Therapy in the chatroom?

The client, their problem, the therapist and perhaps a couch - that's how you imagine therapy. But this constellation is no longer the norm. Constantly sitting in front of a screen is one reason why young people need therapy. But it can also be part of the solution. Many therapists today meet young people where they are: online. Psychoanalytical social worker Sylvia Künstler is one of them.

Ms Künstler, new media have become an integral part of young people's everyday lives. How does this affect your day-to-day work with young people?

It's a huge problem when we have a group of young people in front of us and they all pull out their smartphones. Everyone just needs to «very quickly, very briefly»... If you take their phone away from them, it's like amputating their hand or a leg, figuratively speaking. The mobile phone has taken on immense importance; «being in touch with the world» is essential for young people.

Even if the young people are in a social therapy session?

Yes - and sometimes perhaps even then. Of course, it can also be a way of avoiding contact with us or at least making it more difficult for us to make contact. Clients also tell us something when they seek contact with others when we actually want to make contact with them. From time to time it happens that we are not just the two of us in a one-to-one session, but that the young people bring someone else in via the internet or mobile phone. If a young person brings someone (virtually) into therapy with them, we ask ourselves: Why are they doing this? What is the client trying to tell us? It is possible that this brings a problem into the session that the young person is unable to talk about. Nevertheless, he makes it a topic.

Sylvia Künstler works as a psychoanalytical social worker in Tübingen. She has two grown-up children who use the internet intensively, as she says. She herself is not active on Twitter or Facebook, but uses the world wide web on a daily basis to stay informed and communicate.

Do you see new media in psychotherapy more as an opportunity or a risk?

Sometimes they are a risk, sometimes an opportunity. For example, we see young people with autistic disorders who drop out of the world because they are unable to make contact with others or even build relationships - at least not when these others are sitting opposite them. For them, making virtual friends online can be a great opportunity. And these friendships can be very intense. I remember a client who made friends with a woman in Moscow. They spoke on the phone, skyped or chatted every day and were there for each other when one was in need. It was a real friendship. But the young woman would not have been able to maintain this contact without the physical distance. New media and social networks are a great opportunity for autistic people to enter into relationships. However, if all other relationships are replaced by online friendships, this can also become a problem for autistic people. Of course, there are also the dark sides, such as all the bullying stories. New media are extremely ambivalent.

Many young people spend several hours a day in the virtual world. When does the question of Internet addiction arise?

We have to differentiate here. Excessive computer use is often seen as a problem. However, it should not be overlooked that this is often only the consequence of another problem. The symptom, so to speak. For example, if a young person is listless and develops depression, they may spend a lot of time in front of the screen because they no longer manage to get out and do anything. And time simply passes faster in front of a screen. Many people become completely immersed in this other world. You have to look very closely to see whether the computer addiction is masking other problems and is just the surface. Many of these patients, who at first glance appear to be addicted to computers, do not find it difficult to give up in the clinic. Through therapy and contact with other young people with similar or identical problems, they no longer need the computer.

When should parents worry?

There are a few clear boundaries. However, the number of hours that someone sits in front of a computer is of little consequence. More decisive are the questions: Are young people losing normal relationships? Do they go to school, to clubs, do they meet real friends? If they are not neglecting other everyday things, they may be sitting at the computer for too long, but they are not pathologically addicted. As soon as there is a drop in performance, a withdrawal or a change in social behaviour, these are warning signs that should be taken seriously and investigated.

Conversely, isn't it also a warning sign when young people refuse to go along with all the social network hype?

Girls and boys put themselves outside their youth culture when they reject new media. They often end up feeling lonely as a result. After all, the smartphone is also a point of reference. Young people often sit in threes over a screen and show each other things. Computers and mobile phones also have interactive elements. But if they don't otherwise withdraw from their social contacts, I wouldn't see it as a warning sign.

And what do you do in the meeting if the smartphone is interfering? Do you ban the device?

We struggle with radical restrictions. And, as I said, young people with Asperger's syndrome are sometimes dependent on this medium. It is their access to the world. That's why we allow them to use it. And not only that. We try to get in touch with them through it. There are young people who talk about their computer games and what they do there, for example. We try to listen neutrally and with interest - and not immediately rant: stupid shooting game. Or there are young people who can't talk about their problem and therefore «package» it by talking about a friend who has just written a message about the very conflict that the client is currently dealing with. Groups, friendships and conflicts arise in the virtual world - just like in real life. We have to utilise this. I have actually experienced the Internet as a bridge. Computers and mobile phones also offer us as therapists the opportunity to get in touch with young people. This can also be in a chat room.

Have you already chatted with clients yourself?

Yes, I made regular appointments with one client in the chat room to hold one-to-one social therapy sessions with her. Her difficulties could be «discussed» with her in writing and yet in direct contact. Something that was difficult to do in real life. It was also sometimes easier for me to formulate potentially offensive things in a way that didn't hurt her. In contrast to other correspondence, a chat has the advantage that you can respond to the other person almost immediately - and still think about what you've written for a moment. The client in question was able to put important things into words in the chat and allow an inner closeness that was not possible in direct contact. In general, some clients are better able to address threatening, painful things when it happens «casually» and you don't have to look the other person in the eye.

You say of yourself that you are open to new media. However, as a child of the 60s, you didn't grow up with the internet. Is it difficult for your generation to understand the so-called digital natives?

Of course, it's true that I'm in the position of the learner and sometimes even twelve-year-olds can show me something new on the computer. The fact that children and young people have opened up a whole new world that is foreign to us is definitely a challenge. But one that we can overcome if we are and remain open and curious.
Picture: Fotolia

An e-mail protocol:

What does counselling by email look like? Here is a real example from a session with a 17-year-old.

First aid for young people on the Internet:

Specialist book on the topic:
Screenkids - (on)caught in the net? Risks and opportunities of new media for children and young people with psychological difficulties. Published by the Association for Psychoanalytical Social Work. Brandes und Apsel Verlag Frankfurt am Main. 2015. ISBN 978-3-95558-155-8

The JugendNotmail platform is committed to using new communication channels to help young people in difficult life situations. More than 100 volunteer psychologists and social education workers work for the Berlin-based online counselling service - 365 days a year. It is striking that at least 360 emails from Jugendnotmail came from Switzerland in 2015; the place of residence is voluntary and many do not provide any information. There are no figures for 2016 yet. The enquiries from young people concern depression, self-harm, suicidal thoughts, abuse and eating disorders. «In addition to individual counselling, young people seeking help can also talk to each other in the forum and the monthly topic chats,» says spokeswoman Amelie Schwierholz. However, she also emphasises: «Counselling cannot replace therapy.» If it becomes clear that therapy is unavoidable, the staff will refer the young person to competent counselling centres. Our example shows what email correspondence can look like.
www.u25-schweiz.ch is a free and anonymous online help centre for young people - run by young people with special training. The counsellors are themselves between 17 and 25 years old and are backed by social workers and psychologists. This service is aimed primarily at children and young people aged between eight and 25 with suicidal thoughts. The project is organised by the Lebe! association based in Winterthur.
Many help centres, which were previously called rather frequently, now also offer advice via chat, text message or email. Among them: Dargebotene Hand, Sorgentelefon and Pro Juventute 's youth counselling service.