Ground

Therapy Is Changing and So Are You

Do you remember the days when the digital world did not permeate our lives and our smartphones were not with us 24/7? Or are you a younger therapist who grew up navigating social media? If the latter, you have travelled in this digitized galaxy most of your life. It’s incredible – your skill, understanding, and participation in this world. Well, we need to learn from each other.

Levels of self-disclosure, the dress code in session, the length of the session, the frequency of sessions, what attention and interaction mobile devices are given in the therapy room, how accessible we are to our clients, new methods of treatment at the forefront of education – all of this is part of the new age of therapy practice. Whether we have been doing it for years or are just setting up our practice, we are working toward the health and well-being of our clients.

In many ways, this changing therapy climate requires heightened awareness and due diligence to adapt to new ways to integrate into our own work and orientations. When I am at a conference or in a peer consultation, I love hearing from the younger therapists. Their education and training is peppered with research and methods currently at the forefront of the psychotherapy field. And the truth is that embracing new practices and techniques is essential for any age or level of therapist. One other important truth is that a far less experienced therapist who is authentic, caring, a true listener, and who brings his/her sincerity into the session can be just as connected and effective as a seasoned therapist with years of training. It is that precious relationship we share in the space with our clients that holds them with trust and support to do the work they have come to do.

My challenge to both old and new school practitioners is to cooperate and cross-pollinate in the effort to create a richer therapeutic field that is both contemporary and grounded. Ericksonians are known for welcoming the masters of all psychotherapy approaches and inviting a rich sharing and learning. Old and new need to be interactive, not parallel. This approach matches the way we desire to work together with our younger clients. What we model outside of the therapy hour gets reflected in our work.

Synchronize

I read a wonderful article by Ofer Zur in the Psychotherapy Networker (July/August 2012) about the subject of old school/new school adjustments to cyberspace and changing therapeutic ethics in the digital age.

He called those who are growing up in this time “digital natives” – the younger therapist and our adolescent and young adult clients. Besides comfort and ease with texting, online chatting, Twitter, Instagram, YouTube, online magazines, FaceTime, role-playing, blogs, Facebook, and the new apps and sites that appear every few months, cyberspace natives are comfortable with self-disclosure, short messages, and often feel “real” time is also online, and tend to see confidentiality and dual/multiple relationships as the same thing.

Zur described those of us who didn’t enter the digital age until later as falling into three categories: (1) enthusiastic immigrants, who are technologically smart and adept to begin with, who took to it like a bee to honey; (2) avoider immigrants, who continue to live as if they never left the “old” country; and (3) reluctant immigrants, who adapt gradually and maybe never totally feel like an assimilated native (pp. 26-32, 56). Although I have entered the digital world by gradual osmosis, I still love email, phone conversations, print books, and my privacy.

When I remember sharing one phone in my family growing up, with little phone line privacy, it is my history. When I remember living in Central America for a semester abroad in college, my boyfriend putting $25.00 worth of quarters in a pay phone in the US, it is my history. When I remember, as a graduate student and research assistant, the computer that filled up an entire building, it is my history. I still like 60 Minutes and CNN, and I miss Newsweek. Today, my cell phone follows me around the house, sits next to me in my office all day, and I check it more than I want to admit. I’m old school, part new world, and still adapting.

I’m thinking of one young therapist colleague whose posts on LinkedIn and Facebook, not to mention her tweets, have garnered her a sizable following. I am impressed. Her website has links and a video of her talking about her therapy practice and approach. I can definitely learn from this woman. I watch many old school therapists who have joined the digital age as well, with great marketing, webtalks, and other global networking tools. I am learning – more eager than proficient at this point!

Quality supervision from the experienced therapist and/or mentoring to the less experienced or trained therapist is what makes our field one that recognizes the exponential value of teaching, modeling, and encouraging growth in resources and skills. In addition, we also need to engage in the dialogue of an even playing field.

We want to be aware and diligent in both directions: not to be so caught up in the bells and whistles of being digitally current that we lose the thread of our focus. And not to ignore the digital world the young client lives in and go about therapy as usual. We need to be committed to solid and skilled therapy that sees the whole person as embracing both digital personas and experience and internal states, and help the person move to real life in a connected undissociated way.

Yes, the therapy room is qualitatively different from what it was 20 years ago. The ethics of handling digital information and sharing, the perspective we now hold that includes the digitized persona and experience of both our clients and ourselves, the way it weaves into the administrative part of our practice and other subtle contexts – these changes in circumstances have changed us. But the therapeutic relationship, the real felt presence of each other in an authentic trusting atmosphere, has remained and I hope will continue to be the backbone of our work.

Therapeutic App: We must sort for both differences (learn from each other) and similarities (mutual goals). Older and younger therapists must sit down, catch up, and share. The field will benefit from attention to both the roots of learned and intuitive wisdom and the fresh growth of current efficacy-based research and new ideas. Your adolescent and young adult clients will thrive under your guidance as their Inner Selfies are enriched by engaging with the therapeutic community in its rich diversity and its shared values, ethics, and goals of integrative health and wellness.

Finding Checks and Balances in a Digital Landscape that Doesn’t Have Them

Cyberspace is a place we go willingly, quickly, and often. We have a destination of some sort in mind, even if we are just scanning general areas of interest. It doesn’t feel particularly risky or dangerous most of the time. We just don’t think about it. And yet, it is a lot like visiting a world in anarchy, since there are very few laws or rules to govern.

In real life, if you were in a place where the cars had no brakes, you would likely proceed slowly and figure out how to slow down by downshifting or putting on the emergency brake or turning sharply in order to stop. If there were no traffic rules, you would work out how to negotiate changing lanes, how fast to go, and how to stay out of the way of oncoming traffic. Your horn would be your best friend, and you would find a way to make it from point A to point B, using caution and staying in touch with your GPS in order not to get sidetracked and ending up somewhere other than where you wanted to be.

Still, people tend to be curious. We will always venture out to explore the new and unknown. We travel, seek new experiences, and we enjoy gathering information and social connections. Cyberspace provides these opportunities and more.

But how do young people figure out how to stay away from danger? How do they know how to stop before it is too late, set limits for themselves, and improve online decision making? How can they create healthy checks and balances that make sense to them and still promote positive ego strengths that can handle the emotional challenges of life?

Four Signs on the Digital Road that Point in the Right Direction

Practice

We have to give our clients due respect for managing cyberspace as they develop skill, language, and sense of place there. We know that adolescents and young adults practice their developmental tasks by trial and error. This is no different in digital time. They come loaded with their own personality structure, temperament, family values (structure and health), social influence, and their entire “in real life” experience. Practice on the digital court finds them making mistakes and learning from them (we hope); sifting out what hasn’t worked; reforming and hammering it out; and moving to more evolved responsible ego-syntonic digital behavior that echoes their daily living. It requires practice, practice, practice.

Location

Where one goes in cyberspace is a free-for-all. Where clients go, what kinds of sites they frequent, what happens there, and the pulse of activity are as important as what they are practicing. With the SMA, you are more informed about where clients are spending their time – positive, neutral, or negative. In discussion, you get a sense about the pressure they feel on various social media sites. You will begin to understand how they feel they are being perceived, the “work” it takes to keep up their presence there, and how they believe they will be treated if they withdraw for any amount of time.

When Sandi, a 20-year-old college student, reflects that she was on “chat roulette” (showing her breasts to young servicemen she did not know) when she was a sophomore in high school but is now troubled by some of her earlier online and offline casual sexual behavior, I can help her work through some residual shame. She now stays on certain social media sites and although her digital friend number is high, pursuit of a high number is no longer her focus. She no longer takes “selfies” daily or posts constantly. I can support and applaud her intentional editing of digital destinations.

It is hoped that as our young clients mature, spinning the roulette wheel and taking whatever road comes up is gradually replaced by a more thoughtful process, one that is more selective and intentional.

Time

The checks and balances with regard to how much time is spent on the internet are conspicuously absent too. Parents of young adolescents will give time limits, but often don’t realize that teens find ways to spend more time online anyway. Tracie, a 15-year-old client who struggles with low self-esteem and poor grades, will often come to session without her smartphone, having had it confiscated as a consequence of some negative behavior, such as back-talking a teacher. She still finds electronic access via computer, her mother’s iPad, or other ways. For her, the cyberspace restriction accentuates her social isolation. She will easily spend 6-8 hours online and she scans her smartphone constantly. But I can see a stirring in her awareness of how the excessive time she spends there is blocking her desire for real connection. I can encourage her to be more present with one of her close friends as a start.

