Technology is rarely used in day-to-day therapeutic work or in therapist training. As a result, some therapists can feel undermined by technology. Any technology that is introduced needs to complement their existing work practice; it must not take too much time, given typical busy schedules.
While little technology has been used in the area to date, there are undoubtedly many opportunities, particularly in the development of systems that are relevant to younger people and at-risk groups such as young men.
When we were designing systems for teenagers to use between and during therapy sessions, we needed to consider two very different environments and two very different levels of engagement.
Inside Session. While in a therapeutic session, there are few competing demands on the young person’s attention, teenage clients are notoriously reticent and difficult to engage in face-to-face discussion about their feelings. This makes it extremely important to approach young people using materials with which they are familiar and comfortable. In this setting, technological interventions may provide more appealing alternatives than face-to-face conversation alone. One therapist remarked, “When children come to the clinic… they frequently refer to computers and technology.” Indeed, in most cases we have found they were more comfortable using the technology than the therapist, leading to a degree of role-reversal and empowerment that can be positive for the client.
Within a session, providing some control to the client and bringing a new focus into the situation can help to reduce the level of tension and support a less confrontational interaction between the client and therapist. Systems may also provide clients with ways to express emotions and feelings without losing face or appearing weak. During evaluations of the Personal Investigator computer game, therapists reported that some clients were more comfortable talking with the thera-
From the beginning, it was clear to us that a practical approach was essential. Teenagers and clinics cannot afford special devices or high-end computers. In fact, high-tech devices are more liable to attract the attention of peers. In order to ensure that our work could carry over to actual practice, we designed for mobile phones and basic desktop PCs already in the pockets and homes of young people.
Photograph by Grant Jones
Mobile phones remove the need for special equipment: Users are already familiar with their phone, and using it in public places would not attract extra attention. Most important, as most teenagers carry their phones for most of the day, it could provide them with near-constant support when and where they need it. This was evident in the Mobile Mood Diary (see the accompanying sidebar), which significantly increased the amount of mood entries recorded by young people.
Mobile Mood Diary is based on an established paper-based mood charting exercise in cognitive behavioral therapy. Therapists often ask clients to complete paper charts but compliance is low, they provide unreliable information, and involve added administrative time. A mobile phone mood diary was developed through a collaborative process with therapists.
A psychologist who used the diary in clinical situations remarked, my “client was particularly thorough in their use of the mood diary and this meant that a comprehensive log was maintained for interventions during sessions. I have worked for 20 years in the field and never got such recording compliance.”
Sample mood diary entries include:
“I feel terrible . Week nd dizzy . No sleep” “very bad i want 2 die now or run away” “Why do the meetings always end when i feel were building momentum”
“Tired but happy and refreshed.”
pist while facing the computer. In these sessions, the teenagers generally controlled the mouse and through navigation of the 3-D space were able to control the pace and direction of the therapeutic session [ 2].
While short-lived novelty
factors may be of little use in
[ 2] Coyle, D., Doherty, G., Matthews, M., and Sharry, J. “Computers in Talk-Based Mental Health Interventions.” Interacting with Computers 19, 4 (2007): 545-562.
November + December 2009
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