































Graduate Student Journal of  Psychology
2014, Vol. 15

Copyright 2014 by the Department of  Counseling and Clinical Psychology
Teachers College, Columbia University

81

Psychosocial Media: An Argument for the Utilization of  
Online Social Networks 

as Clinical Adjuncts in Psychotherapy

Jett H. Stone
Teachers College, Columbia University

This paper argues for the utilization of  online social networks (OSNs) as clinical adjuncts in psychotherapy with ad-
olescents and young adults. While privacy and ethics are critical issues in psychotherapy, these concerns should not 
overshadow the various ways that an OSN adjunct may enhance the therapeutic alliance and advance psychothera-
peutic practice. The argument asserts that a joint exploration of  OSN profile pages – a mental health professional 
in conjunction with an approving client – may provide clinically relevant details, and a more comprehensive con-
ceptualization of  emotional and interpersonal functioning. The specific content of  OSN disclosures are discussed, 
referencing current cyberpsychology and communications research. In addition, the procedural question of  when, 
in a therapeutic relationship, it may be appropriate to initiate a psychosocial media approach, is also addressed. 
Comparisons are then made between OSN integration and previous incorporation of  personal images and visual 
expression in psychotherapy. The penultimate section details how OSNs may be viewed from a narrative psycho-
logical standpoint, and the numerous ways these new social tools can be interpreted or understood within various 
other psychological frameworks. Lastly, this paper cites the general effectiveness of  other technological adjuncts 
in psychotherapy, and offers final recommendations for the potential marriage of  social media and psychotherapy.

 The speed, ease, and seeming frivolity of  so-
cial media may seem antithetical to the core values 
of  the sensitive and difficult process of  psychother-
apy. Popular social media sites or online social net-
works (OSNs) such as Facebook and Twitter, are 
profit-seeking companies racing to claim stake in the 
future, and are built on the premise that consumers 
will publicly share personal information. Conversely, 
psychotherapy – ideally practiced – is a healing pro-
fession that holds client confidentiality and privacy 
sacred, and only advances at the irregular speed of  ev-
idenced-based practice. While these distinctions may 
ring true, they overlook the potential role of  OSNs as 
valuable clinical adjuncts in the therapeutic process. 
One of  the challenges in psychotherapy is fine-tuning 
treatments and clinical strategies to match the needs 
of  an individual. This paper asserts that social media 
profiles – when investigated alongside adolescents 
or young adults – can be powerful tools to tune into 
and ultimately treat present-day psychological issues. 
 Because so much personal information is shared 
in therapy, authorized access to OSN profiles may be 
an important added ingredient for a complete 21st 
century client conceptualization; especially for the 
youth and young adults whose online social tools are 
ingrained into their daily lives. The cultural influence 

of  OSNs is evidenced by the statistic that over 80 
percent of  teens use OSNs, and 92 percent of  fe-
males between the ages of  14-17 use an OSN site 
(Brenner, 2012). Social media adjuncts could poten-
tially be expanded to adult populations as well. In 
fact, adults over the age of  18 are increasingly turning 
to OSNs, despite using them in smaller numbers: of  
adults who are online, 67 percent use OSNs (Bren-
ner, 2013).  There has been recent research look-
ing into how adults use dating sites to find poten-
tial mates (e.g. Finkel et al., 2012), and how online 
support groups can impact-health related outcomes 
(e.g. Rains & Young, 2009). In addition, there are a 
growing number of  older adults utilizing these social 
tools. Thirty-four percent of  Internet users 65 and 
older use OSNs (Zickuhr & Madden, 2012). None-
theless, it seems useful to begin adapting OSNs as 
a clinical adjunct with teens and young adults who 
are in a critical maturation stage and are general-
ly more vulnerable to dangerous online behavior.
 Potentially maladaptive social networking be-
haviors, as well as more incidental status updates or 
postings, may be best discussed in therapy for teens 
and young adults, not only because clinicians possess 
the training to intervene appropriately during inter-
personal dilemmas, but also because psychotherapy is 
inherently a venue for disclosure. In a clinical report 
released by the American Academy of  Pediatrics, the 
authors stressed that pediatricians are in a unique po-

Correspondence concerning this article should be ad-
dressed to Jett Stone, 166 West 72nd Street #10C, 
New York, NY 10023. Email: jettstone@gmail.com.

