As telehealth becomes a more established practice for both clinicians and their clients, the convenience of it opens many doors to both the busy and the disabled. However, as we shift more attention to telehealth practice and develop that as an option for clients, it's important to understand the ways that cyber communication can affect both the relationship and the individual. While telehealth appointments offer many advantages to clients and clinicians, understanding the limitations of them, and the nuance of how they affect bonding and trust is key to developing trust and the ability to help your clients. People act differently, depending on their setting, and that is especially true when placed against the semi-anonymity of the internet.
Hyper Personal Effect Theory
Developed by Joseph Walther in 1996, hyper personal effect theory was a theory that came from studying the effects of commuters in mediated conversation, and it a theory that should be kept in mind when dealing with clients via text based exchanges. Walther suggests that visual and verbal cues are key components in developing relationships, and the lack of them in cyber communications can lead to deeper and intimate connections quicker than in other situations. Cyber communications can be a beneficial way of communicating with clients, but the nature of text based communication without the benefit of verbal or visual components is that there is more time to craft an image, tailor it to the perceived wants and desires of the other party, and present that image in the best possible light. Without tonal inflection to read and body language to assess, the only thing to go on is the words on a screen. It is important to keep hyper personal effect theory in mind when communicating with clients, but also when discussing their own relationships--more and more frequently, people are finding friendship and romantic relationships in online spaces, and the immediacy of the relationships found there can become an emotional problem--for clients who spend the majority of their social interactions in online spaces, understanding hyper personal effect theory and what bearing it might have on those developing relationships is an essential piece of their care.
Friendships and bonds created online with hyper personal effect theory are not necessarily negative, however. For many, the ability to cut the fluff from a relationship and focus on the factors that bond them is exactly what they need in forming friendships and relationships, and it allows for an intimacy and a depth to the friendship that could not necessarily be found without the influence of hyper personal effect theory, where understanding the social cues and body language can be a struggle for neuro-divergent individuals.
Social Information Processing Theory
Not all people respond the same way. While removing nonverbal cues can cause Hyper----- in some, the same thing can result in a slowness to trust and deepen relationships, something that is explained by Social Information Processing Theory, or SIP.
SIP posits that the individual has a slowness to trust without the nonverbal social cues--body language--to assist. In essence, with the lack of tone and body language of an offline meeting, there is an inability to trust what is being conveyed over digital mediums, which results in distrust and a slowness to deepen the relationship. This is something that should be kept in mind, especially for clients who are uncomfortable with telehealth--individuals who distrust technology or telehealth, in general, may struggle to connect with a clinician through telehealth services, which can impede the trust built between client and clinician.
SIP is also something to be kept in mind in the client's relationships both personal and professional. A client might feel disconnected and dissatisfied with their relationships if they are unaccustomed to online interactions and are thrust into a work from home situation, as many have been over the past few years.
How does information that is shared affect relationships formed online? In the case of online dating, there's often a mistrust of the information shared because it's designed to put the sharer in the best possible light, and the other individual is rightfully wary about it until that information can be verified by themselves. This is an example of what's known as Warranting Theory and in the age of misinformation and disinformation, is something clinicians should be aware of while working with patients. The ability to verify information for themselves is important to build trust and deepen the relationship for individuals who are suspicious and slow to trust the information given to them online. Providing information that is easily verified--especially numeric information that is very tangible--can go a long way in building trust with them.
It's also important to note when working with clients who show signs of warranting theory in their relationships. If a client has been in online relationships in which they are told things that cannot be supported by facts, or verified by facts, it can cause a slowness to trust and damage the bonds that have formed. Being wary and wanting proof of what one is told on the internet and in new relationships is a healthy thing--a safe thing that many have abandoned in the increasingly digital social world. However, there should be a balance in trust that is earned when sharing personal information--both as the sharer and the receiver.
Social Identity Model of Deindividuation Effects (SIDE mode)
Why do people on the internet participate in mob behavior--why do so many follow the lead of a few when an actor is canceled, or a child's surgery GoFundMe is passed around, or a social injustice is brought to light?
None of those examples are necessarily bad things to speak against. But the phenomenon of deindividuation is something that clinicians should be aware of and understand in dealing with clients who spend large amounts of time online, especially teens and adolescents. Social Identity Model of Deindividuation Effects, also known as SIDE, is the study of this phenomenon--what causes mass group thinking and what does anonymity play into it?
As previously noted, deindividuation is not necessarily a bad thing - often, it can be the reason for doing something good, like caring for other people, donating to social causes, speaking out against injustice, and sharing information about human rights violations. In fact, SIDE theory sees a positive side of crowd behavior as opposed to negative effects. SIDE theory relies heavily on anonymity, when individuals think they are part of a group and feel attacked--how they react to that attack is when we see SIDE theory in action. It is important to note that the attack does not necessarily need to be directed at or affect the individual for them to react, if they perceive themselves to be part of a whole. An example of this would be the outrage of fans over the way an artist is snubbed at an awards show. While the slight is largely imagined and not affecting the individual fan, the outrage they feel is part of a larger collective and the boycotting of the awards show is the action of the collective.
Why is understanding SIDE theory important? As teens and adolescents spend more and more of their recreational and academic time in online spaces, understanding the factors that determine their behavior is essential. Actions that would be unthinkable to them, like online bullying, without the anonymity of the internet, suddenly become normal, ok even, when large groups of their peers--people they self identify with - are doing the same. Understanding the mentality of the phenomenon allows the clinician the knowledge to guide their clients.