Cyberspace fatigue is often reported as the adolescents and young adults with whom I work grow tired of spending so much of their time online but aren’t sure how to better manage their time. They often feel pressure to stay on to avoid rejection and do not feel confident enough to try cutting down. Being able to modulate digital engagement is a skill that will more easily emerge as internal states develop. You can help clients install those digital brakes as you guide them to their Inner Selfie.

Maturation

Digital use and presence changes as the adolescent and young adult matures. If young people can get the support and attention they need as they proceed through these practice years, they will be many steps ahead of those who are going down digital roads without any sense of direction, who may lack guidance in mapping their routes and cyber identities. The ageless existential questions of “who am I and where am I going?” mark the journey of the maturational process. Cyberspace experience can provide both the fragmentation and the integration of their identity formation.

On observing that she is posting selfies, editing blogs, and increasing her twitter following on multiple sites, I figure out with 17-year-old Stacy, who is bright, intelligent, and hyperactive, that she has at least 20 cyberspace identities or presences, not to mention her presentation at school, at home, and in sports. We can look at what each of these means to her, as well as what emotional or cognitive states are expressed by them and how her online/offline life may conflict or synchronize. Stacy is already discussing cyberspace activities/personas she has discarded, what she has held on to, and what she is developing. Even she seems somewhat amazed by the multiplicity of her parts or ego states. Her awareness of how these digital states are a real part of her is growing. I can help her sort this out as she works toward a stable sense of self.

Maturation then moves forward as a natural process. If your young clients get stuck or thwarted along their path, your understanding of their digital engagement can help smooth bumps and signal dead ends or stumbling blocks on the cyberspace journey that is running parallel to their real life and internal states.

Using the Hypnotherapy Lens toward a Growing Sense of Self

We have looked at the digital landscape where little exists that governs time and location. Meanwhile, our clients are spreading their developmental wings. Again, there is little censorship and there are no rules of engagement, conflict resolution, or tests of authenticity.

Pointing the hypnotherapy lens at this digital world provides therapeutic photographs and videos that sharpen our focus as to how we assess and evaluate, seed and tailor with each individual young client. This view helps us plan our inductions, interventions, and follow-through for treatment, as we invite the client’s dissociated digital parts or ego states into the body and felt presence. We can use this lens to help clients down-regulate or experience an elicited internal state that is heartfelt and authentic, as well as to integrate digital parts with the real self. Thus, we encourage the strengthening of internal checks and balances, which translate into online brakes and speed limits that foster digital responsibility and accountability for healthy ego development.

Therapeutic App: There are few parameters in the digital landscape. And it is in this digital wilderness that younger clients practice and mature, where preference, performance, and persona of pattern and change are now almost completely filtered through an encompassing digital experience. Some young people proceed to develop a healthy balance between cyberspace and real time. Others lose their way, end up on self-destructive paths, and find themselves struggling with increasing despair and loss of self. Those who sit in your office seeking guidance will benefit from your tuned-in hypnotherapy lens that melds their online and offline worlds with a creative experiential integration of all parts or ego states that they share.

Life as a Reality Show: The Paradox of Global Privacy and Secrecy

Facebook may have been there first, but many young people have moved on to other social media sites. This information comes out in the SMA and, of course, from discussions in my office. And there will be new sites and lingo and behaviors that add to the ways and ease of sharing one’s life online so that today’s latest thing will already be vintage tomorrow. The SMA helps keeps us up to date! Most of us, and for sure, our young clients, will also absorb, adapt, and embrace the next advancements in technology and online novelty immediately and without hesitation.

Is Anything Private or Sacred Anymore?

This digital “global village” creates a generalized consciousness (Carnes, 2001) in its world wide web of sharing of what used to be considered private. Your client wanders through this village and decides where to share what and with whom. What they reveal about themselves makes many of us older folks squirm uncomfortably and question their sense of privacy. Younger therapists may raise an eyebrow, but accept it as the way it is now.

When 25-year-old Amanda moves home after college and graduate school, her social life consists of posting and selfies, bar hopping with a large group of college/high school friends, and trying hard to find a relationship with someone who likes her for who she is. With a fragile ego state and in a job requiring only a high school diploma, her sense of self-value and her decision-making are very dependent on the advice of her 40-plus “friends.” She confides in one of them about her lack of sexual experience and within a nanosecond the entire group is weighing in with words of young wisdom, suggestions, and graphic encouragement. She is only slightly embarrassed. Of course, none of this gets discussed at happy hour, when she actually sees them.

One’s best self – from physical appearance to how one wants to be thought of – takes practice but is generally not difficult to achieve. Young people create their selfie, profile, and identity through the process of posing, writing, editing, and remixing until it accomplishes what they want in that moment. Often, there is some amount of misrepresentation of self with “real” parts, which then elicits responses from others who are doing the same thing. I suggest that these contrived personas are actually parts of our client’s online ego states. It is who they want to be. It can be seen as an aspect of their experimentation in mastering the developmental tasks. But although the “selfie,” for example, can be fun and provide simple documentation of life, many young clients use their social media sites to show themselves in an over-the-top starring role, more confident, experienced, and, often, less naive than they actually are.

Social technology promises friendships of a kind, but has difficulty delivering the real thing. Its focus is really on performance; it’s in the business of manufacturing “friends.” The more “friends” one has online the higher one’s perceived social status (Turkle, 2011). Turkle quotes a study of 14,000 college students that saw a dramatic decline in empathy and interest in others (2011). With the constant focus on self and self-promotion, this is not a surprise. Part of our therapeutic resolve is to help young people transition to real time and develop an authentic relationship with themselves and with others.

Pressure with regard to one’s response time on social media sites and how often one is posting can be high. Keeping it current assures continued online cyber relationships. Many report strong feelings of rejection when they are not responded to quickly or are ignored, chastised, or “unfriended” when they disappear for too long. Every mistake or false step leaves a cyber footprint and threads that can expose people at any time in the future. Deleting the photo or piece of writing doesn’t mean it no longer exists; it is still out there somewhere, even if just in the hands of viewers who choose not to get rid of it.

Tikki, a 14-year-old client who sent out her deepest secrets to one of her Twitter posts with a following of more than 2,000, decided to delete it after just 20 minutes. She knows her mother still has access to that site and doesn’t want her to freak out if she reads it. What she cannot ascertain is how many of her followers will keep it.

The New Wailing Wall: The Online Confessional

Cyberpresence is, in part, a reality show, revealing the deepest, most personal and confidential information to the listening digital ear and prying digital eye. It used to be that friends, family, church, teachers, or mentors were our confidantes. Now, disclosure takes place with whomever is on the virtual site, where an unknown someone substitutes for the IRL friend or other trustworthy person. Opinions from online friends and anonymous responses can swing from kind encouragement to cruel and ugly tear-downs. Venting is considered by some as the new online sharing. With the maturing and ego-fragile young client, positive support can go far, but negative responses can create more self-loathing and can lead to dangerous self-destructive behavior. You can be as nasty or as pleasant as you want to be. You have permission to say anything. And saying anything is exactly what many young people are doing.

No-holds-barred fights with friends or strangers in the “safety” of online space can be a projection of what our clients don’t like in themselves and be a short-term fix (Turkle, 2011). Or they may offer pearls of wisdom and positive affirmation that someone on the other end finds inspirational. It is a throw of the dice. Whether one is being dissed roundly or strongly supported, cyberpresence is a land full of intense reaction in the moment of delivery and receipt that then can be dismissed quickly and easily – if one is confident and in a good place. When it comes to that young person who is depressed or anxious, and is vulnerable to negative suggestion and who believes what is being said, the negative, sometimes vicious, feedback reinforces their despair and self-loathing. We are all too aware of stories of suicide, self-injury, or of harm being done to others that are the result of cyberbullying and other negative online experiences. If the young person is also experiencing this IRL, it can form a fatal perfect storm.

