Cyborg Psychotherapy?

What happens when a cyborg arrives in your office for treatment?

Sounds like science fiction? Think again. Most of us already fit the qualifications of a cyborg. It's today's social reality. Don't visualize Robocop, Terminator, or the Borg from Star Trek. Consider your self.

A cyborg is a life form that merges human and machine - a hybrid of mechanism and organism. I'm a cyborg - I wear a machine called contact lenses so I can write. I work on a word processor and submit my articles through email. I take synthesized nutrition called vitamins because I never have time to eat right. The list grows every day.

What about you? Most of us already fit the qualifications of a cyborg. Dr. George Landow, at Brown University, estimates that at least one in every ten of us are fully endowed cyborgs -- people living with machines such as pacemakers, artificial joints, drug implant systems, implanted corneal lenses - new technology is introduced every day. These are the people that celebrate the many technologies that dramatically improve their daily physical lives - enabling them to do things that only a few years ago would have been impossible.

But that's only part of the picture. Most cyborgs have merged with machines for specific social, psychological, occupational, or behavioral purposes. Do you make telephone consultations - with patients or managed care? Have you tried online therapy, exchanged e-mail with patients, or consulted with colleagues online? Ever visit NASW Online or Mental Health Net?

What about surgeons that use lasers, airplane mechanics that use augmented reality, pilots that use flight simulators, clinicians that use virtual reality therapy? And don't forget the millions of people around the world who go into a machine to experience reality in cyberspace - where they live, love, lie, and play in a computer-created world.

In essence, we're altering our physical or psychological processes to regulate everything from medication, body rhythms, social interaction, emotional states - the list is only limited by technology.

Now let's reconsider that cyborg who walks into your office for treatment.

He or she most likely uses computers at work, school, or home. Whether sitting behind a screen, using video conferencing, or computer software, adults, kids, families, friends use computers as partners, associates, assistants, and research tools.

Then they go home to computers who are household members - from big screen TVs and AOL to cell phones and kitchen tools.

People work, make friends, communicate, make plans, and play in computerized worlds. They do just about everything online, in simulated environments, that they do offline. And that's the key. We're all cyborgs. And as cyborgs, computer-assisted or -informed psychotherapy is as important as the couch once was to psychoanalysts.

These are the experiences and relationships we hear about every day. Kids leave school and instead of hanging out on street corners they go to chat rooms. Young people meet significant others online - they court, they date, and they eventually meet offline. Many cyber-relationships lead to marriage. One matchmaking service, American Singles, boasts over 700,000 registered members. But this isn't the sole domain of the young. There are sites for senior citizens looking for partners - as well as every specific interest, orientation or preference. And the friendships, professional affiliations, business contacts are all part of our cyborgian existence.

This leads to a whole host of new disorders - everything from compulsive overuse to cyberinfidelitites. The bottom line is that the internet - and all our cyberspaces - are computerized simulations of our lives off-line. If we don't use computers, the internet, multimedia, and virtual reality in social work we ignore a very large part of our patients' lives.

How does it work? First, we need to acknowledge the reality of our cyborg existence. Second, we need to redefine our work.

The multiple, flexible, and recycling selves that typify cyborgs need flexible, multi-modality social workers. What works for a specific patient is far more important than adhering to a single approach. A postmodern social worker needs to move freely within the parameters of their cyborg patients.

For example, I call myself a family therapist because it's a systems approach. I customize treatment to the patient - not the other way around. I'll use anything from behavioral to psychodynamic techniques - as long as it suits the content. It comes along with serious pitfalls as with any multi-tasking application. I run the risk of becoming a therapeutic jack-of-all-trades and expert in none.

So I bring in an "associate" if it suits the context. That's my computer. It's set up perform a wide range of tasks.

With kids, I do classic "play therapy" - on AOL, the internet, or carefully selected software. We do things like explore social behavior using chats; self-esteem in building a home page; learning basic skills while constructing cities or families in sim-software.

I break through adolescent resistance by going on the computer and surfing - admiring internet skills, exploring favorite pages, peeking into personal web sites.

I've taken families who are totally unable to communicate and brought the computer in as an objective mediator.

It's not just the computer that "speaks" to our cyborg patients - technology is their language. Use it - and it works.

I've taken silent, withdrawn young girls into eager conversations by pulling out my pager and comparing colors. I connected successfully with a mildly autistic teenager by marching through electronics stores and staring, wide-eyed, at the "stuff." I've helped adults, who feel isolated, return to the "swing of things" through internet surfing and socializing.

The key is in understanding and using cyborg psychotherapy.

It's not inherently good or bad. It's who we are today.