John Suler’s Online Disinhibition Effect
The final theory to discuss is one proposed by John Suler, the Online Disinhibition Effect. Why do people bully their peers online, when they wouldn't in person? Why do adults fight with relatives over social media in ways they'd never do at the Thanksgiving dinner table? John Suler's Online Disinhibition Effect looks at several factors in online behavior to create a theory as to why many exhibit behavior that, in any other case, would be out of character and unthinkable for those doing them. Sauler's effect examines six factors and how they influence behavior online that is out of character for them.
- Dissociative anonymity: How much do you know about the people on the other end of a screen name? While we might be inclined to trust the other person is presenting themselves in an honest way, there's anonymity on the internet that has to be accounted for, and an ability to change who you present yourself as with very little effort. This dissociative anonymity is a key part of Suler's theory in that there is an ability to separate self from actions. For many, their online persona is not an ingrained part of their personal identity - and therefore, there are no consequences to themselves as they shed that anonymous skin for another.
- Invisibility: As previously discussed, the simple phenomenon of not being able to see the person you are communicating with can change the course of the relationship and how it is formed. In Suler's theory, that is taken a step further - how does invisibility affect those who linger on message boards unseen, in chat rooms, observing without interacting? The ability to observe unseen can give people the courage to do things they might not otherwise do. That can be good - speaking up about an issue in the workplace via an email to HR, reporting bullying to a school administrator--but it can also be seen in a negative light--sending anonymous messages of hate to people you disagree with, for example, is a common and unfortunately, growing problem in online spaces.
- Asynchronicity: Have you ever put off a conversation because you don't want to deal with the other person's response at the moment - or at all? What would you say if you didn't have to? Asynchronicity refers to the lag in communication online. A post that is shared on social media or message boards, emails that are sent there is often a pause in response time. That conversation you don't want to have because of the other person's response suddenly becomes easier to email because you do not have to deal with that response--there's time to process, and that lack of instant response can color how one frames the response, further crafting a persona that is not necessarily true to themselves.
- Solipsistic Introjection: Without the aid of voice and visuals, there's left a lot of gaps to be filled in a relationship, and that is where solipsistic introjection comes in. Suler theorizes that when receiving texts and messages, the recipient assigns characteristics and a voice to the other person. That mental representation is influenced by how the sender presents themselves but it's also influenced by the recipient and what kind of person they need in their life at the moment--and that can lead to a dissociative reaction if or when they are confronted with reality. The letdown upon meeting online friends in real time is something many feel because they do not fit the mental image built. This is often done without intent--there's no desire to craft their friend into something they aren't, merely the mind's ability to fill in the gaps.
- Dissociative Imagination: Affecting the minds of those who spend a lot of time online and who form relationships there is dissociative imagination, or the idea that what happens online is not necessarily 'real'. Suler discusses this phenomenon in which people use online spaces almost as if they were a game, where there are rules but a lack of consequences, and further explains the idea that what is done there does not apply to or affect 'real life'. This is a dangerous mindset, especially for those who are active on social media, as what is done there can influence job prospects, future education, and the perception other people have of you.
- Minimization of Status and Authority: The final factor of Suler's theory is the minimization of status and authority. Online, it can be difficult to determine who, if anyone, has authority, and people are even slower to respect it. There is an absence of the cues that are used to recognize authority figures in social settings. Without that, online authority is stripped away, and it allows for freedom of thought and speech that isn't always present when people are aware of authority figures.
Suler's theory combines many different aspects of why individuals act the way they do online and why they don't act the same way in their real world spaces. Examining and understanding them can assist in understanding client's mindsets and actions both online and offline and how it affects their relationships.
There are many different theories about how personality and behavior are affected by the constraints of technology and digital mediums. Knowing them, understanding them, will not only assist in telehealth sessions but in understanding clients and how best to help them.
Written by: Nazarea Andrews
Buote,Vanessa M., Wood, Eileen , Pratt, Michael. (2009). Exploring similarities and differences between online and offline friendships: The role of attachment style, Computers in Human Behavior, Volume 25, Issue 2, 2009.
Erin K. Ruppel, Clare Gross, Arrington Stoll, Brittnie S. Peck, Mike Allen, Sang-Yeon Kim. Reflecting on Connecting: Meta-Analysis of Differences between Computer-Mediated and Face-to-Face Self-Disclosure, Journal of Computer-Mediated Communication, Volume 22, Issue 1, 1 January 2017, Pages 18–34.
Chang, Jenna. (2020) The Role of Anonymity in Deindividuated Behavior: A Comparison of Deindividuation Theory and the Social Identity Model of Deindividuation Effects (SIDE). Undergraduate Journal of Baylor University.
Felipe Vilanova, Francielle Machado Beria, Angelo Brandelli Costa & Silvia Helena Koller | Justin Hackett (Reviewing Editor) (2017) Deindividuation: From Le Bon to the social identity model of deindividuation effects, Cogent Psychology, 4:1, DOI: 10.1080/23311908.2017.1308104
Suler J. The online disinhibition effect. Cyberpsychol Behav. 2004 Jun;7(3):321-6. doi: 10.1089/1094931041291295. PMID: 15257832.
Liu, N., & Zhang, Y. B. (2020). Warranting theory, stereotypes, and intercultural communication: U.S. Americans’ perceptions of a target Chinese on Facebook. International Journal of Intercultural Relations, 77, 83–94.
DeAndrea, D. C. (2014). Advancing Warranting Theory. Communication Theory (1050-3293), 24(2), 186–204.
Bernstein, L. (2022). Social information processing theory (SIP). Salem Press Encyclopedia.