Graduate Student Journal of  Psychology
2014, Vol. 15

Copyright 2014 by the Department of  Counseling and Clinical Psychology
Teachers College, Columbia University



82

STONE

sition to educate families about the “complexities of  
the digital world” and cited social and health issues 
that online youth experience, such as cyberbullying 
and “Facebook depression” (O’Keeffe & Clarke-Pe-
terson, 2011, p. 803). The authors define Facebook 
depression as when preteens and teens spend inordi-
nate amounts of  time on Facebook and, as a result, 
demonstrate “classic symptoms of  depression” (p. 
802). This argument for an authoritative intervention 
holds true perhaps even more so for child psycholo-
gists and other mental health professionals whose do-
main it is to have a strong grasp of  the psychological 
fitness of  youth. In short, a mental health profession-
al should be adept at entering into this social domain 
when called upon or when deemed necessary. How-
ever, it is impossible to ignore the tensions and ethical 
issues in this union of  new media and psychotherapy.

Ethical Concerns and Other Considerations

 Many psychotherapists are wary of  OSN use from 
a personal and professional level. Understandably so, 
as the lines of  privacy – determining what is public 
versus private on the Internet – have become increas-
ingly blurred. To ease this uncertainty, a growing body 
of  literature has addressed issues of  ethics and privacy 
as they relate to OSNs and mental health care (Taylor, 
McMinn, Bufford, & Chang, 2010; Fogel, & Nehmad, 
2009; Debatin, Lovejoy, Horn, & Hughes, 2009). 
 In order to protect clinicians and their clients 
from inappropriate self-disclosures, clinicians are 
generally discouraged from following or befriending 
clients or potential clients on OSNs such as Face-
book or Twitter (Van Allen & Roberts, 2011). The 
concern is that these digital “friendships” will create 
a slippery slope-type cascade into a breach of  confi-
dentiality and/or privacy (Gutheil & Simon, 2005). 
In their paper, “Critical Incidents in the Marriage 
of  Psychology and Technology: A Discussion of  
Potential Ethical Issues in Practice, Education, and 
Policy” authors Van Allen and Roberts (2011) refer 
to a metaphor previously used by Maheu (2010) that 
describes therapists’ utilization of  OSNs as similar 
to drivers handling shiny new sports cars on bumpy, 
old roads. Naturally, the sports car signifies social 
media, and the dirt road signifies psychotherapy. Van 

Allen & Roberts’ (2011) argument is that clinicians 
have the tools to be innovative, but lack the “current 
infrastructure” to support the testing of  these tools 
without “considerable risk” (p. 434). While the au-
thors never explicitly refer to the potential of  using 
OSNs as adjuncts in therapeutic practice, they assert 
that current technologies bring about significant risk, 
and it still remains unclear how these concerns could 
be better addressed (p. 438). However, it must be 
made clear that utilizing OSNs as an adjunct would 
be entirely distinct from befriending or following a 
client, as the therapist would not engage in any in-
terpersonal OSN communication with the client.
 While there remain unresolved issues, many 
therapists and institutions have been creating so-
cial media policies, and there have indeed been sig-
nificant steps forward in creating more widespread 
recommendations and guidelines for appropriate use 
(Myers, Endres, Ruddy, & Zelikovsky, 2012); Jent et 
al., 2011). Regardless, privacy and ethical guidelines 
are critical issues when discussing the integration of  
social media and psychotherapy. Yet the functional 
fixedness of  OSNs as inhibiting the therapeutic al-
liance overlooks their potential as clinical adjuncts 
in enhancing the therapeutic alliance and advancing 
psychotherapeutic practice. However a purely tech-
nological, distant and asynchronous level of  therapy 
communication may not work well. A recent Austra-
lian study of  individuals age 18-80 found that close 
to 77 percent of  people prefer face-to-face therapy 
rather than therapy by electronic means. The authors 
defined electronic as “Internet-based mental health 
assistance with or without support [i.e., communi-
cation with a therapist via email, instant messaging, 
web-cam or Skype])” (Klein & Cook, 2010, p. 29). As 
Clough & Casey (2011) noted in a review of  techno-
logical adjuncts in psychotherapy, a major goal has 
been to focus on ways that technology can “replace 
or duplicate face-to-face therapy” (Clough & Ca-
sey, 2011, p. 280). Therefore this paper proposes a 
more transparent, face-to-face application of  OSNs 
in therapy that counters the commonly held notion 
of  OSNs as purely fodder for social academic re-
search, self-promotion, or personal communication. 
 Based on a PsychInfo search using the search 
terms “online social network,” “social media,” paired 



