Texting: The Third Client in the Room

Dubus (2015) presented a case study example of the utilization of texting in the psychotherapy process with an adolescent female and her father during family therapy sessions. The goals of the article were to highlight generational differences, explore the meaning of text messaging for adolescents, and discuss the utility of texting within sessions. Dubus (2015) concluded with recommendations for future research to enhance understanding of best practice with clients in the current digital environment.


The article noted there are generational differences, including knowledge of popular culture, media events, and age-specific experiences, that can influence therapeutic relationships between a therapist and client (as well as multiple family members during family therapy) in psychotherapy. Dubus (2015) cited Kennedy et al. (2010) to point out that adolescents are “native” to the digital world. In their lifetime, they have been surrounded by digital technology and were born into a world where digital technology already existed. By contrast, individuals of older generations, labeled in the article as digital “immigrants,” may have developed their social identities before digital technology was introduced. Therefore, adolescent clients and psychotherapists or mental health professionals may find themselves on different pages or on either side of this digital divide.


While some studies have warned about challenges related to digital technology, including issues related to confidentiality, others have highlights the benefits. Although she did not provide specifics, Dubus (2015) mentioned studies that have reported “the use of digital communication as an effective treatment venue and as a form of intervention.” However, Dubus (2015) raised some important questions: “What are the rights, responsibilities, and risks for both the client and provider when a client introduced test messaging within the counseling setting?” “For a minor, who has a right to see the text messages written during therapy sessions?” “What are the implications of cell phone use in the counseling room?” and “What dynamics does it introduce?”


Frank (2010) found that nearly 20% of adolescents send more than 120 text messages per day during their school day (as cited by Dubus, 2015). Dubus (2015) discussed texting as a coping skill for adolescents, a way for them to develop and maintain social relationships and supports, as well as a means of connecting with family members.


Case Illustration
Dubus (2015) described a family therapy scenario with a father, Bob, and his 15 year-old daughter, Megan. The background information provided included that Megan’s mother (Bob’s wife) had died of cancer three years prior and that Megan’s brother (Bob’s 19 year-old son) had recently left home for college. Bob and Megan relationship could be described as strained, with Bob describing Megan as “disobedient” and Megan describing Bob as “critical.” Megan was reportedly very close with her mother prior to her death. Megan and Bob were going to psychotherapy per Bob’s request, as he felt he was having a difficult time getting along with his daughter.  Megan was initially resistant to attending.


During the first session, Megan expressed her frustration with her father being critical and unavailable. In response, Bob stated Megan was never around and that she didn’t listen to him. As Bob talked, Megan apparently turned away from her father and began texting. Dubus (2015) acknowledged that in that moment, the therapist had a few options, including asking Megan to put away the phone, commenting about the texting, or not to say anything. The therapist chose not to address the texting. She allowed Megan to continue to text, feeling the texting was serving Megan in some way. Bob did not mention the texting either.


Over the next few sessions, the therapist noted Megan began to text when she was feeling criticized by her father. The therapist was aware that by mentioning the texting there was a risk of Megan feeling further criticized by another adult in the therapy sessions. Furthermore, the therapist felt Megan almost left the room at times out of frustration with her father and that the texting provided Megan with a buffer and she stayed in the room. Overtime, Megan and Bob’s relationship began to mend and the therapist noted Megan texted less during the sessions. By the sixth and seventh sessions, Megan apparently did not use her phone at all.


Dubus (2015) pointed out that Megan seemed to use the texting to maintain a sense of connection when she was feeling disconnected from her father. Barak and Grohol (2011) and Ling et al. (2012) found adolescents will text in churches and classrooms as well as other environments where even college age young adults will not (as cited by Dubus, 2015). Texting is seemingly a cultural norm for today’s adolescents and will likely continue to be for future generations (until, of course, there is new technology). Many therapists would have handled the same situation differently; however, the therapist in this example seemed to put herself in Megan’s shoes and attempted to understand the purpose the texting served for Megan. The last line of the article was well stated, it read, “As counselors, therapists, social workers we will continue to meet the client were they are at, and that may be with technology.”


Dubus, N. (2015). Texting: The third client in the room. Clinical Social Work Journal, 43 209-214. doi: 10.1007/s10615-014-0504-3


Brittany Best, MA
WKPIC Doctoral Intern

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