– [Roy] Unit Two. How do you use it? Use it for good. It’s a power, use it for good. Do not allow it to control you. Fight the force. Okay, alright, some concrete risks of disinhibition. How can it make things go bad? One, clients can literally switch you off. I mean that in the sense of they can just quit like, select quit, and then leave the session, alright? And so that’s interesting because this is actually one of the many reasons we want to enroll clients in taking more responsibility for their side of the session, because they can switch us off. We want to make sure they know you shouldn’t do that. The power is in your hands there, alright? Part of your ability to get help here is not doing that. But the fact that they can switch you off will actually increase disinhibition. And they may find themselves in a, if they’re stressed or made anxious by what’s going on, by the material, they may be thinking about switching you off. That’s not something they can do in a room. When there’s inhibition of in person, the person will usually feel like they have to remain and face what’s going on, alright? But if they can switch you off, they may, that may be a kind of emotional vent that allows them to stay out of that difficult but growing kind of range of anxiety. Because you know we talk about ideally in therapy you wanna keep people in that sweet spot of anxiety where change is gonna occur because they’re anxious enough but they’re not so anxious that it floods and they can’t do anything, alright? The ability to switch you off, to have this inhibition may cause them to be able to just slip out of it. So that’s one of the concrete risks. Similarly, they may think of you as semi-imaginary. And so I joke about that with clients. I’m like, hey, I’m the man in the box, right? That’s naming the frame, saying this is what’s happening. This is a psychological effect that you could be experiencing. I’m just a man in the box, I’m not real. Like I’m actually a robot, like Max Headroom. But in fact, in actuality, I’m real. For I am actually here. Pay attention to me, engage with me. And of course, they can turn down the emotional intensity of responses. They just can do that. It’s not just the switching you off, like they can just look away. They can just kind of disengage a little bit. And it’s not necessarily obvious that they’re doing that. So, well it is if you’re looking for the signs. So conceptualizing if a client is avoiding the anxiety of the moment, you know, depending on what are you doing, and how you’re trying to induce or reduce the anxiety. You may want to add to your conceptualization the possibility of Online Disinhibition. Especially if you’re trying to increase the kind of adaptive or motivational anxiety during that moment in a scene, or in the session. Okay, and then… Okay, that’s concrete risks, how about concrete advantages? Mmm, right? Like, how can you do it, right? So, here’s a cool thing about disinhibition effect. Clients can take risks with less prohibitive anxiety. Because it feels like a game, they can play it like a game, including doing risky things they might not do otherwise. And this is actually a big point of where AVATAR therapy really shines. It lets people really create a very imaginative space, in which to explore what’s happening to them in a therapeutic way. But even with video there’s a certain amount of that. They can talk about things, and they usually are felt, they feel less inhibited because of Online Disinhibition, and may be able to bring in material that normally would be too anxiety-inducing to talk about in the room. That actually happens quite commonly. That people cite that frequently. That, ah, you know what? When I do the work online I suddenly can talk about things, I can open up about things, that I just wouldn’t be able to do before. And that’s Online Disinhibition Effect, like, that’s how it’s working. You guys can use imaginative play in more powerful ways. Get into that. You can come up with new interventions, or at least just enhance your interventions because that context allows for more ability for imaginative play, especially if you take advantage of tools like whiteboards you guys can write on, draw on together. Or using websites together, and that kind of thing. And of course, the client can make the clinician what they need the clinician to be. Which gets us to the story of Le Petite Roy, which is, I’ll tell this in the last minute here. This is a real story, from a real online client. And I got her permission to use the story in educational contexts, even though I won’t identify her. It’s a woman in her fifties, who I started working with by Telemental Health. And I guess we should probably start with this. Hey, hey Liath, am I five foot two? – [Liath] You most certainly are not. – [Roy] Yeah, I, you can’t usually tell from the talking head kind of context here, but I am like six foot four, and I’m actually really big. That’s actually part of why I show this picture here. You guys can see I’m a really big guy. I used to be a linemen in football. I’m very power, I’m very physically powerful. Trust me. But here I’m joking. Like here’s 20 inches, here’s five two, what? So, okay, here’s the thing. What we’re doing, we started the relationship online, ended it online, there was never in-person. It lasted about six months. And it started with just anxiety, about how she’s relating to her husband. Over time we started to learn that that anxiety is rising because she had suffered a lot of sexual and emotional abuse at the hands of her father when she was little. And part of how she learned to deal with that trauma was to be very strong and powerful. And fiery was the word we used. And so for her, relating to men was hard. Like that part of her that experienced the trauma, by the way, I’m an IFS therapist, I’m gonna talk about parts, alright? So like a part of her that experienced the trauma, or parts, were really actually often very frightened of men. Like that is all parts, had a lot of fear there, and so she developed like managers and firefighters who would dominate men, whether that’s socially or interpersonally, or various ways. Possibly even physically, she be tried to do that. She was a really powerful woman, she was. Is, still. And like, and that was kind of her strategy there. And we realized, you know, working with those parts, that’s actually, a lot of the anxiety with her husband, was that she was torn between that. Like how exactly do I wanna deal with this guy? And luckily that got resolved, and there’s a lot of good outcomes there. One thing we realized that, towards the end she realized like, oh that’s my problem. It’s like how I relate to men. Like I did not notice this before. And then as we were doing the termination session, we, for some reason we, I forgot how it got onto the topic, but it was sorta the question about like, oh, okay, so it’s, oh I remember what it was, right. ‘Cause she’s coming back to the states, ’cause I work with people in Japan, right? So we had to terminate because she’s going to a state that I’m not licensed in. Also, it was actually a good moment to make a transition to an in-person. She said, I wanna see a male therapist now, I think that’s gonna help to continue doing that relating to a man in a emotional way. And the… The, she talked about like I wonder if it’ll be, feel okay to this time see a male therapist who’s about my size. At which point I’m like what do you mean? Like how big do you think I am? And she said, oh I figure you’re about, you’re about five two, right? And I’m like, oh God, I am not five two. Now of course with a talking head it’s actually hard to tell, right? I actually am proportionate, in such that I don’t look like a big person. But, so you know there’s some physical realities there. But that was the Online Disinhibition Effect at play and we didn’t even know. She made me what she needed me to be, so that she could work with me. And we discussed it, you know, discussed that thing, and she said, yeah, if I’d had actually seen you how big you actually are, I would’ve just run the other way. We would never had worked. Like this would never have occurred, and I never would’ve gotten that help. ‘Cause, she’s like, oh, she was really happy that she managed to get over that, the hump, and do that work with a male therapist because I gave her the challenge she needed. So the Telemental Health allowed that to happen. And Online Disinhibition Effect allowed that to happen. And that’s something, the difference is of Telemental Health facilitated that outcome. Wouldn’t’ve happened in person. Now of course, you can say that some things about in-person, where Telemental Health can’t do it either. They’re different. And Online Disinhibition Effect is a big aspect of the difference in Telemental Health. You can use it, for good. Use it as a power. Don’t let it get in the way and leverage it, and it’ll help you make things better.