The shrink is in...cyberspace

by Elizabeth Zelvin

As regular readers of SleuthSayers know, my blog brother Dixon Hill knows all about explosives. My blog sister Eve Fisher visits prisons. And I too have an alternative identity. Am I Wonder Woman? Nope. Outrageous Older Woman? Well, yes, but that’s not what I’m talking about today. 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, LZcybershrink.com. I’ve even got the T-shirt. On the back, it says, “Shrink online…grow online.”

I started doing this work around the year 2000, 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 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 or 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 still a new field. It attracts a lot of skepticism. 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. Don’t you? 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 and still feel safe 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 was born to schmooze. I do it face to face at Malice, the Edgars, MWA and SinC events, and book tours, and online on mystery e-lists such as DorothyL and various social media as well as one to one via email. 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, not a rhetorical question. You can answer by posting a comment. :) My husband likes to tell people that every time he passes through the room, I’m smiling at the computer. LOL Not really. I’m smiling at you, if you’re on the other end of my fingertips at the time. :)