How to Talk About Your Patient’s Electronic Communication

I never thought as a child psychiatrist I’d be encouraging the use of social media and time online, but the world has turned upside down. Pre-COVID I would be encouraging IRL (in real life) social gatherings and get togethers. Since I mostly treat teens and young adults with mood disorders, a major component of treatment is increasing socialization and connectedness. Being connected to others improves mental health.

Every session I ask my patients: who have you talked with this week or hung out with? Now, I ask: have you been able to get together in a physically distant way with any friends? Who are you texting or Facetiming? Are you playing any games online with friends?

Use of electronic communication has increased since the COVID-19 physical distancing efforts have been implemented. There’s been an uptick in anxiety symptoms due to social limitations, worry about self or loved ones contracting the illness, and grief over loss of milestone events like graduation or prom.

Given all of these changes, efforts to incorporate patient electronic communication information into clinical visits can offer us unique insights into our patients’ lives. We should ask about events in the past week that have either improved or worsened their mood. These changes in mood are often linked to interpersonal interactions. We can then ask the patient to share about the interaction.

With electronic communication we have new opportunities to see the written exchange of patients and their support network. This can offer more insights into patterns of communication than having the patient recall a conversation from memory. If there’s a text exchange, we can ask if the patient is willing to share the conversation so we can see how they’re communicating with their friend, significant other, or parent. Through these text conversations we may then find times when communications lead to arguments or misunderstandings. Or we might focus on the limitations of texting and encourage Facetime or phone calls when trying to resolve disagreements.

Some people struggle with challenging exchanges on social media. We can ask if they’re comfortable sharing the posts so we can work together to improve their communication or help them decide when to post comments and when to refrain. Another scenario is patients who mention they’re constantly looking at social media and they think it’s affecting their mood in a negative way—perhaps by comparing themselves to others and then judging themselves, or by getting caught up in the comments people write. This can open the door to look at some of the sites they’re perusing. I might say, “You mentioned these sites might be a problem—can we look at them together and see what you get out of them? And how they’re impacting your mood?”

While there are definitely scenarios where electronic communication negatively influences our patients, there are also opportunities for positive connections. I remember a teen patient who was living with her great-aunt who was her guardian. Her great-aunt clearly loved her, but was perceived as strict by the teen—the great-aunt made decisions out of fear or misunderstanding. My patient, an artist, was posting pics of her paintings to sell. I asked if she would mind sharing the site with me with me so I could see the paintings. She showed them to me and said that her aunt had asked the teen to refrain from selling “the yellow one” as she wanted to display it in their house. In that moment I could see the pride my patient felt and feel the love and caring her aunt had expressed in reserving the yellow painting. This was a unique glimpse into their relationship I wouldn’t have otherwise seen by only discussing their disagreements from the past week.

Sharing electronic communication can be a way to see other sides of a patient’s life and we might gain unexpected depth and understanding.

Here are two tips for how to start talking about about a patient’s electronic communication:

1. Look for opportunities to ask about text exchanges or social media activity that can offer a window into their life.

2. You can begin by simply asking, “Would you mind sharing the texts or postings with me so I can better understand what’s going on?”

From these exchanges or postings you and your patient can examine their patterns of communication that may be leading to arguments or misunderstandings. Alternatively, you can also highlight positive exchanges and their impact on your patient’s well-being.