83

PSYCHOSOCIAL MEDIA

with “adjunct” and “psychotherapy” there has been 
no available research to-date exploring how OSNs can 
serve as therapeutic instruments. Yet a history of  social 
science literature, along with a boom in cyberpsychol-
ogy and social networking research, indicates that there 
may be a place for such an innovative intervention.
 With the explicit, endorsed permission of  cli-
ent or guardian (depending on the client’s age), so-
cial media access may provide a more comprehen-
sive case conceptualization. It would be revealing 
to walk through an individual’s Facebook or Twitter 
profile – alongside a client – as a way of  stepping 
inside their interpersonal world. Clinicians would 
address or interpret online self-presentations in-per-
son as they would for any verbal or nonverbal face-
to-face disclosure, but these online disclosures may 
provide access to more elusive clinical content not 
typically shared in session. This side-by-side OSN 
exploration would potentially allow for a fairer, 
more mutual interpretation of  social activity rather 
than what often occurs asynchronously and from 
afar between Facebook friends or Twitter followers.
 An OSN adjunct would naturally require Inter-
net service in a therapist’s office, and also necessitate 
that a client actively use OSNs. This then raises the 
question of  whom – therapist or client – would pro-
vide the computer, mobile device or tablet in therapy 
sessions. While the therapist could bear the burden 
of  providing the media, the client may feel more of  
a sense of  control over their privacy if  they use their 
own technology. Taking the initiative and bringing in 
their own media would grant the opportunity to pre-
pare an OSN profile prior to a therapy session, in 
order to avoid stumbling upon uncomfortable pho-
tos, messages or postings. While the therapist may 
not explicitly request that a client alter, include, or ex-
clude elements of  their profile prior to arriving in the 
office, it is likely that a client will feel inclined to do 
so without prompt. Surely, allowing this ability to cu-
rate a personal profile leaves the clinician with a more 
restrained version of  a client’s OSN presentation. 
Nonetheless, safeguarding OSN activity outweighs 
the rupture in therapeutic alliance that may arise from 
discovering social content that is embarrassing, eas-
ily misconstrued or irrelevant to psychotherapy. As 
the alliance develops over time, perhaps clients will 

grow more open to revealing aspects of  their online 
lives. Additionally, it seems necessary to remind cli-
ents to disable any instant messaging preferences (i.e. 
Facebook chat) so as not to be disrupted by incom-
ing messages from followers or friends in session. 
While these are suggestions, the therapist and client, 
based on their relationship, should mutually decide 
how to logistically and fairly incorporate OSNs into 
session to facilitate positive psychological outcomes.