Two quick examples:

Ana, an 18-year-old bulimic, was encouraged online to keep bingeing and throwing up, with suggestions on how to do it more effectively. She reluctantly agreed to stay only on positive sites for eating disorders, but this took some time, as her internal ego strengths and healthier behaviors needed time to grow.

Jen, a 28-year-old woman with depressive symptoms and suicidal feelings, would enter negative chat rooms to inflate her self-hatred. She admitted to me that they suggested easy ways to “do it” and she had begun to collect her “supplies.” Intervention central! Evaluation for inpatient treatment immediately. Luckily, after she was stabilized, and because we had a history of openness and conversation about these risky social media sites, she could include in her contract for safety an agreement to stay out of those rooms completely, and to build a network of sites that were helpful and encouraging.

On the more positive side, I have many clients who have shared uplifting texting and messages from social media sites they receive after they fully disclose their own upsets and negative feelings. Or they tell me what they say to the down and forlorn who share with them, nuggets so loving, positive, and wise, they sound like shrinks in the making. I am often blown away by their understanding and sincerity.

Texting as the Primary Mode of Communication

Who makes phone calls these days? Or even listens to messages? Texting lets us decide when to respond, and to whom, and how. It is a quick and effective way to communicate anything, from schedules and meeting times, to check-ins among family and friends. Able to be carried out at almost any time in any setting, texting is convenient beyond description, and few of us would vote to get rid of it. We can worry less about our children and loved ones on a certain level, and are able to keep in touch across the globe. It has become the primary mode of communication.

Of course, every manner of message is transmitted in a matter of seconds: arguments, sexting, love talk, flirting, breaking up, breaking news, alerts and alarms, and the whole range of human communication. While focused on the text, we are dissociated from being fully present IRL because we are cyberpresent. We can use texts as “stand-ins” to write a better apology to someone, finalize a “break-up,” and even flirt for us more effectively. Any of these interactions face-to-face requires effort; we can be more distanced from our feelings using stand-ins. We want to believe this is all sincere, but how can we really know? People may fake their feelings or posture, or they may sincerely mean what they are texting. It’s even tough to discern the sincerity of our own communications when time and feelings are so fleeting.

And remember, the dinging of our smartphones, with that little hit of dopamine each time we hear a text come in, increases our interest and compulsion to use texting; it’s more immediately compelling, perhaps, than picking up the phone or planning to meet in person.

Texting is convenient and effective. To our young client, it represents all of the above. But “cybertrust” is cheap, leaving a lot to the imagination, and there are no guarantees. When l6-year-old Amanda texts a friend her recent horrible experience of being drunk at a party where she heard she was videoed naked, the friend had already seen the video because it had been sent to her by another so-called “concerned friend.” She berated Amanda (although she had been drunk at the same party) and forwarded her admonishing rants with Amanda’s confidential text to a large group of high school peers. The betrayal felt overwhelming, but also important, as Amanda began to examine who her “real” friends were.

Dissociation when absorbed online seems to protect people against the fallout of using online behaviors as a reality show, at least in the moment. Many of the adolescents and young adults I talk with just shove things that they have said or done in cyberspace – things that shame or embarrass them, things they wish they hadn’t shared – out the memory window and into a faraway place they just don’t visit. Since feelings can then be kept at a distance, dissociation and compartmentalization have become staple mechanisms for surviving digital life.

Three Ways to Help Your Clients Manage Online Reality

Therapeutic App: You and your client share in the experience of the digital reality show through the ever-growing cyberspace footprint that is online forever. The sharing and exposure there by your client is extensive, from harmless minutia to risky, extremely private and personal data that often includes the person’s innermost thoughts, fantasies, and longings. When online, cyberpresence, cybersincerity, and cybertrust can range from total honesty to embellishment, fabrication, and misrepresentation (each one of these in varying degrees). With texting as the primary choice of communication, and “selfies” as the trending self-promotion, your clients need encouragement for self-regulation online, using healthy filters and coming into themselves in real time for essential practice and growing comfort with their Inner Selfie.

Discerning Healthy, Compulsive, and Addictive Use

As you assess your client’s use of and relationship to their smartphone, mobile devices, and computers, remember to assess your own! The Seven Stages of Smartphone Attachment outlined in the discussion of “the phantom appendage” will help you determine where you are and where your client is. Your evaluation of your client’s use takes into account the information from the SMA and from your observation of his or her computer use, as well as what the client discloses in discussion about the use of all devices, including gaming.

Healthy Use

What constitutes healthy use? It is not a precise science with clear guidelines; it is more about developing an awareness of how dependent people are on their devices. Healthy use may allow for continuous connection or proximity to the device, but only for a limited time actually spent on it. Part of healthy use includes periodic times of being unplugged and the intentional decision to disengage sometimes. Since we know that most of us – and especially young clients who have grown up using technology – are connected many hours a day, healthy use might be defined in terms of time spent there not taking the place of time spent here.

Does digital engagement perpetuate the client’s avoidance of IRL interactions? The IRL sphere includes relationship across multiple dimensions: interaction among IRL friends, school work and study, physical movement and activity, responsibilities at home, job commitments, in-person conversation and meals shared, along with rich moments of solitude. Healthy use means the important successful practice and experimentation of developmental tasks IRL, not only online.

If Amy, 19 years old and going into her sophomore year of college, runs 3-4 miles a day and belongs to a recreational volleyball team; and if she tells you about a healthy open relationship with her parents, hanging out with her boyfriend and good friends, sometimes opting to avoid texting when together; and that she keeps an old-fashioned journal on paper; you might surmise she is engaged in healthy cyberspace use. Although her smartphone sits next to her in session, she checks it rarely. As a therapist, you will keep tabs on any changes in use during the course of treatment, but for now, this client’s use appears pretty healthy.

Determining healthy use also encompasses what is done online, the kind of interactions that take place there, and how one feels about the experience when cyberpresent. If clients seem satisfied with the threads of their travels with both those they know IRL and those cyber-only connections, with low conflict, and you don’t hear the clanging of guilt or shame, you might conclude that they practice fairly healthy engagement. But be vigilant. Some behaviors remain hidden or are withheld for a period, but as the trust between you and your client builds, perhaps these too will be shared.

Healthy use can cross the border into excessive use for any of us. We can creep across that line at any time as usage is so normalized that we have a hard time tracking what is okay and what is too much. We must pay attention. As I keep going to the cupboard to break off a morsel of dark chocolate, an automaticity sets in where I lose track over time of how often I have returned there. It shows up later in weight gain or blood sugar level. Long-term overuse of our electronic devices also has side effects that compromise physical and mental health. It can be slow and subtle. You may be vaguely aware of backaches or fatigue and irritability. You may plan to get up and move but you have just one more thing you want to do. You wake up one day and there it is, the bundle of symptoms that range from muscular tension to mood changes. As online hypnotic phenomena have been noted earlier in this course, there are clear examples of when compulsive or addictive digital time promotes dissociation, time distortion, catalepsy, and more!

Compulsive/Addictive Use: Electronic Crack

Okay, if you and your client can straddle healthy use in every area except time spent online, then you have a comorbid (mixed and complex) diagnosis. Excessive time puts both of you on the compulsive continuum. Perhaps you are on the milder axis side but you’re there.

Compulsive use is a gateway to more addictive use. Make no mistake, cyberspace is highly addictive. Remember the short-term rewards of having a squirt of dopamine released every time we a get a response (ding), which charges the compulsion engine, just like a gambler experiences every time a new card hits the table. And when this compulsion engine morphs into addictive behaviors and symptoms, one can lose the ability to regulate boundaries. Even those who have no history of other compulsive or addictive behavior can develop this behavior online (Carnes, 2001).

The compulsive urge to respond to the ding (the knock, the chime, or trumpet) can land us in unsafe behavior. Think about it: in most states texting while driving is against the law because so many more accidents occur when a driver is distracted; still, many people continue to do it because they want to respond immediately and not miss out on anything.

Other normal adolescent and young adult practices and experimentation online, such as exploring various sexual sites, role-playing games, political forums, or looking for the novel and “forbidden,” can lead to increasing compulsivity that demands more time and more dramatic behaviors, which then become “normalized,” and, of course, then lead to more. All the while, symptoms of anxiety, physical complaints, depression, irritability, and avoidance of IRL increase.

