Contemporary Technology and the Therapeutic Frame

Unfortunately, Dr. Trub and I have been facing an obstacle in the completion of the study, due to the delayed transportation and installation of necessary cameras into the nursery at Pace’s McShane Center. Because this study is rooted in the observation of dyads and the coding of their behavior, we cannot proceed until the cameras are installed. So, for this post I will be blogging about another study I am working on with Dr. Trub.

This is a qualitative study which will explore the impact of contemporary technology on the therapeutic frame. The study will be based on semi-structured interviews with clinicians from various theoretical perspectives. For this study, I will be coding, transcribing and analyzing qualitative data. In a later phase, I will also be trained to conduct interviews. The study has been approved by Pace’s IRB and we will begin interviews by the end of the month, so there will be more material to write about and present at the conference at the end of the year.

The therapeutic frame is the context in which therapy takes place (i.e. the time, place, the method in which a therapist and patient schedule appointments, or how much personal information a therapist makes available online). What is referred to as the “therapeutic frame” is not uniform. Each clinician, regardless of theoretical orientation, has different ideas about the best way to facilitate effective therapy.

As I mentioned above, we are asking “where does contemporary technology fit into this?” Clinical psychologists make active decisions about maintaining aspects of the therapeutic frame. With changes in communication technology (email, cell phones, social media), the therapeutic frame may be changing as well.

Only a few years ago, many therapists could only be contacted by their office number. Now, a patient can potentially reach a therapist at any time of day (i.e. sending an email or leaving a voicemail on the therapist’s cell phone) and therapists must make active decisions on how to navigate these situations.   

What you know, or think you know, about your therapist informs the way you view them, stirring up judgments, fantasies, and attitudes about who they are and what they believe. In psychodynamic psychotherapy, these transferences — these transferred emotions and assumptions — are thought to be facilitated through the therapist’s anonymity. Contemporary technology (like Google searches) may allow patients to disintegrate the therapist’s anonymity. How does this play out in therapy? Our goal is to explore how today’s therapists navigate these contemporary challenges in maintaining the therapeutic frame.

Mindful Messaging Blog #4

I

My previous blog post discussed the qualitative data retrieved from Mindful Messaging. I attempted to analyze the shifts in usage of its compose message function and discuss the potential processes behind message editing. The data collected was small but hopeful – many users used the compose message function, drafted texts, and edited them or chose not to send them. I also discussed the motivated responses users had when asked to reflect on the part of their lives in which they most desired to increase mindfulness. So we found it surprising that users did not use the Compose Message function more often.

We came to the conclusion that many people have their phones set as not to receive notifications from their apps. Furthermore, the only way to access the message composition function is by opening the app. In order to catch users at the moment of impulsivity, we need the Compose Message tool to be more accessible. We are currently looking into creating a text messaging app so that users will be able send a Mindful text as quickly as they would a normal text.

Through the analytics service, Mixpanel, I have gained some insights on usage. The past month can be used as an example. There was a steady decrease from compose, redraft, and send, as was predicted. This data shows that most people decided to edit their messages, either its content or tone, in order to have a more effective text message. Only ⅓ of the original number of composed texts were sent – contrasting with the data I analyzed in my last post, in which users more often than not sent a message after the drafting process. Indeed this is a completely different batch of participants. In March, we saw 21 new participants begin using the app.

Approximately 70 people have used Mindful Messaging since our launch in November. In February and March we see some of the highest number and frequency of users pressing the “Let’s Begin” button –

  • Each of the 36 users visiting the app (21 of which were new) pressed “Let’s Begin” an average of 8 times throughout the month (December saw the highest at 12 times with 29 unique users)

  • The “Let’s Begin Button” was pressed 283 times in March, increasing 99.3% percent from February.

  • In March, 113 new messages were drafted and only 57 of them were sent.

  • In December, 112 new messages were drafted and 85 of them were sent.

 

The batch of participants using the app really makes a difference in our statistics. This is illustrated by the steady changes in statistics from month to month. The best comparison to illustrate this is December and March because coincidentally 29 users began the app in each month. In December, 17 unique users drafted 112 new messages and 85 of them were sent. In March, 12 unique users drafted 113 new messages and only 57 of them were sent. An explanation for this could be that by March, the app developed a steady group of participants who used the app, long after the 21 days, to revisit lessons and use the “Compose Message” tool. These veteran Mindful Messengers may have been more likely to use the app to draft more texts and send less of them than the less experienced users in December.