Content of  OSN Disclosures

 Integrating OSN into therapy sessions as-
sumes that online disclosures provide clinically 
significant content. Recent research indicates that 
clients do indeed disclose clinically relevant infor-
mation online, and may also be receptive to the 
use of  technology in therapy sessions. An indi-
vidual’s thoughts, experiences, and emotions are 
quite often found across the web, from blogs and 
OSNs to dating websites (Joinson & Paine, 2007). 
 One study, using a sample size of  400 (aged 17-
61) randomly selected, accessible, personal profiles in 
Canada, developed a scoring tool that assessed the 
content of  Facebook disclosures. They recorded ev-
erything from birthdate, ability to message, phone 
numbers, content of  profile photo and educational 
information to favorite quotes, music, interests, po-
litical and religious views. They found that subjects 
displayed approximately 25 percent of  possible infor-
mation for others to view on their Facebook profiles 
(Nosko, Wood, & Molema, 2010). The authors also 
discovered that there is often “highly personal, sen-
sitive and potentially stigmatizing information” on 
Facebook (p. 416). The authors define highly person-
al as “details that could be used to locate or identify 
an individual, and could be used to threaten or harm 
another” such as email address, employer and job po-
sition (p. 410). Nosko, Wood, & Molema (2010) also 
define stigmatizing as “sensitive personal information 
that could result in stigmatization within society” such 
as religious views, political views, birth year, sexual 
orientation, about me sections, and photos (p. 410). 
 Such studies looking at online disclosure patterns 
do not necessarily reveal the whole story of  how dis-
closure operates on OSNs. This is because users, over 



84

time, become more aware of  how they can alter their 
default privacy settings, as was shown in one longitudi-
nal study of  5,076 Facebook users at Carnegie Mellon 
University (Stutzman, Gross, & Acquisti, 2013). Many 
OSN disclosures – perhaps the most highly emotion-
al, personal and therefore pertinent to mental health 
practitioners – are shared privately or shared only 
among a limited set of  friends or followers, especially 
with the advent of  more advanced privacy settings. 
Therefore, a large portion of  salient OSN activity is 
inaccessible to researchers working only with public 
data. These disclosures add another layer to Nosko, 
Wood, & Molemas’ (2010) operational definition of  
highly personal and stigmatizing. Given their sensi-
tive content, these more behind-closed-doors social 
interactions may be useful to address in-person, in a 
private therapeutic environment. Online disclosures 
may be especially prevalent in adolescents and young 
teens that use OSNs obsessively or even just frequent-
ly. Research indicates that the younger the age, the 
more personal information is likely to be shared on 
Facebook profiles (Nosko, Wood, & Molema, 2010). 
 There has also been evidence to support the idea 
that online self-disclosure is used to rehearse offline 
disclosure in pre-adolescence and adolescence, espe-
cially for boys (Valkenburg, Sumter, & Peter, 2011). 
This implies that online disclosures may be highly 
reflective of  offline behaviors that a therapist might 
otherwise not have the opportunity to witness or un-
derstand given limited client contact. Or, perhaps a 
therapist would be able to corroborate online behav-
iors with in face-to-face behaviors and thus come to 
a more confident, complete conceptualization of  the 
client. Other preliminary research indicates that OSNs 
such as Facebook contain useful clinical information. 
 One study looked at publicly accessible college 
student Facebook status updates, and used DSM cri-
teria to determine whether these disclosures showed 
signs of  depressive symptoms or major depressive 
episodes (Moreno, Egan, & Brockman, 2011). From 
the 200 Facebook pages, they found evidence to sup-
port the notion that students do display symptoms 
of  depression on their profiles. Twenty-five percent 
of  the studied Facebook profiles displayed DSM cri-
teria for depressive symptoms, while 2.5 percent met 
criteria for a major depressive episode. Additionally, 