Although it is not listed in the current American Psychiatric Association’s DSM-5 (2013) there was a lot of discussion about adding an internet addiction disorder before it went to press (Internet Gaming Disorder is listed in Section 3 as needing further research to warrant it as a diagnosis in the future). You can find many references online, though, to Internet Addiction Disorder (IAD), so a lot of folks believe it exists. It can be seen as being similar to other addictions and behavior, causing (among other things):

We’ve heard of “phantom vibration syndrome” (thinking our cell phone is vibrating when it isn’t). Symptoms of overuse have been dubbed “Facebook depression” and “cyberspace fatigue.” With teens averaging over 3,700 texts a month, and over 38 hours a week “plugged in,” it’s easy to lose perspective on how common compulsive cyberspace behaviors have become. In studies of those under 50, it has been found that checking social media sites or emails every 15 minutes is common. The more time spent online, the more compulsive personality traits. Many people check their mobile devices before bedtime, during the night, and before getting out of bed (Rosen, 2012).

The brain of a cyberspace addict looks a lot like the brain of a drug abuser/alcoholic (Hao, et al., 2012). This is the opposite of what the brain looks like when people are engaged in relaxation practices, meditation, silence, or trancework. If abnormalities from overuse show up in areas of the brain that regulate attention, control, and executive function, then this is also interfering with the normal growth and development of those still-forming areas in the adolescent and young adult.

Patrick Carnes, a leading researcher and educator on online sexual and addictive behaviors, describes such compulsive behavior as “the loss of being able to choose to stop or continue a behavior” (p.25, 2001). According to Carnes, this inability to create such boundaries may manifest as:

Many of us note that today’s youth culture is open to almost anything sexual online; it is “cool” to be so accepting. I attended a lecture a few years ago in which Patrick Carnes noted that 34% of middle school students were involved in some kind of sexual behavior while doing homework. And when addictions begin between the ages of 11 to 16, high-risk behaviors often continue into adulthood.

And, again, we know what makes compulsive use so compelling. Everything. Contact is only a click away, the user can be anonymous, connection is affordable, little effort is required, it’s easier to cross lines that are not easily crossed IRL, and consequences seem unreal. Everything is available, or so it seems.

Your client, who is practicing, experimenting and mastering developmental skills in “privacy” from IRL, is running with the wolves. With no limits on use, it is no wonder that compulsive behaviors are also unlimited. Since there are hardly any rules, it feels as though no rules are being broken. And that dopamine rush …

Shame

The positive side of being de-marginalized in cyberspace cannot be stressed enough. If young clients have obsessions, desires, or fantasies, their feelings of shame can be reduced and more positive feelings developed when they know they are not alone. One client, a college student, found a site that matched a particular fetish she had. She developed a relationship with someone there and the real time spent with him grew into a positive friendship. This “normalizing” of their developing identities can be either a positive or negative consequence. It is important to keep vigilant about the degree of compulsivity of the behaviors and to track whether the experiences are detrimental or lead clients to a better sense of themselves.

Shame can often develop from digital behaviors and activities. The “secrecy” or sense of risk-taking may heighten the arousal template and be a signal that a boundary for our client has been crossed. This arousal template begins when one is very young, and is influenced by thoughts, smells, sights, fantasies, images, sounds, and objects. It also includes physiology, biology, genetic factors, culture, religious and ethnic background, family history, experiences of physical, emotional or sexual abuse or exploitation, if any; and general life experiences and sexual history (Carnes, p. 84-89, 2001).

The more one is absorbed online, the more dissociated one is, which can make cyberspace-based shame behaviors and experiences feel detached and easily dismissed. Jamie, age 16, may respond to any attention from young men who sext with her. She can’t stop herself because as bad as she feels right now about her body, the attention is a temporary balm. Doria, age 14, feels like she is always being left out at school by peers; online she lets her anger out uncensored and claims it doesn’t bother her a bit. It gives her a sense of control as compared to her shyness at school. David, a senior in high school, poses as girls he knows his friends have crushes on. He sees the upset and drama at school that result from his anonymous faking it, but he feels vindicated because he has been rejected by many of the girls he has approached. As a consequence of these and other problematic encounters, our clients may describe high generalized anxiety that they can’t place. It is helpful to keep exploring their online personas and cyber-ego-states. When brought into the therapy hour without judgment and with support, a young client may experience a flood of emotions that can begin to move toward an awareness that the behavior is just a part of who they are (ego state) and work toward acceptance with a resolve to establish a healthier online presence.

Jenni, a bright articulate 19-year-old client, frequently visits certain social media sites when feeling blue and down on herself. The posts are sadistic and nasty and take her to a familiar place of shame. Her father emotionally and verbally abused her when she was growing up. He verbally shamed her when he found her touching herself once as a young child, an event she still feels traumatized by. She can barely speak through her tears when she admits a big secret, that when she is being put down by posts on this site, she feels sexually aroused, which adds to her feelings of self-loathing. As she realizes how her cyber-ego-states on these sites of anger and hostility feed into her confusion about her sexual identity and self-worth, she begins to move toward reparative work in our sessions. She hears that I am acknowledging her experiences without judgment, and she says that I understand. By looking at both her online and internal ego states, plus utilizing trancework for building her ego strengths and diminishing the trauma, she has come close to being able to stop her travel to those sites. She has had a couple of slip-ups, but they are few and far between.

Blurring of Digital Life with IRL and Extreme Use

With extreme use, and choosing digital interactions over those IRL, boundaries can become blurred. Believing that a digital relationship is authentic and real is ultimately a huge letdown once it is discovered just how contrived the relationship may be. One of my clients, 15-year-old Tamara, who spends excessive time on many sites, was told after she and a “boyfriend” broke up, that all the texting conversations they had had were actually sent by a couple of his friends to see if she would bite. And most of us have heard of LeBron Williams from Notre Dame, up for the Heisman trophy, who made headlines a couple of years ago when his fiancee, whom he had met and connected with online, turned out to be a fraud. Unbeknownst to Williams, he had fallen in love with a man and his accomplice who were posing as a young woman.

When a young client tells you he or she would rather be online than off, this can be another sign that compulsive use has trumped fully living IRL. There are so many examples of extreme use. An article in Newsweek (2012), just before it went out of print, described some extreme international use of the internet … a young couple whose baby died of neglect while they cared for an online baby … a reported case of a young man who bludgeoned his mother to death and then used her credit card to purchase more hours online. There are reports of users dying from blood clots from sitting too long while using the web. Although sensational and extreme, such stories speak loudly to a global need for balance and internal regulation.

Therapeutic App: You can join your client in assessing where they are on the continuum from healthy use (the ability to go on and off digital time with intentional awareness) to more compulsive behaviors that can easily morph into online addictive behaviors and symptoms. With the SMA and the Seven Stages of Smartphone Attachment, you have a place to start that will open doors for helping those who are using cyberspace in a compulsive or addictive way. Your acceptance and nonjudgment of your clients’ activities and experiences will add to the total picture you will use as you bring them, once again, into the space of being present IRL, building internal awareness, and finding their Inner Selfie. As you guide them in self-regulation skills and relationship-building with others and themselves, you can appreciate the value of including the digital experience of your client as essential for comprehensive and deep emotional impact that is relevant to their world.

The Inner Selfie Technique: An Instant-Access, Mobile Device Support System

I encourage everyone to incorporate this technique into therapy practice with adolescent and young adult clients. It integrates the hypnotherapy lens and the ego state and “parts” work. This approach acknowledges digital personas and behaviors, IRL experiences and personas, as well as clients’ developing ego states. Using their smartphone or mobile device, clients create an instant-access video that reflects the part of them – the Inner Selfie – that can encourage them when there is self-doubt or they need a boost to remind them of their strengths.

Many of us record trancework, homework assignments, and meditations on our clients’ smartphones already. Erickson’s poetic image, “My voice will go with you,” has become today’s literal message. The recordings can be very powerful and useful in times of trouble.