II

When users complete Mindful Messaging, they are asked to complete a follow-up survey which is almost identical to the one given prior to using the app. The survey consists of a number of established measures with high validities we believe relate to texting behaviors. We look to find correlations between measures assessing: attachment style, emotional regulation, risky texting behaviors, and mindfulness, to name a few, with texting behaviors. In addition to these measures, we ask follow-up questions about the app. Here, I will take a close look at some of the preliminary data gathered from 15 users who began using the app between February 20th and 29th.

We asked users what their biggest challenge was using Mindful Messaging. At least two or more users mentioned each of the following: not getting alerts about the Night Reflection, not remembering to use the Compose Message tool, finding the meditations repetitive, and difficulty keeping up with using it everyday (which was mentioned by 5 users).

“The biggest challenge is trying to pause and think about my text before sending it. Texting allows me to send a message quickly, but when I have to pause to think about it, it seems so counter-intuitive and I find it hard to stop.” This response illustrates a conflict that is probably challenging for many users. People are drawn to this app because they want to increase intentionality in their texting behavior, but part of texting’s lure is its instantaneous nature. And users may feel pressured by their peers’ texting styles, finding it hard to text less instantaneously, less often, or whatever change it may be. Users may also view practicing mindfulness in texting as a black and white endeavour, feeling discouraged when they cannot always use the Compose Message tool, or when intimidated by the length of each lesson. Maybe part of this issue with speed in sending texts, as mentioned above, simply has to do with the inconvenience of having to go through the app in order to send a mindful text. The Compose Message tool may simply be inefficient, considering many people can check the weather by clicking on an icon. Another user suggested a separate app to replace their phone’s current texting function.

In response to being asked what changes would better the app, a few requested an option for longer meditations, lesson length options, and more varied guided meditations and practices. If the first two ideas are implemented, the app would be more appealing for a wider range of users. I would imagine an app which is not structured enough would not make a good practice for mindfulness, but at the same time the structure of this app is not written in stone. One user commented, “maybe some sort of maintenance plan for after you finish the 21 days.  Structure would help me continue easier.” This user commented that the Night Reflections and Practices became repetitive doing them every day. Although potentially more avid than most, this user brings up a good issue with the structure of the app. In anticipation of users like this, we could implement additional alert functions for the messaging tool and meditations and, in future versions of Mindful Messaging, including a wider variety of meditations and practices.

Although many participants indicated they felt they did not use the app enough or did not have the patience to compose mindful messages, their responses to another question is highly positive and in a way contradictory. When asked in what way they found the app helpful, users’ responses varied from being more aware of others’ technology use to “helping me put away my phone through boredom.  Not turn to social media for a lift. Helping me with putting my phone away during projects. Turning my phone all the way off at night.” Some users even noted that it helped them in their close relationships – one user reported reducing instantaneous venting and another reduced their use of profanities. Yet another reported being more aware of his/her general technology use. With each of the 15 users indicating personally specific changes in behavior, I find this preliminary self-report data successful. As noted earlier, these highly self-aware and introspective responses seem to contrast with users’ views on their persistency using the app. It could be that users are not completely aware of their progress. But given the app encourages users to think about how their behaviors have changed over the course of the 21 days, I find it more likely that they have a high standard for themselves in increasing mindfulness. In assessing future data we will look deeper into the comments and concerns voiced by this group, finding patterns, and getting a better idea on how to make the app more useful.

Mindful Messaging Blog #3

Since my last blog post, 26 people have been recruited to use our app for pay – 17 of which are still busy completing each day of the app. Dr. Trub and I have been using Mixpanel, an analytics service, to track our participants’ use of Mindful Messaging. Using Mixpanel, I have been able to view our users’ responses to questions we ask about the app as well as their drafted, sent, and unsent messages that go through Mindful Messaging’s text message composition tool. In this blog post I will be analyzing this preliminary data.

At the end of day 1, users were asked to focus on the definition of mindfulness – “setting an intention, being in the present moment rather than allowing yourself to be distracted, and not judging any feelings or thoughts you have” – and to rate their level of mindfulness on a scale of 1 to 10 during eating, socializing in person, daily commute, being in class/work, working alone on an assignment/task, and use of their phone/ipad/etc. Almost all the users’ scores varied drastically between each category, suggesting an awareness of the presence (or lack of) mindfulness. In other words, users already had an idea of where in their lives they felt most and least mindful. I find this exercise to be a great way to prompt users to think about real-life applications of mindfulness and to view mindfulness as something that affects their lives outside of 5 minute guided meditations.

