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.

Blog 2

Since my last blog, three important things have happened. One of our hold-ups has been a technical one — we needed to be granted permission and assistance by Pace to move cameras from one room to the nursery where we will be conducting our study. In our past pilot sessions we used cell phone cameras (through a one-way mirror) and an audio recording device inside the nursery to record the caregiver-child interaction. Aside from the difficulty of sinking the audio and video, there was the fundamental issue that we missed many of the nuances of facial expression when the participants were not facing the one-way mirror. With cameras on the interior of the nursery that capture the scope of the room, we will be able to insure that we do not miss any nuances in the interaction.

The second important thing that has occurred is that we have honed in on a potential scale which we may use to code our observations, the Dyadic Prestressor Interaction Scale (DPIS) which was designed for a study observing the interactions between parents and young children when a stressor (in the case of the original study, a doctor’s visit) was anticipated. We had originally considered the Emotional Availability (EA) scale, but the training process and cost was a roadblock. It is significant that we have found a highly relevant scale, the DPIS, for a few reasons. The scale is based on attachment theory and attachment-based dynamics. This is relevant as the angle through which we are analyzing the phenomena of text-message based distraction is very much inspired by attachment theory. Furthermore, using an attachment-based scale may lead to implications on the effects of this type of distraction on the attachment system of dyads. Another appealing aspect of the DPIS is that it is designed to code the behaviors of bothmembers of the dyad. Many observational scales do not account for both the child and caregiver, while other scales assess the child’s behavior in relation to peers. In reaching out to the authors of the DPIS, we learned that their methods of insuring reliability may be feasible to our own interests — the authors insured reliability amongst themselves and then trained their research assistants to be reliable.

The third important thing that has happened is that our study has been funded by Pace. This will allows us to pay participants a small gift for their participation and hopefully help attract more participants!

Smartphone Strange Situation

The Study Defined

Cell phones are a pervasive mode of communication, indispensable to professional and social life. Professional and family life is often not entirely inseparable and it is commonly recognized that the presence of cell phones may at times muddle the two. Our study is focused on examining the immediate influence and effects of parents’ cell phone usage on their young children (12-24 months). Through a text-based distraction during free play in a therapeutic nursery setting, we will observe how both members of dyads respond to this distraction.

We will observe dyads’ interactions before, during, and after the distraction, focusing on individual differences between parents, who respond to and manage two competing demands, and children, whose unique temperament will determine a unique reaction.

We believe our findings will shed light on a common phenomenon and expand upon literature on child development in the digital age, leading to practical implications for parents and practitioners.

Change in Pilot Design

From the onset of our pilot study, our general research goal has remained the same — to observe how the parent navigates the competing needs to interact with the child and to respond to the phone, and to observe the child’s behavior in regards to the parent’s reaction to the distraction. Our specific hypotheses are crafted around this general frame of reference.

However, there has been a small but crucial change in the structure of the study. In our first pilot structure, diads would engage in free play before we sent them a text message distraction (we pretended to have forgotten to request certain demographic information). Parents were suggested to keep their phones on for safety reasons, but had no reason to expect a text from us. After the observation portion of the study, we debriefed the parent and asked follow up questions. This study design suggested a number of things.

We felt uncomfortable that in a sense we were tricking the parent in answering the phone. We also felt that there was an implicit “correct” way to conduct the free-play and that parents who answered their phones “failed.” We were also confronted with the idea that, due to the setting, parents might pay more attention to play and turn their phones off.

In our current model, parents are told they need their phones to be on so that they can complete a memory task. This puts parents on a more equal playing ground — it simulates a time in real life when a parent is expecting a text or email and is also engaged playing with the child. This new model also solved our problem with deception — we went from deceiving the parent into answering the phone to simply deceiving the parent about the motivation behind sending them text messages.

There is also a real-life, conceptual advantage to structuring the study in the way we are now. As I mentioned earlier, in the first study, parents may have felt that they did wrong in the eyes of the observers by answering the text message. Indeed during the follow up interview after free play, many parents voiced a sense of guilt on the subject of how cell phones affect their parenting. In restructuring the study model, we approach the subject at a slightly different angle. In seeing the cell phone distraction as an unavoidable, we isolate the way in which the distraction is dealt with. I hope this small gesture will reflect a shift in viewing the distraction presented by the cell phone in less of a dichotomous way, thus opening our view to a larger spectrum of interpretation of our cell phone related behavior so we can deal with it accordingly. Dealing with smartphone distraction accordingly means being aware of the nuances of our conduct.

Mindful Messaging attempts to aid the user in better understanding their relationship with digital media and the potential motivations which lie behind their behaviors. Through education and applied strategies (for example, guided meditations or an interactive text message composition tool), the app aids individuals develop an awareness and acceptance of their behaviors. By doing so, the app aims at reducing impulsivity/high-risk behaviors and increasing personal and relationship satisfaction.

We expect to further our analysis of the data which is constantly in the process of growing in order to better understand the usefulness of our app, the trends of users, its effectiveness in changing behaviors and attitudes, and to understand the population we can help the most, amongst other aims.

We will also use the data from this pilot study to apply for an NIH grant for behavioral intervention so we can study the app amongst a larger population. We will also produce several papers and presentations this data.

We will use qualitative analysis of data collected through Mixpanel, an analytics platform tailored to analyze data from mobile devices and will also run various correlational studies in order to observe changes in the behaviors of users before and after using Mindful Messaging.