Britain’s therapists have been busy over the past six months. In the weeks that followed the EU referendum, there was barely a client who didn’t kick off with Brexit. Some wanted to express feelings of disenfranchisement and anger, alongside guilt for not having done more to convince others of their opinion. Others, who had struggled with feeling excluded or rejected in the past, felt alarm bells ringing again. As one therapist blogged last summer, “External events can often trigger deep-seated feelings of anxiety” – and this was one hell of an external event. Other arguably bigger events have followed.
The conversations that take place in the consulting room are critically different from the kind you might have with a neighbour, friend or relative. There are no nods, no groans, no knowing smiles; that’s not the way most therapy works. Sigmund Freud was the first to argue that a therapist needed to be a blank slate, so that a client could project their feelings on to them, a process called transference. These feelings can then be acknowledged and talked about.
But Freud lived decades before the internet. Online searches and social media mean clients can now unearth myriad personal details about their therapist – not just whether he or she is married, but whether they have children, sign petitions, share photos, supported Leave or Remain. This has turned some clients into quasi-stalkers, not unreasonably: if you are expecting someone to help sort out your life, you might well want to see what they’ve made of theirs.
Pam Custers, a couples therapist working in London, tells me she is scrupulous about her neutrality. Recently, she has been aware that some clients want her to drop the barriers, to talk about world politics and how it is affecting them; but she is careful about what she writes or posts online.
A therapist might be divorced, or of a particular religion – such things can resonate deeply with certain people
“I find myself censoring what I put out there. I would describe my approach as extremely mindful – not paranoid, I hope – about taking certain positions. So I have set my Facebook settings as high as they go, and I try to stay neutral on Twitter. But, at the same time, I do worry about having to internalise who I am in the world and how that will affect me.
“It’s a real conundrum for us therapists. We want to have opinions, we do have opinions, but if we express them, some clients may take them as judgments. And I believe people do their best work when I’m a blank canvas.” Custers has a website and is trialling an online relationship-therapy programme, so she is far from a technophobe. “But I was trolled recently on Twitter, so I can see the potential problems. It’s quite a scary world out there.”
Sophia Hilsely, a psychodynamically trained psychotherapist, takes a slightly different tack. According to psychoanalytic convention, she should fend off all personal queries about herself by asking why her clients are asking. “The idea is that you want to heighten anxiety, to get through to the subject.”
But this is something that fewer and fewer clients are happy with. “Most people now want solutions immediately,” Hilsely says. “I will share some things with some people.” For example, she wears her wedding ring, and notes if and how clients react. Her directory profile also informs them that she has a law degree, has lived in the US and Europe, and has worked for the civil service.
Many clients won’t settle for such scraps of information. Aaron Balick, a relational therapist based in London, wrote what he believes was the first-ever clinical paper on the effect of being discovered on Google, and then followed it up in 2013 with a book about social media, catchily titled The Psychodynamics Of Social Networking: Connected-up Instantaneous Culture And The Self.
“We can’t predict under what conditions people will Google their therapist,” Balick tells me, “or how what they find might unconsciously affect the relationship. Hot topics are very individualised. A therapist might be divorced, or have one child, or be of a particular religion – such things can resonate deeply with certain people.”
So Balick teaches therapists how to keep their professional and personal personae separate and secure. “The boundaries are more permeable now; it’s difficult not to give something away. Some are less worried about it; others are very strict. With an issue like Brexit, client and therapist can be on opposite sides of the divide, but you have to be able to talk about it. That doesn’t mean saying how you voted, but I’d say most therapists give a bit away.”
It’s hard not to. In Glasgow, a female therapist who offers post-abortion counselling, and who wished to remain anonymous, tells me she has been burned by Google search. She was invited to speak about her work at a Scottish university; afterwards, a student journalist contacted her to ask if she was the person of the same name who had posted comments below a feature about abortion on the Glasgow Herald website. She asked for clarification, but the student paper ran a story linking them to her anyway. “If a client saw that article, by Googling my name, they would conclude I was judgmental about abortion – and there is nothing further from the truth. As a therapist, you want your clients to know that you are there for them and you are not going to judge them.”
Even Freud fed his patients, sold them paintings, gave them dogs. He went to see the mother of one, saw one dance
In a city with a history of sectarianism, she aims to be neutral. However, because she is involved in refugee work at a local school, a project that has a digital footprint, it’s easy to work out her religion and that she has children. She’d prefer greater anonymity. “It gets in the way. It puts up barriers. You learn not to respond to any of the usual signals [from clients] – Rangers, Celtic, the different schools – because you have to manage what they know about you.”
Many therapists blog about mental health or current affairs to help them stand out from the pack. As Martin Pollecoff, chair of the professional therapy body, the United Kingdom Council for Psychotherapy, points out, some of the best-known psychotherapists in the UK, such as Susie Orbach and Stephen Grosz, write extensively about themselves and their work. “Freud’s idea of the blank screen was a cute one, but even he never did that. He fed his patients, sold them paintings, gave them dogs. He went to see the mother of one, he went to see another one dance.”