I believe this preliminary question also helped evoke a strong response to the proceeding task – to reflect on the part of their lives in which they most desired to increase mindfulness. There were many specific and powerful responses to this question (for example, “I would love to be more mindful when dealing with situations that leave me fearful and anxious.”)Many of the responses reflected some of the applications for mindfulness mentioned in the previous question, like being mindful while completing a task or while eating (a very common response), but by far the most common response had to do with bettering communication, whether by text or in person. Some users expressed a general desire to be more mindful in their relationships while others recognized specific instances in which they are least mindful: “I want to increase my mindfulness when I have drama in my life, because then I will think more clearly and know what to do next in a situation.” I could not be any happier about this response. The aim for having a mindful texting function imbedded in the app is to allow users to reflect on their current emotional state, imagine that of the person to receive the text, imagine their response, and have a chance to edit their drafted text.

The first quote mentioned above, although not necessarily referring to an interpersonal situation, anticipates the way in which many users chose not to send texts when using the messaging tool. Some users, after recognizing their current mood, decided not to send texts (which often contained positive or neutral content), for example: “Hey baby, how is your day going?” This person indicated they felt “stressed/frustrated” and that the person to receive the text would feel “indifferent” about it. I believe our mindful text messaging tool allows users to act (in a new way) without necessarily sending a text. A user can really feel what it would be like to send a text, have a moment to reflect on their motives and the apprehended reaction, and decide whether to proceed. Viewing one’s thoughts from a new perspective can help create more meaningful and useful texting habits. In this previous quote, suppose the user simply wanted to a reminder that his/her significant other is there as support in a time of stress. He/she felt like texting that person simply to be replied to. Now suppose the significant other was on the subway or at a meeting, the user would be waiting for a text and anticipating a kind of gratification. Maybe by using Mindful Messaging to draft this text, the user would take a moment to reflect, think of his/her significant other and the support they usually offer, and be solaced by the thought.

 

Mindful Messaging App Survey – Blog #2

Currently, Dr. Trub and I are working on accumulating a large amount of data from the Mindful Messaging App Survey. We have been trying to get as many eligible participants (between ages 18-29) to take the survey, using social media, word of mouth, and mturk.com. To encourage participation, all participants have the chance of winning one of three $75 Amazon gift cards.

The survey consists of a number of established measures with high validities we believe relate to texting behaviors. We look to find correlations between measures assessing: attachment style, emotional regulation, risky texting behaviors, and mindfulness, to name a few, with texting behaviors.

In order to create a reliable survey, the factors we created were cross-validated by results from two sample groups. In this final survey, we’ve included established scales with high reliability so that when we can prove that our measures are reliable. While developing our measures, we kept in mind the themes discussed in the app for inspiration. For example, I would think, “What factors contribute to texting while driving? Maybe a desire to stay constantly in touch, maybe impulsivity.” Through this process we began to slowly formulate questions that tap into behaviors (texting to escape negative affect, texting to express feelings, texting to find companionship etc.).

I hope that once done collecting and processing the data that we spark a discussion amongst scholars and fellow researchers. This survey does not seek to simply define an individual’s texting habits, but instead what factors prompt the texting behaviors of individuals.

 

Mindful Messaging

Mindful Messaging. The goal of our research is simplified to these two essential words. We want to bring the highly beneficial practice of mindfulness to the omnipresent practice of sending text messages. Texting is part of the way we interact with people be it colleague, family member, or love interest.

There are many risk behaviors associated with texting (such as texting while driving and sexting) that have potential for serious repercussions. We believe that much of our normative texting behavior, let alone texting behavior that could be risky, is not frequently subject to mindfulness. It is easy not to be fully aware of one’s state of mind when sending a text.

We look forward to seeing a correlation between mindfulness and use of the app. Our goal is to figure out what population will gain the most from using the app and to follow their progress as they learn more about mindful texting.

Through an increase in general mindfulness, we expect users to become less impulsive, more conscious of their motivations to text and its effects and thus maybe even increase relationship satisfaction. We also expect to see a substantial drop in risk behavior associated with texting.

Conducting this research I came to realize that even I, the self proclaimed mindful texter, was not as mindful of my texting motivations as I had liked to believe. The realization came to me through the course of a month working on the app. This is the kind of experience we hope our users will experience.