Clues From Adolescent Online Activity Can Be Of Value in Therapy

HONOLULU — These days, nearly every adolescent has experience with online social networks such as MySpace and Facebook, but the value of this activity has been questioned by medical professionals.

Some child psychiatrists regard these networks as barriers to normal identity development and maintain that they interfere with genuine social relationships. But at the annual meeting of the American Academy of Child and Adolescent Psychiatry, Dr. Nicholas J. Carsonsaid that online social networks can have positive effects on identity formation and can also provide important insights during therapy.

Dr. Carson, who is at the Center for Multicultural Mental Health Research at Cambridge Health Alliance and an instructor at Harvard Medical School, Boston presented a publicly available MySpace profile of a teenager, and itdescved to be a gold mine (see sidebar). “This is really great content. There's so much [there] about this person,” he said, adding that he'd be “absolutely delighted” if a patient were that self-revealing in an hour-long therapy session.

He acknowledged, however, that there are some good arguments against adolescents' use of social networks. They can expose a child to dangerous or unwanted online contact, for example. And as long as the country is in the midst of an obesity epidemic, it might be unwise to endorse sitting in front of a computer screen for long periods of time.

Furthermore, some therapists have argued that the social networks encourage narcissism, satisfy a child's craving for attention, and promote shallow relationships.

But Dr. Carson argued that on the contrary, online social networks provide a framework for an adolescent's identity formation. For one thing, they promote trust and affiliation by providing a child with new peer groups.

“I have a patient who has PDD [pervasive developmental disorder]. He's memorized the Pokmon characters, and he goes online and he mails the president of Japan when he's unhappy with certain story lines and TV shows,” Dr. Carson said. “And I have another patient also with PDD who really had no friends at her school, but she was the moderator of one of these [discussion groups] for a certain anime series that she liked. I'm very proud of her, [and] she had a lot of pride in herself.”

The anonymity that is an occasional feature of online networks is often criticized for encouraging disinhibition but it can also have positive effects on identity formation. “For some youth, perhaps those with anxiety or depression, being anonymous affords a certain type of protection,” Dr. Carson said.

Blogs, which are essentially online diaries, are conducive to self-disclosure and self-creation. And the concept of “The Long Tail,” which refers to the phenomenon that even someone with highly esoteric interests can find communities of like-minded individuals online, can help adolescents who feel alienated in their physical communities.

MySpace gives its members great latitude in managing the physical design of their pages, and some identity theorists have suggested that this can be seen as the online equivalent of body language and nonverbal communication. Adolescents who construct such a page are investing in the self, forming “identity capital,” said Dr. Carson.

He suggested several ways in which therapists could use a child's interest in online social networks in therapy:

▸ Ask the child about his or her imagined audience. “Who do you think is reading what you post online? How do you think they react to what you're saying?”

▸ Explore the reasons the child posts what he or she does. Are they doing it to rebel, to conform, or to experiment?

▸ Think about how the patient's online postings reveal typical cognitive distortions and defense mechanisms. “You'll see hostility, you'll see self-deprecation, [and] you'll see grandiosity,” Dr. Carson said. It might be possible for therapists to see ways in which patients are missing social cues.

▸ Explore the extent of the child's personal disclosure. A small percentage of adolescents will post their phone numbers, the names of their schools, their addresses, and even sexually suggestive photos. “It's very important to get a sense of what kind of judgment the youth are using in the way they post information about themselves online,” he emphasized.

Although Dr. Carson believes in using online social networks in therapy, he nevertheless injected a note of caution. “Using a computer in the office can sort of devour the whole therapy session if you're not careful,” he said.

Dr. Carson stated that he had no conflicts of interest to disclose.