Do You Google Your Shrink?

Why should your mental well-being be different from every other aspect of your life?

In fact, what makes you think there is any difference? JL

Anna Fels comments in the New York Times:

Patients’ electronic histories follow them everywhere — and so do doctors’.

I knew my psychiatric practice was forever changed the day a patient arrived with a manila folder stuffed with printouts and announced that it contained the contents of a Google search that he had done on me. He pulled out a photo of my mother and me, age 7, that had been published in my hometown newspaper; architectural plans for an addition to my house that was never built but apparently was registered locally by the architect; an announcement about my great-grandfather’s becoming editor of Amazing Stories magazine in his old age; and my brother’s history as a college activist.

I’d forgotten that many of these documents existed, and there were others I’d never seen or heard about. My patient knew things about me that I didn’t know.

Photo

Credit Ruth Gwily

In psychiatry, there’s a long tradition of viewing any personal information about the therapist that the patient stumbles upon as “grist for the mill.” In other words, it’s material that can be processed in the treatment just like any other experience or dream or recollection the patient might have. (A colleague of mine once asked her psychoanalyst why his head was wrapped in gauze, only to have him reply, “What are your fantasies as to what it might mean?” She never got a straight answer.)

But after a few minutes of listening to my patient present his findings, I was nearly overwhelmed by feelings both of exposure and of curiosity about his trove. Clearly, this was part of his intent, which would be the subject for many a future session. But I also realized that the relative anonymity of therapists, and all the mystery, power and privacy that attended it, were being swept away.

Patients’ access to huge amounts of information about therapists’ lives can’t help but change both members of the therapeutic dyad. It can have, for instance, a chilling effect on the therapist’s work outside the office. As a psychiatrist who occasionally writes and speaks, I now have to think about the impact of these activities on prospective patients. If I write a feminist article, will I end up with only female patients?

And what about a therapist’s avocations? A friend of mine Googled her therapist and discovered that he was an accomplished singer — intensifying her already romantic and idealized transference. On a later occasion, an Internet search revealed that the therapist had participated in a gay musical event. When she asked him about it, he explained that he was not gay and had been helping out some friends, but it had been a confusing piece of information for her — and, I suspect, for him. Will he feel as free to sing at the next concert with these friends?

The blurring of boundaries between the personal and professional can get quite creepy. A patient told me, in greater detail than I wished to know, about her Match.com date with a psychoanalyst with whom I’ve had professional dealings. It was an encounter that almost certainly would not have occurred in the pre-Internet-dating era, and it will be hard ever to think of him in quite the same way.

Googling, of course, can go in both directions. An emergency room psychiatrist tells me that it’s routine to check out new E.R. patients on the Internet before they are seen — to determine, at the very least, if they have criminal records. “I wonder how we survived without it,” she muses. But more than legal infractions are revealed by such Internet searches; the patient may turn out to be a V.I.P. or someone with an unsavory past. E.R. psychiatrists even check YouTube for patient postings. The experience of evaluating a patient with fresh eyes and no prior assumptions may, for better and for worse, disappear.

Patients’ electronic histories follow them everywhere — and so do doctors’. Patients can now, in effect, blackmail therapists by threatening to post negative reviews of them on the Internet if the doctor does not accede to their demands — whether for medication, hospitalization or special treatment. A supervising psychiatrist at a teaching hospital told me the frightening tale of a patient with a severe personality disorder seen in the E.R. by a psychiatrist who was just starting his practice. The patient threatened to place — and then actually did place — a potentially career-destroying evaluation on a physician evaluation website.

But the impact of technology on psychotherapy is not all bad; it’s even, at times, beneficial. The transparency of information can serve as an antidote to the fusty, authoritarian therapies of the recent past. For some patients, the new access to information about a therapist is liberating. They feel like Dorothy in “The Wizard of Oz,” pulling back the curtain to reveal that the wizard is a mere mortal. Therapists, it turns out, are just folks like you and me. Their authority is not a given, but something to be earned.

Technology can also insert into the often hermetic world of the consulting room a tonic dose of reality, an experience of how the patient actually functions outside the office. My patients arrive in my office and, like gunslingers in a saloon, unload their various electronic devices, laying them on the sofa, often two or even three, before turning them off. But there are times when the phones have to stay on: There’s a sick child at home or the boss may call. Hearing in real time patients’ responses to important figures in their lives gives me an unfiltered glimpse into those relationships. A man who sarcastically belittles his girlfriend to me is surprisingly tender speaking with her on his cellphone. An unhappy, self-deprecating executive is suddenly a confident and even commanding figure speaking with one of his subordinates. An aggressive lawyer becomes shy and awkward when speaking with his mother.

IN some ways, the relentless electronic interconnectivity of our lives serves to highlight therapy’s singular virtues. We are more appreciative of the strange, private dialogue that is the heart of therapy. There are precious few times and spaces left in our society in which people quietly speak to one another in a sustained, intimate conversation. The therapist’s office is one of the last safe places. Secrets, reflections, fears or confusion never leave the room.

And it is also a refuge. My patients often arrive early just to sit in the waiting room — an unusual interlude of quiet. Then there’s the session itself. In some ways therapy is, more than ever, the ultimate luxury: To be the focus of a thoughtful person who is listening, caring and helping to make sense of life’s chaos is something that the Internet can never provide.