In my work, I wanted to find new ways to bridge clients IRL and cyberpresence. I began to think about the ubiquity of the selfie. Young people, especially, spend many hours creating and editing pictures of themselves, the external picture carefully crafted for the digital world. How these pictures are rated by others can affect their view of themselves – what others think is central to young people. Cyberpresence is the manifestation of the imaginary audience (Ryan & Kuczkowski, 1994), what has been considered the egocentric belief of adolescents that they are constantly being scrutinized, judged, and evaluated by others. This audience, in fact not imaginary anymore, lurks in clients’ imaginations and cyber-realities well into their 20s. With maturation, most clients become more realistic about the importance of other people’s perceptions or supposed perceptions. While the shift in understanding does not mean that people are necessarily less likely to react to positive or negative feedback, but the feelings may be less intense and easier to let go of than in a younger adolescent.

The Inner Selfie takes an already-familiar idea to the young person – how their selfies are received by others (external locus of control) – and expands upon it to acknowledge an inner voice of positive, supportive self-regard. The Inner Selfie enlists the developing ego strengths (internal locus of control) that are being encouraged in the therapeutic work being done with them. It seems like a good bet that watching themselves would be much more appealing to them than listening to “trancettes” made by me. In a paradoxical way, this method of watching themselves actually invites less egocentricity due to the messages coming from deep within rather than from more superficial sources.

My clients report using the Inner Selfie videotape regularly when they need encouragement because their insecurity is high or their self-esteem is low and they feel vulnerable. Sometimes the negative self-talk just won’t quiet down. It is important to glean from your discussions the origins of their self-doubts. Do they come from social media shunning that accentuates an already low self-image? Do they come from IRL influences of friends, family, or others? Are they self-inflicted or are they the consequence of a combination of factors?

Here’s how it works:

Prep Work

The therapy with your clients so far has enabled them to become aware of their different “parts” or ego states online and off. They have experienced both down-regulation and defining moments in therapy, perhaps with direct or indirect trancework, where they have been able to adjust, change, or move toward greater self-worth and resiliency. They are comfortable sharing online and offline realities as they know you “see” them fully, starting from the SMA and your understanding of both worlds. They are aware of “parts” of them that get in their way and stop them in their tracks or sabotage their movement forward.

Creating the Inner Selfie

Now you and your client are ready to access a new or developing resource that is reliable and flexible. They will come on board as you discuss the value in filming (capturing and preserving) the stronger more confident part of them. You will discuss what they might be struggling with and then invite them to video a way to remind themselves of the ego strengths that can overcome shakier insecure or self-destructive aspects of them.

First, ask them to remember what they will tell themselves when, for example, a part of them that is feeling insecure has surfaced in an intense way. You can rehearse this with them before recording. Then, press the video button on their phone and begin.

You are the coach, so guide them along as you are videotaping and remind them of those stronger internal parts they have been working on. These videos are short, from one to several minutes. You will look at the video together, and redo it if they think it necessary. In general, clients are pleased or appear to feel more peaceful and more confident when they see it. You will want to check in with them about what they are feeling. I generally ask clients to go into their body for a few minutes and get in touch with how seeing themselves support their inner strengths feels. This will anchor an internal awareness of inner strengths that will fire up when they watch the video at other times.

Encourage them to watch the Inner Selfie that has been taped when difficult feelings arise so that they can be reminded of their greater ego strength and how far they have come at the press of a button.

Always follow up and encourage the use of the Inner Selfie in future sessions. Make new ones in the course of your treatment. The evolving Inner Selfie is a good image for them as they grow and change. If the client is near the end of the therapy, you can support the use of the Inner Selfie recording when self-doubt and low resolve creep up later on.

Two Quick Examples:

When Suzanna, in her mid-20s, decided to stop using drugs and alcohol, being with guys who were just using her, and jumping from one low level job to another, it was her self-loathing and addictive sides that often reared up. She had been in and out of hospitals and rehab centers since high school. She had little ability to focus inward and her impulsivity led her down many dark destructive streets. After a few months of sobriety and committing to attending AA and church programs, she was able to use the Inner Selfie technique when her urges were strong. It helped her choose another direction rather than going to the downtown area where engaging in self-destructive behavior was a high probability. We made several Inner Selfies that corresponded to where she was in her progress. Her chronic lack of object constancy was counterbalanced when she remembered to use this technique.

Tim, a young man now in his early 20s, whom I had seen when he was in high school, returned to therapy for direction and confidence-building. His parents, who were divorced, both had drug or alcohol issues and had been unable to give Tim much guidance for managing life. He used the Inner Selfie technique to stop comparing himself to others. He talked about his ability to figure things out on his own, like graduating from high school, holding a job, and knowing he could manage college once he decided what he wanted to pursue. He felt more confident to go at his own pace and in his own time.

The Inner Selfie Technique Synthesizes Hypnotic Phenomena with Building Healthier Ego States

When your clients watch their Inner Selfie videos, they are in a self-trance which is down-regulating and activates changes in mood and brain activity. Thus, they are dissociated in a way that brings them into the body and yet they are absorbed by watching the video. A simultaneous double entendre: a felt emotional presence with their inner ego strength alongside their external focus on the video where they watch themselves send what is positive, good, and strong back to them. This “feel-good” message resonates deeply and underlines their gifts of inner strength and inner wisdom. The video provides encouragement to actually believe in these attributes with the same instant access they have on social media sites; clients are enabled to begin to self-mentor. This technique is both post-hypnotic and future-paced by anchoring belief in self and ego states that are helping clients master developmental tasks successfully.

Because the Inner Selfie is available 24/7, your clients can use it as their own personal ego-strengthening app when they need a reminder that they have confident parts that can overcome more vulnerable ones.

Therapeutic App: You are adding to the emotional growth and well-being of your young clients by introducing the Inner Selfie ego-strengthening technique, a video “trancette” made on their smartphones. You are the videographer and coach, guiding them to give voice to the part(s) of them that are positive ego strengths that can be called upon instantly when they are struggling or lose sight of them. This can help them avoid or minimize self-destructive behavior and negative self-talk. This post-hypnotic and future-paced technique encourages the positive internal sense of self while simultaneously providing an external view. The experiential moment that your client can access when using the Inner Selfie video allows for a readiness state of deepening inner strengths to be experienced over and over again. It can create empathy and understanding toward the struggling ego states, moving away from egocentricity, while affirming their ability to overcome self-doubts and blocks. You have given them another way for essential emotional impact that transforms and transcends – a trance that goes deep within, using the very same device that so often keeps them focused outwardly.

Ways to Help Clients Down-Regulate and Increase Affect Regulation

Down-Regulation Goals

Being able to evaluate the level of mastery of developmental tasks in the maturation of our clients helps us to formulate the goals for helping them down-regulate, interiorize, and regulate affect. We want them to improve in their decision-making skills, executive control, and ability to create healthy boundaries. The following discriminating observations will help guide the implementation of interventions.

Physical Affect

Are clients active or inactive? Do they need to slow down or expand their energy? Do they know how to use abdominal breathing exercises and relaxation techniques? Are they able to decrease dissociation levels to be more present, more in their bodies and more aware of their physical surroundings?

Psychological Affect

How can clients become more oriented to the present, being more in the moment and mindful? Has their experience expanded to self-awareness, and how can this be enhanced? How developed is their “observer self” in improving regulation? How can their skills in diminishing intrusive negative thoughts or an unhelpful “busy” mind be improved?

Social Affect

How much real time do clients spend connecting with others? How significant are their online relationships? What is their progress from social self-consciousness to more self-awareness? How much enjoyment and contentedness in their daily life do they report? How do they report the quality of social networks and relationships, including those IRL (friends, family, love relationships)?

When we sort for affect differentiation like those just listed, we uncover clues for strategic interventions. Indirect suggestion is often the meat of our interventions. For example, if 22-year-old Maggie is listless and depressed, you might be very lively when using a trancette with her, and use stories and metaphors about “waking up” or about “how time flies when you’re having fun.” You may have her stand and stretch, reaching up to the sky with you, both before and after the trancette. Teaching concrete ways to reach these goals of down-regulation, affect regulation, and healthy ego boundaries provides a script they can follow that has both the experiential and indirect benefits built in. As you look at the following suggestions, think about how you might help your clients incorporate them.

Lack of Trust and the Need for Constant Feedback Are Down-Regulation and Affect-Regulation Busters

“My generation is constantly needing to know someone is there” (Derrick, age 19).