Moreno, Egan, & Brockman (2011) conclude that 
those who receive online reinforcement from friends 
are more likely to be public in expressing their symp-
toms. Despite the stigmas associated with mental 
health disclosures, Facebook appears to be a safe 
place for many young adults to disclose personal de-
tails because of  the support of  their social networks 
(Moreno, Egan, & Brockman, 2011). Other research 
shows that increases in depression may be a direct 
result of  negative social media interactions, and that 
OSN activity is a medium where psychological prob-
lems are apparent in dysfunctional interpersonal in-
teractions (Feinstein, Bhatia, Hershenberg, & Davilia, 
2012). Another study found that Problematic Inter-
net Use, defined as online behavior that negatively 
impacts social and emotional functioning, is pres-
ent in about four percent of  high school students in 
the U.S., and is associated with levels of  depression, 
substance use, and aggressive behaviors (Liu, Desai, 
Krishnan-Sarin, Cavallo, & Potenza, 2011). It is often 
considered symptomatic of  an impulse control disor-
der (Shapira et al., 2003). Other, potentially more dan-
gerous, behaviors such as cyberbullying, or Internet 
aggression, have also increased in prominence (e.g. 
Hinduja & Patchin, 2008; Ybarra & Mitchell, 2004).
 Researchers have begun to compare cyberbul-
lying to more traditional bullying. One study with 
adolescents found that cyberbullying increases with 
age and amount of  time spent using the Internet 
(Walrave & Wannes, 2009). Therefore if  a clinician 
were to incorporate OSNs into their sessions with 
adolescents and young adults active on OSNs, the 
topic of  cyberbullying – as victim or perpetrator – 
may arise. Recent research indicates that students 
differentiate between offline and online bullying: 
in online environments they make less of  a distinc-
tion between bully and victim and differentiate be-
tween the specific modes of  bullying, i.e. messages 
or pictures (Law, Shapka, Hymel, Olson, & Water-
house, 2012). Since they make such distinctions, it 
is therefore important that clinicians have at least a 
basic understanding of  how adolescents and young 
adults interpret cyberbullying, as well as an under-
standing of  the various working mechanisms of  
OSNs. Such an understanding on the part of  the 
therapist would also aid in helping youth explore 

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85

more adaptive utilizations of  these popular tools. 
 In general, psychotherapy is a revealing pro-
cess. Psychotherapists are privileged to have unique 
access to the “inner, private life” of  individuals 
(Shedler, 2006, p. 44). Social media offers just one 
more path to a person’s private, subjective world. 
A psychosocial media approach may be one means 
of  exploring sources of  suffering. Complicating 
matters, however, is the fact that this inner, private 
life is often on display publicly in cryptic, maladap-
tive or more selected, adaptive self-presentations. 
 Some research has found that people make 
more intimate self-disclosures in computer-mediated 
communication as opposed to face-to-face commu-
nication (Tidwell & Walther, 2002). Other research, 
including a systematic review of  15 studies com-
paring online and offline self-disclosures, indicates 
that disclosure of  personal information online is 
not necessarily greater than it is in offline environ-
ments. Rather the mode of  communication, the re-
lationship between communicators, and the context 
of  the online interactions seem to better moderate 
the degree of  disclosure (Nguyen, Sun, & Camp-
bell, 2012). Another group of  researchers, after a 
review of  the existing articles on psychological fac-
tors contributing to Facebook usage, propose a mod-
el that focuses on two personality traits as motiva-
tion for using Facebook – the need to belong and 
need for self-presentation (Nadkarni & Hofmann, 
2012). Disclosing online (versus offline) perhaps 
more easily satisfies these two personality traits.
 One study (Suler, 2004) examined the Internet’s 
“disinhibition effect,” whereby people are more likely 
to self-disclose online, and appear uninhibited rela-
tive to their offline selves. This effect describes two 
different forms of  inhibition found online: benign in-
hibition and toxic inhibition. Suler defines the benign 
version as “a process of  working through – an at-
tempt to better understand and develop oneself, to re-
solve interpersonal and intrapsychic problems or ex-
plore new dimensions to ones identity” (p. 184). Suler 
differentiates this from toxic inhibition or a “blind 
catharsis, a fruitless repetition compulsion or acting 
out of  pathological needs without any beneficial psy-
chology change” (p. 184). These two theories may 

be helpful in not only in interpreting OSN profiles, 
but also in understanding the recent rise of  popular 
mobile applications such as Snapchat that allow users 
to send fleeting, risqué photo and video messages to 
each other. These Snapchats disappear from a recip-
ient’s phone after only a few moments, encouraging 
users to share pornographic content. While a clinician 
should never have access to such intimate social con-
tent, these examples illustrate uninhibited behavior 
and the willingness to share or perhaps over-share very 
personal information in new media environments.
 While the continuum between Suler’s notion of  
benign and toxic inhibition may be difficult to deter-
mine just yet, in future decades more trained mental 
health professionals will be likely confronted with so-
cial media-related issues. Thus, it is important for them 
to make sense of  – but not overly interpret – the many 
emotions, personalities, unconscious drives and cogni-
tions behind these OSN presentations and behaviors. 

