Therapeutic Texting with Teenage Clients

I've never been much of a texter, but I have a 13 year-old client with PTSD and a few anxiety disorders for whom texting is an important part of her therapy. Both she and her mother gave me permission to share some texts.

Therapist=T. Client=C.

Last night: C :-(    T: What's happening?  C: I feel spacy. (She can be dissociative, but it was almost 10) T: Spacy or Tired? C: Both  T: What tipped off spacy? C: Like when I am spacy and scared. T: Scared of what? C: That someone might kidnap me. T:% of likelihood? C: 3  C: I think I am so spacy that I can't think. :-(  T: Feel the anxiety in yr body and calm it down. Then sleep. C: How? (How many times have we practiced this in the office!!!): T: Tap under eyes, on sides, on collarbone. Remember? Breathe slowly & deeply.  (After a while) C:Yes! Thank you. T: UR welcome. C: :-D  T: Yay!  C: Wow it works! Next time I come can y write it down so I can remember. (For at least the 3rd time...) T: Yes  C: Thay u!! Ttyl! (Talk to you later.)

This took about 10 minutes, during which time I was doing something else. She texts about once a week and it helps her to know that she has access, when she doesn't have access to other supportive adults (due to a complicated family situation).

Sometimes the texting is brief. I've been working on her to promote connecting through positive affect. I asked her to text me if she ever felt happy. These texts go like this: C :-)  T :^)  C: <:-D T: @;^)--<--<  C:LOL, Ttyl.   Her mom says that she is starting to approach with positive affect more often.

Sometimes even the hard ones are brief. C ;-( :-(  :-(  T: What's going on?  C: I'm sad!!!!  T: Sorry!!!  (Minutes later) C: I feel better, cause I told you. T: Good! C: ;-) ttyl.

These texts mimic talking. Connecting. Responding. Responding to response. And a change in affect. The first one had a diagnostic phase, a therapy phase, and a resolution. With this particular client it cut down on phone calls and deep distress. She feels contained when there are no adults around. And she's learning a great skill for her age group.

Comments

[Nancy Smyth]

Great example of how to use this medium therapeutically Robin. I'm thinking it also turns her cell phone into an object that represents connection to you.