“My generation is more guarded. When you think you are sharing something confidential, it could be going out to anyone at the same time” (Amy, age 22).

These quotes from two of my clients refer to their online feelings of constantly seeking feedback and surfing until they find it (a type of cyber self-medication to lower anxiety) and knowing that even with self-disclosure, the receiver may not keep it to themselves (trust is conditional). This experience is common life online for most of our younger clients. If the feedback or evaluation is negative, anxiety doesn’t abate, it increases.

Difficulties being alone (feeling lonely and anxious) and trusting others fully (the guard is always slightly up) add to the importance of working toward these next goals of affect regulation, down regulation, and creating healthy boundaries.

Seven Things You Can Do to Increase Affect Regulation, Down-Regulate, and Build Healthy Boundaries

Teach Resiliency

Our clients often come to us unaware of their strengths and resilient characteristics. Educate them as to what resiliency means. Provide examples of resiliency. Here are a few that I find helpful:

Seeing problems as a challenge. Being flexible and thinking before making a decision. There is always a way to approach, reconsider, and tweak what may initially feel like “no way out.” Not seeing oneself as a victim caught in a vicious cycle of defeat is a huge step in building confidence, creating that connection with the Inner Selfie, and seeding feelings of empowerment.

Setbacks are a fact of life. If your clients understand the realities of “falling down and getting back up” as an inevitable part of life, they may not feel as ambushed every time they experience a disappointment or roadblock. This awareness lowers feelings of isolation, self-recrimination, and self-doubt. They can remind themselves: “Hey, this happens to everyone” (even though they might not be able to see it).

Developing strong problem-solving skills. You can use a limitless number of therapeutic ways to approach a problem or state clients feel stuck on. Beware of being convinced they have “tried everything” and getting sucked into their defeatist mindset. This is a caveat for all of us; to not join in the belief, “If you had my life, you would give up too.”

Being aware of self and others: Strong social connections IRL as well as online are essential. Commend clients’ ability to ask for help and reach out; they are not alone (psychotherapy, support groups, positive online forums, courses, etc.). In reaching out and helping others, perhaps a friend who is struggling or a grandparent who will light up when they walk in, clients can act on their altruism, which can then increase empathy, an important aspect of their growing self-awareness.

Good self-care habits: Having good personal hygiene, healthy levels of physical activity, and maintaining a nutritious diet would seem to be no-brainers; however, for many of our clients, these are areas that are in a blind spot. And young people are sometimes unaware and dissociated from the long-term effects of ignoring one area or another since a youthful body can tolerate a lot of abuse or neglect on these levels before evidence emerges.

The ability to laugh at oneself. Being able to laugh at oneself puts us automatically in the “observer self” and simultaneously relaxes our physical body.

Novelty and change: What young person isn’t drawn to something a little different, out of the box, against the “norm” (even as they seek to “fit in” and be accepted)? Young people love the idea of this even if they need help identifying and relaxing areas of rigidity. You can use their openness to novelty to underline untapped resources and enhance their emotional responsiveness to that “yes-set” of change.

Increasing internal locus of control: These roads lead to further developing the Inner Selfie. The reflection, “I can affect my life by my actions” echoes your message, “Of course you can.” What a pleasure to witness the young client’s burgeoning ability to sit alone in silence from time to time as he or she cultivates a growing awareness of the benefits of mindfulness – that ability to be right where you are right at that moment and nowhere else, the conscious and present mind and body.

This list is built on the idea of spotlighting inner resources. It is so important to acknowledge a useful resource in clients, even if they are having difficulty. Have them tell you a story about when they have used this resource and help them deconstruct it to find the pieces of resiliency there. The “WOW” factor (“It’s true, I did that!”) can emerge as self-realization, and then awareness really lands in them.

Janie, a woman in her mid-20s with poor impulse control (episodic rages, drug and alcohol history, constant conflicts, and anger), couldn’t think of any personal resources. However, she was bright and responsible, and had worked her way up to acting director of a day care center. I had her sit in my chair and tell me how she managed the center and about the daily challenges she had to meet. The lightbulb went on and she was able to identify areas of resilience that she could then build on.

Trancework

Use “trancettes” with cyber-friendly language: These can be direct or indirect, as short as several minutes or as long as 8-10 minutes. Target your goal, use the basic structure of a trance (or meditation or guided imagery) and intersperse your language with words and metaphors that acknowledge digital cyberpresence and cyber-ego-states with IRL alongside internal states experiences. Trancework always brings our clients into their bodies and a felt sense of self-awareness.

Employ the Inner Selfie technique: This technique uses your clients’ awareness of parts of themselves to amplify their ego strengths and to more actively reference them when difficult parts rise up and cause stress, anxiety, depression, or self-doubt. Clients go into a mini-trancette, watching themselves on their mobile device, which makes it experiential and significant. This extends the hypnotherapy lens – which is so effective for transformative change – into their daily lives, where it is instantly accessible and “trance-forming”!

Record trance sessions on their smartphones: Encourage them to listen to these sessions when they are stressed or are needing to calm down and focus on being more present and in their body. Keep them short when possible – in accord with clients’ fast-paced life! Follow up and discuss how and when the recordings were used and how successful they were. Record all of your trancework on their smartphones, as listening to it later underlines your therapeutic intervention and gives post-hypnotic suggestions intensity and “stick-to-itiveness.”

Down-regulating induction techniques: There are scores of classical and Ericksonian induction techniques (i.e., Geary & Zeig, 2002; Zeig, 2014), and for the Ericksonian therapist, inductions are always tailored for the client and can be interspersed from the beginning of therapy to the end. Here’s one I find young clients can do easily and without resistance since they are “in charge.” They often report it is easy to do on their own when they need to “calm down” and it teaches self-control, gives the experience of down-regulation and self-hypnotic phenomena, a sense of self-empowerment. In my office, it is often a useful segue to trancework.

“After a couple of easy breaths … bend one arm up to your eye level and pick a spot on your hand or arm to focus on … as you keep focusing on that spot and breathing easily … allow your arm to lower slowly … comfortably … taking its time … all the time it needs … until it rests easily on your lap … allow your eyes to slowly close … and just rest and be comfortable … for a couple of minutes … feeling how relaxed you can feel … in your body … in your mind …” (Hand and Arm Lowering Technique, adapted from Advanced Hypnotherapy Training, MHE Institute, Geary, 2010).

Use Ego States and Parts of Self to Build the “Observer Self” and Self-Acceptance

By talking about and identifying online personas, IRL behavior, and internal states, a change in perspective can begin to percolate and a greater self-awareness can emerge. Your clients can discuss different parts of themselves without defensiveness. They can look at these parts of their ego states and personas as aspects of their whole person. You are helping them discriminate, de-amplify, and process what parts are troubling – and amplify strong or healthier ego states. This freedom from self-judgment allows them to move toward healthier integration and individuation.

Exercise: Get them off the couch and help them move from one ego state or part to another (different positions or chairs in the room to represent different aspects of self). It is important to bring their online states and profiles in here as well (some will parallel IRL states, some won’t). You can begin by playing one of their parts, exaggerate the role, and have them eventually take over the representation. As the parts begin to dialogue as “actors,” watch the light go on as they are able to “experience” these parts as just states, moving away from believing and owning a negative feeling that these states represent all of who they are. They begin to transition from emotional reasoning, for example, “I don’t fit in, I’m a loser,” to a clearer, more accurate perspective, for example: “That experience triggered my being bullied in fourth grade, no wonder I reacted that way.” The exercise always closes with the stronger and healthier ego state (the one that triumphs over conflictual and self-loathing ones). “Just because I feel that way, it doesn’t make it true; most people aren’t thinking about me like that.” (The exercise is an assimilation of ideas drawn from my personal professional history and experience culled and adapted from family systems, psychodrama, gestalt, hypnotherapy training, CBT … you get the idea).

