Thursday, September 4, 2008

Another Use for Words

Elizabeth Zelvin

This mystery writer has a secret identity. Am I Wonder Woman? Nope. Outrageous Older Woman? Got the T shirt, but that’s not it either. In the world of mental health professionals, I’m known as LZcybershrink. That’s the monicker by which I do counseling and therapy online with clients all over the world on my eponymous website, I’ve got that T shirt too. On the back, it says, “Shrink online…grow online.”

I started doing this work eight years ago, after fifteen years as a clinical social worker, psychotherapist, and director of alcoholism treatment programs in New York. New York City is a therapy-rich town. Walk out the door and spit, and you’ll hit six therapists. So there’s a lot of competition for clients who sound a lot like Woody Allen. Since I went online, I’ve treated folks who would never have walked into a therapist’s office in their communities: the stutterer, the 400-pound compulsive overeater, the farmer’s wife whose husband is drinking again, the flasher, the rape survivor, the gay guy and lesbian in the military. I’m the only shrink in Manhattan who’s had a client in crisis because her pregnant horse got cancer. I’ve helped a lot of people by doing exactly what I do as a mystery writer: sit down at the computer and let those fingers fly.

Online therapy is a brand new field. It attracts a lot of skepticism, especially from the older generation who grew up without the Internet. How can you connect with people if you can’t make eye contact and hear their voices? How can clients express themselves and convey authentic emotions through the written word? I hope every writer and avid reader can answer that second question. Did Shakespeare convey authentic emotion in King Lear? I think so. My two professions have a lot in common. Both use the medium of the written word expressively. Both are all about connecting with other human beings on an emotional level. And both are careers about which everyone says, “Don’t quit your day job.” ;)

So what do we substitute for visual and aural cues? For one thing, the smileys, emoticons, and acronyms that already form the common currency of Internet communication. As I explain to clinicians for whom I provide online training in online practice skills, these can be more nuanced than you’d think. As an office-based traditional therapist, I would never have winked at a client. But I can use a winkie to soften a hard truth when I think a client needs “tough love” or to add affectionate irony to what I say. The client can get mad at me safely by adding LOL to a critical or even hostile comment. That simple ;) or LOL can mean, “You said it’s okay to get angry, and I’m taking the risk of expressing my anger to you. But that doesn’t mean I’m about to quit therapy.” And see how I used the winkie in the line about “Don’t quit your day job” (above)? In that instance, it means, “Hey, I’m kidding—and not kidding.”

Beyond word choice and Internet shorthand, I’ve found I can connect with clients over time by developing shared vocabulary and an intuitive grasp of how each one uses text and pauses to convey resentment, sadness, humor, sarcasm, and a host of other subtleties. In other words, what mental health professionals call the therapeutic relationship springs to life in a chat room just as it does in a therapist’s office. As for clients who work with me by email, some folks naturally dig deeper in narrative, in reaching within and taking time to tell their story than they do out loud in the moment—as every writer knows.

Personally, I have an additional advantage. As all who’ve met me know, I’ve demonstrated face to face at Malice, the Edgars, MWA and SinC chapter meetings, and my recent book tour, and online on mystery venues including the MWA and Sisters in Crime lists, DorothyL, CrimeSpace, and Murder Must Advertise, that I was born to schmooze. My, um, intense and lively personality comes through whether I’m there in person or keyboarding my way through cyberspace. And please note that well-placed “um.” What was I telling you about the statement it modified? That’s a pop quiz: you can participate by posting your answer as a comment. My husband likes to tell people that every time he passes through the room, I’m smiling at the computer. Not really. I’m smiling at whomever I’m talking with in text.


Rhonda Lane said...

Online therapy may be the only answer for people living in rural areas in which the choices for counseling can run from slim to none.

Even in that circumstance, though, have insurance companies accepted online counseling?

Still, keep up the good work, Liz. You've helped a lot of people.

caryn said...

What an interesting blog topic Liz! I don't know that I would choose to do therapy online, but as Rhonda said, for some it may be the only alternative.

Elizabeth Zelvin said...

Rhonda, online therapy is so new that insurance doesn't cover it. On the plus side, clients and therapists don't have to deal with managed care. Caryn, online therapy is for those who prefer it as well as those who have no choice. As the generation that grew up on the Internet gets old enough for therapy, this way of getting help and support will be comfortable and natural for more and more people.

L.J. Sellers said...

That well-placed "um" means you're using a euphemism or perhaps putting a light spin on your description of yourself. Okay with me. I too am "um" energetic and socially engaging.