Therapist Philippa Perry makes TV and radio programmes, and writes an advice column for Red magazine. She doesn’t bury her opinions or her personal life – she has 21,000 Twitter followers and is often photographed alongside her artist husband Grayson – but then, she no longer sees clients privately. “If your online presence puts potential clients off, so much the better: you probably wouldn’t get on anyway,” she says. “I’m not going to compromise who I am outside the therapy room. But inside it, I am there for whoever has signed up to work with me.”
She believes that people should use technology to inform prospective clients about how therapy works, and what they personally have to offer. “In order to find a therapist, you probably need all the information you can muster. Being a blank is not my way. I’m for transparency.”
How much do clients want or need to know? I spoke to a woman in her late 20s who told me she’d used Google to start her journey into therapy. “I contacted two therapists and then, based on their responses, met with the one who seemed the best fit. After that meeting, I Googled her. She has a website but she’d also written some articles about her own mental health. I didn’t want a therapist who would be preaching from on high; I wanted them to be able to relate. From what I read about her, I felt she would.”
Since then, she has stayed away from Google. “To be honest, I am not sure now that it is a good idea to know too much, so I haven’t done it again, but when making those first tentative steps, it helped.” As she says, it’s the way we now approach many initial meetings, from work contacts to first dates.
She has blogged about how she felt to be without her therapist over a summer break. Coincidentally, her therapist wrote about the same thing, from her own perspective. “We didn’t know that the other was doing it, and at first I did feel it was a bit bizarre, like an unsaid dialogue.” It would have been easy to read a lot, or too much, into it. “To start thinking: is she trying to say something to me? I prefer that now we meet every week, and it is what we say when we are face-to-face that is important.”
If clients shouldn’t Google their therapists, a therapist shouldn’t look up a new patient, at least in theory. The idea is that they should know only what the client brings to them; anything else will muddy the water. “The relationship is what’s created between the four walls of the consulting room,” says Nigel Dawson, a therapist based in Manchester. “To be influenced by other routes is damaging – to the client and also to the effectiveness of the therapy. I might find out information they hadn’t disclosed to me, and it might affect my opinion of them.” Also, as Perry points out, it might not even be true.
One therapist Googled a client who said he had a grand job, and he did. ‘It helped disentangle my disbelief’
Privately, some psychotherapists will admit that they have Googled clients. One female therapist told me about one client: “He was quite disturbed and I found some of what he told me a bit fantastical. He was paranoid, but I also thought my response to him might have been counter-transference [in other words, that she was responding emotionally to him]. He claimed to have a grand job in a big company. So I looked him up – and he did. I felt it was an excusable use of Google. It helped me disentangle my disbelief.” Another told me she might do an online search if a name seemed familiar, or if she had concerns for her safety.
Technology has transformed the way therapy can be delivered: by email, phone, video, options that some clients find easier or cheaper. Most therapists I spoke to offered some online counselling, though usually only to clients they had already met “in the room”. There are myriad support groups and mental health blogs. One therapy client, who as Life In A Bind blogs about borderline personality disorder, has had 14,000 people read her most popular post, about obsessive attachments. She sends her therapist a link to her posts, “but I’m very clear that I don’t want to communicate with her in writing when I should be telling her in person. So quite often I blog about things we’ve already discussed. The real strength of it for me is the community – the feeling that I’m not alone. But sometimes, reading other blogs, means I compare my treatment with theirs. I tend to want to live out my therapy through someone else’s story, which is not good. Equally, there’s a danger in relating to another therapist whom I met online. I tend to go to him when things are not going well with my own therapy.” Her regular therapist has warned her against this.
Therapy is not friendship, but the lines are just as easily blurred in the digital age. Some therapists give clients contracts that help them negotiate potentially tricky areas, such as whether they will acknowledge you if you happen upon them in the street. But what if you bump into each other on a dating site? Or find out more personal details through a friend’s Facebook connection? As Pollecoff says, “I’m 67 – my indiscretions were done in the dark. Dating is in the light these days. And you’ve got the whole James Bond life of trying to appear marvellous on Twitter and Instagram, too.” He recalls one client who spotted an ad he’d placed on a community noticeboard about wanting to buy a dinghy when he was living in Wales. “In the middle of the session, the chap says to me, ‘Are you still looking for a dinghy?’ It seemed creepy. I thought he was saying to me, ‘I know stuff about you.’”
On the day I speak to Pollecoff, he is off to see a client’s exhibition, but he is clear about where the lines are drawn. “I was invited. A client often wants you there, alongside them. I’ve been asked to give away the bride, and I will do that. I’ll be at the ceremony, but not at the reception. It’s never social.”
The digital age has given people access to more information and support, while eroding many of the strictures that surround a peculiarly formal relationship. Will a traditionally private practice continue to open up, in a blaze of light-filled expansion, or will the professionals be pushed into a monastic silence? For the “talking cure”, that would be ironic.
• Louise Chunn is the founder of welldoing.org, an independent directory of psychotherapists and counsellors.
Search me: should you Google your therapist?
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