Mindfulness Exercises for Building Down-Regulation States

Your clients know how to use the smartphone like a master ninja. Incorporate their knowledge into new ideas. Teach concrete ways that can help them down-regulate. Here are a few approaches I have found helpful:

Encourage sending a text message to themselves as a self-listening exercise when they need help to delay reaction time – things like, Stop, Breathe, Think,, or Breathe deeply and slowly and count down from 10 to 1. Have them use ringtones that transmit something positive, meaningful, or relaxing when they hear it so that it may be followed by taking a couple of breaths. When a ding comes in signaling a message, invite the client to take those breaths and to wait 15-30 seconds before responding. This encourages an internal response over an impulsive, reactive one.

Find and develop guided imagery exercises: There are many meditation and mindfulness practice exercises to refer to. Creating guided imagery that is more personal to the client’s own life and issues can increase the experiential change, just like hypnotic trances that are structured and tailored to the individual’s targeted goals.

Teach a relaxation response they can practice when anxiety and thoughts are racing. I teach a simple one that can be used readily and many of my young clients report that it has been very helpful. I start by pointing out that when they are worried, anxious, or upset, they breathe in a shallow way, from the chest, or that they even hold their breath. Most are unaware that this is happening. Further, I explain that by becoming aware of their breath, and using relaxing abdominal breathing, they will begin to relax.

“Put a friendly guard at your minds door and while you are practicing this relaxation response, if your thoughts wander – and they will – have that friendly guard tell your thoughts to come back later, youre busy right now. Your mind needs a break, just like your body.

“Breathe in slowly, filling your stomach up like a balloon. When you exhale, deflate your stomach, like you would a balloon.

“On your in-breath, count down slowly … .5 … .4 … . and on your out-breath … .3 … 2 … 1 … . Do this at least 8-10 times and when you have more time, practice longer. Practice this daily, even when you are not upset. The more you practice the more benefits you will get.” (Adapted from Harvard Medical School, Mind-Body Institute for Continuing Education, 1998)

Do this in your office with your clients for 3-4 minutes and make sure they are feeling more relaxed. Do a body scan with them for awareness of being in their body and any changes felt. Check in from time to time in future sessions and go through it again if they need more practice. There are many variations and ways to practice the relaxation response, but they all will involve abdominal breathing and focused thought. You may know others that are just as effective.

Journaling (on paper or online): to relieve emotional distress and promote well-being. One study showed that those who wrote at least twice weekly over 10 weeks showed a significant improvement in pre-assessed social emotional difficulties (Psychological Svcs, Dec. 12, 2011). Many of our clients love to write and express their thoughts and imagination. This often includes blogging, twitter accounts, fanfiction sites, Tumblr, etc.

Physical movement: Sports, yoga, walking (with or without headphones or music), running, martial arts, or any exercise that relaxes, follows the breath, and reduces busy or “monkey” mind is crucial. The well-being of every young person is enhanced by physical activity, especially given that so much time is being spent plugged in and sedentary.

Encourage Real-Time and Face-to-Face Connectedness

Start with short intervals, as comfort with face-to face time can be like developing muscles in strength training class; it gets easier with practice.

Phone time versus texting: Encourage picking up the phone, maybe once a day, for a “live” conversation. Call a grandparent, plan an event with a friend, anything. Many find this difficult, as texting feels so much easier.

Psychotherapy hour: Be aware that 45-50 minutes of face-to-face time with you might be too long for some clients. Use the smartphone medium as an album of pictures they may share with you or have them read a text that is current and made them feel happy or upset to create comfort while they are getting used to this intense face-to-face. Clients often voluntarily check their smartphone less often as time in therapy becomes more comfortable and connected. Or you can show your comfort with its presence by accommodating a short intrusion, as in, “Do you need to take that?” One high school freshman appeared to be glued to her smartphone, and simply could not put it down. At some point she agreed to put it under a pillow during our session. She had 65 hits in the 40 minutes it was tucked away!

Daily real-time conversations: Encourage initiating even 5-10 minutes with a friend or parent. This might mean a high schooler agrees to come out of her room for a while and talk with a family member, or a young adult plans an activity with a friend where they both agree not to look at their smartphone for a while. This can be difficult. Talk about the specifics of how they will accomplish this and follow up in the next session. Real time in real space, being present physically and mentally, cannot be emphasized enough. Our clients often default to texting and being online. Real-time connectedness cannot become extinct or only a rare social occasion. It is an essential part of what makes us human and real.

Store a Treasure Chest of Metaphors and Stories that Showcase Autonomy and Down-Regulation

Sometimes it’s hard to remember examples and metaphors that are salient to a young person’s life. They provide many in our sessions with them. Just keep adding to your list, and you will be surprised by how many gems you collect and how they handy they are as you proceed.

Teach Peace in Solitude

It is important for your client to understand that there is a difference between the serene experience of solitude and the empty feeling of loneliness. Feeling comfortable being alone once in a while is integral to general well-being. Solitude can be a place to gather inner strength, a time of reflection and creative thought. Encourage clients to think about situations in which they would be comfortable being alone by choice. It doesn’t have to be for an extended period, just refreshing, like sitting under a tree or taking a short walk, unplugged. for 10 minutes and taking in what they see around them so their body can relax.

Tap into clientscreativity. They might paint, draw, read, write poetry or make or listen to music. Donnie, a senior in high school with significant ADHD and a history of self-injurious behavior, but very talented musically, created songs using guitar and voice. He harmonized with himself on tape. I play one of them in my workshops: He explains, “I wrote and produced this song because it makes me think of good times chilling out with my friends and girlfriend.” Making his music meant that those times of solitude were a space in which to promote his growing sense of self.

Make solitude versus loneliness a homework assignment. One client in her late 20s and on disability for a mood disorder with minimal self-regulation, found a framed poem at home that had given her inspiration when she was at her lowest point. I encouraged her to record it, to appeal to the budding actress part of herself. She would listen to it when she needed to gain a sense of peace. Both the recording and listening to it were acts of solitude. It was a structured assignment that accessed her budding Inner Selfie.

Encourage sending someone a card or letter via snail mail. Choosing or making it, and writing, thinking, and mailing it can be a good experience for both the sender and the recipient. Suggest doing something for someone else who doesn’t expect it. You might keep some stamps and cards in your office. Having supplies readily available can serve as a stepping off from the digital transmitter. I will send cards to clients sometimes with an encouraging note to model what it feels like to get snail mail that is personalized. If a client plans it intentionally, it takes some thinking and action that begins with solitude and then reaches another being. Remember that even this small gesture (just one example) puts into practice a sense of altruism, which is an integral part of resiliency, and can tap into and increase levels of empathy.

Whenever a client tries on a different behavior, does something slightly different, or views something from that developing observer self-perspective, the experiential charge of real change moves the person forward. A fruitful balance can begin to develop between daily time spent in cyberpresence and experiencing real change in the body, thoughts, behavior, and internal states from being truly offline in a full way.

Therapeutic App: As you reflect on the different ways you can help your client down-regulate and build affect regulation and healthy ego boundaries, be open to trying new techniques and energizing familiar ones. More novel interventions will occur to you with each client as you polish your therapeutic focus on providing practical skills that they can participate in experientially. It is the combination of applying our training and background and being current with the online life of our young clients that will foster a healthy alliance. Our own gifts of resiliency and authentic “self” model for them in the process. Only then can we touch the core of our clients in ways that resonate and motivate toward building their internal states, that essential Inner Selfie.

How and When to Unplug

A Sense of Community

The “sense of community” I am talking about here involves membership, influence, integration and fulfillment of needs, and a shared emotional connection (McMillan & Chovis, 1986). It means a group of people in some place, real or virtual, who have particular characteristics in common – values and interests, intent, needs, preferences, resources, and beliefs. The members of the community, formal or informal, have a feeling of fellowship or warm shared identity.

Your adolescent and young adult clients need to feel this sense of belonging, warmth, and caring in the communities they seek out, both virtually and offline. When they experience this, there is less reported depression and emotional pain. This social connectivity – with friends, family, teachers, religious communities, therapists, positive online and offline support groups – gives our younger client the protective resiliency needed to master developmental tasks and to thrive. The communities found in the digital world, although vital and important for many, are of course relatively anonymous and thus have less potential for stable ties to be established. And on sites such as Twitter, Instagram, Snapchat (deleted after a short time), Facebook, dating and meet-up sites, one can virtually follow folks invisibly. The online practice known as “lurking” refers to visiting sites without identifying oneself.

Ubuntu

When I was in South Africa, I heard a talk about the Southern African philosophy of Ubuntu: “The belief in a universal bond of sharing that connects all humanity,” or “I am because we are.” I was thrilled to embrace this philosophy as one to teach younger clients about, that would likely be experienced with low resistance. Authentic relationship. And because most of our young clients embrace novelty (a trait linked with resiliency characteristics), threading that interest to a concept that appeals to them can resonate and trigger positive internal states.

Desmond Tutu, the revered spiritual leader of South Africa, called it the “essence of being human.” He said, “A person with Ubuntu is open and available to others … it’s about our interconnectedness … you can’t exist as a human being in isolation … you can’t be human all by yourself … you are connected and what you do affects the whole world … it spreads out … for the whole of humanity … when you have this quality … Ubuntu – you are known for your generosity …” (Tutu, 2008).

The relationship our adolescent and young adult clients have with others can only take root in a solid relationship to themselves. We have looked at helping our clients land inside themselves and develop the “observer self.” By seeing all parts of themselves both online and off, they will be enabled to process internal states and build the Inner Selfie.

(Ubuntu, also a huge operating system on the internet, has been one of the most popular Linux distribution systems on desktop/personal computers and very popular on servers and for cloud computing. Committed to the principles of free software development, the system encourages people to use its free software, improve it, and distribute it).

A “Sense of Community” Strengthens the Ability and Desire to Unplug

The SMA provides information about your clients’ activities and personas in cyberspace, but it does not tell you about their positive virtual communities or the strength of their family, friends, and other supports in their day-to-day physical world. As you work with them with the door to digital experiences now open and they share their lives and struggles with you, you have gathered the essence of those supports or lack of them and their ability or challenges in using them.

I find that overall, the stronger the positive social ties are both online and IRL, the less difficult it is for younger clients to unplug without high anxiety or compulsive behaviors being obstacles. In my observation, the less strong these ties, the greater the difficulty in unplugging from cyber connections.

Still, there are certainly cases where this is not true. For example, a young high school client, David, who has grown up on gaming and role-playing sites, seems to have strong family ties and many friends but has moved from healthy use to compulsive use in terms of the amount of time he spends online. But stronger positive social connectedness usually reflects more developed ego strengths and a willingness to try ways to unplug. In David’s case, he cooperated with a structure he could handle and with an intentional commitment to stay with it during school days.

Promote the Benefits of Unplugging and How to Do It

The Plan Has to Be Intentional: This idea is proactive and self-initiated. It does not mean losing a charger, leaving it somewhere by mistake, or an externally enforced restriction by a parent, school, or activity.

The User Chooses the Amount of Time to Be Unplugged: If it is intentional, your clients decide the length of time to be unplugged. Some may only be able to stay away for 15 minutes to an hour, and some may be able to last longer. Those who may be experiencing “cyber-fatigue” are often willing to try longer periods off without checking in. Sometimes this longer period of time does require an “excuse” like their device “running out of juice” or “misplacing it” so they can handle the pressure from online social media sites that they feel demand immediate responses or face rejection. Whatever they need to do to tolerate their time offline, support it.

Unplugged Can Mean Turned Off or Silenced, Out of Sight, Airplane Mode, or Periodic Check-Ins: Unplugged sounds very definitive as in being completely off, but there are actually many ways to unplug. For some of our clients who are being intentional for the first time or who are highly dependent and compulsive in their use, making an intentional plan to check every so often, like between 15 and 30 minutes but not in between, is a new concept. At first they may report a desire to check before the time they have given themselves, but since it is their own intention setting the parameter, it becomes easier for them and they may find that they can extend the time more easily.

Concrete Benefits to Unplugging: Discuss some of the benefits listed here and others that might be specifically relevant to your client.

Clients will establish opportunities to:

set clearer digital boundaries and feel more in control;

become more productive (off and on-line);

have greater focus with a clearer head;

remind yourself of how nice it is to spend time with people you love;

experience better, more restorative sleep (without the electronic undercurrent);

be surprised by the lowering of stress and anxiety; and

enjoy nature, being creative, and giving yourself (and others) your full attention.

When Not to Unplug: Yes, there are actually times to encourage your young clients to stay connected to their digital life.

When their positive social communities on social media sites or FaceTime alleviate or reduce feelings of isolation, loneliness, and despair; or connect them to loved ones far away who are not accessible in real time. It is also important when they need affirmation when internal states feel shaky and no one is available in real time. This level of connection is supplementary and does not take the place of encouraging their growth and development in real time in the form of such things as internal reflection and real connectedness with others.

Being connected online with their mobile devices at their side is part of their life and it keeps them current, in touch, and accessible. Cyberspace reality is part of all of our daily lives, and it is here to stay. In the right amount, for the right reasons, with positive learning, social connections, skills, and experiences, cyberpresence is a good and essential part of all of our worlds.

Balance, Balance, Balance: How do you know if your own life is in balance with your cyberpresence and IRL? This discussion of community and unplugging applies to every one of us, but our younger clients need our guidance and continued support in how to navigate. We therapists need to look at our own SMA, time spent online, levels of anxiety and stress associated with being plugged in ourselves, and practice intentional time off as well. It is a challenge for us all. In some ways, perhaps, we may be “recovering cyberspace dependents” who model what we have overcome as we help our clients do the same. Let’s go for “cyber-interdependence” that is the ideal relationship – the rapprochement and acceptance stage noted in the “Seven Stages of Attachment.” This stage is where intentional unplugging happens because we know it is vital for our well-being and our interconnectedness with others in real time.

The National Day of Unplugging: In 2009, a National Day of Unplugging (every March 6th or 7th), was established and is sponsored by The Huffington Post. Inspired by the Jewish tradition of turning off electronics and abstaining from work from Friday sundown to Saturday evening, the public is encouraged to take this time off from electronic devices. Participation has grown with each year.

It is recommended that people make specific plans for activities that can be experienced without mobile devices or computers, even replacing the GPS with a map. The Huffington Post folks suggest that we finish the sentence “I unplug to … ” on a large piece of paper. I did this exercise with a local group of adults and youth with interesting results. Some found that sleeping, driving, and maybe eating were the only options they could think of to fill in the blank.

We can ask our clients to reflect on and finish the sentence too. Some will have a very limited number of ways to complete it at first. The goal is to practice intentional time off-line, which doesn’t include sleeping!

Therapeutic App: The ability of your clients to develop their capacity to unplug in different ways, from an intentional position, promotes the therapeutic goals of self-regulation, healthy boundary formulation, and the mastery of developmental tasks. Helping them recognize the benefits of attaining these goals while supporting them as they do it, creates the springboard for growth and well-being as they continue their journey. They are now aware of their cyberspace personas, parts, and behaviors as well as those IRL. They are aware of cyberpresence as differentiated from social connectedness IRL and how sincerity and trust can be circumspect on both sides of the cyberspace communication chain. Threads of authenticity and honesty can be found there, but the best place to practice and experience them is in day-to-day life – offline with others and by themselves.

Conclusion

As you work with your adolescent and young adult clients, you will begin to feel how instrumental you can be as you recognize your client’s entire world, starting with the opening door of the SMA and your decision to see them in their wholeness, including both online and offline behaviors, their experience and presentation of themselves, and their complex internal states. You will have assessed their relationship with their mobile device in terms of stages of attachment. You will have evaluated the hypnotic phenomena they experience online to synergize with therapeutic goals using trancework, both direct and indirect, in your office. You can use cyber-friendly language with ease in “trancettes” or interspersed elsewhere in your work. As you sit with your adolescents and young adults, you will bring your whole “self” into action, using all the tools in your therapeutic toolbox. From bringing in hypnotherapy as the lens to ego-state work, to CBT mindfulness training, and many other ways, your unique expertise and knowledge are your artist’s palette, allowing you to move with your client gracefully, courageously, and effectively.

And your client? He or she will have had the profound, perhaps life-altering experience of being both seen and heard. The Inner Selfie – the central resource for the adolescent/young adult client – will have been found, consolidated, encouraged, and nurtured. The road of personal development will now include many new resources that will continue to develop and evolve, as they call on their Inner Selfie to reliably navigate the complex world they (and we) live in, both online and off.

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