Shame and Timing of  a Psychosocial Media 
Adjunct

 Another major concern may be that OSN ac-
cess engenders feelings of  client shame. One criti-
cism may be that social media access disrupts the 
natural unfolding of  disclosure, or induces shame 
before the therapeutic alliance has been established. 
Because these two points are important to consider, 
the timing of  a psychosocial media intervention may 
play a vital role in its effectiveness. In one study of  
adults undergoing face-to-face psychotherapy, initial 
disclosures generated shame and anticipatory anxiety, 
but eventually, over time, produced feelings of  safety, 
pride and authenticity (Farber, Berano, & Capobian-
co, 2004). Farber and colleagues’ multi-method study 
further found that disclosure can provide a sense of  
relief, and that keeping secrets inhibits the process of  
therapy. Participants expressed a desire for therapists 
to pursue their secrets more actively by answering 
the question: “Once in a while I wish she [therapist] 
would guess them [secrets]” (p. 343). Perhaps OSN 
profiles can strengthen the therapeutic alliance by 
substantiating guesses about such secrets. Farber et 
al.’s study was conducted with an older age group than 
the target demographic of  discussion, but a strong 

PSYCHOSOCIAL MEDIA



86

therapeutic relationship is similarly important with 
youth and has shown to be an important factor in 
successful youth therapy outcome (Karver, Handels-
man, Fields, & Bickman, 2005. Therefore integration 
of  OSNs may be a tactic best employed after sever-
al sessions to ensure that a therapeutic relationship 
has been firmly established and online profiles can be 
placed in context with previous in-person disclosures.
 Alternatively, for some adolescents and young 
adult clients, a psychosocial media adjunct may prove 
more fruitful during the beginning stages of  therapy. 
Research shows that the therapeutic alliance gener-
ally forms in the beginning phases of  psychological 
treatment and helps to predict positive psychother-
apy results (Henry & Strupp, 1994; Horvath, 1993; 
Martin, Garske, & Davis, 2000). Scrolling through a 
client’s profile may initially increase clients’ feelings 
of  anticipatory shame. Yet for some individuals – es-
pecially for those who are shy or socially anxious – it 
may reduce such shame compared to face-to-face dis-
closures. Online resources, in their varied forms, can 
often help facilitate social relationships and overcome 
shyness (Maczewski, 2002; Valkenburg, Schouten, & 
Peter, 2005). OSNs are inherently engagement tools, 
and if  a non-engaging or shy client actively uses on-
line social tools prior to treatment, these tools can 
perhaps provide clues about how to engage the cli-
ent by colorfully exhibiting his interests, attitudes, 
beliefs and interpersonal style. OSN access may ease 
disclosure during the beginning – critical – phases 
of  therapy by engendering feelings of  positive re-
gard, which also play an important role in positive 
psychotherapy outcomes (Farber & Doolin, 2011). 
In a general way, OSN integration may engender a 
sense of  congruence because the therapist is active-
ly seeking to understand and appreciate the genera-
tional interests and interpersonal world of  the client. 
 A recent study looked at the course of  action 
by clinicians that increases depth of  elaboration and 
therapeutic alliance (Lingiardi, Colli, Gentile, & Tan-
zilli, 2011). The depth of  elaboration is defined as 
the “dimensions of  the quality of  the psychothera-
py sessions,” essentially whether they are powerful/
weak, valuable/worthless, deep/shallow, full/empty 
and special/ordinary (p. 391). One key finding in-
dicated that relational patterns play a role in both 

depth and alliance. It is therefore important to help 
“explore, with the client, their interpersonal issues, 
identifying recurring themes and relational patterns 
in clients’ past relationships…” (p. 398). The study 
also found that therapists could increase the depth 
of  elaboration and therapeutic alliance by focusing 
interventions on client emotions, especially those 
regarded by the client as unacceptable (i.e. anger, 
resentment, envy). It seems that both client rela-
tional patterns and affect are evident on OSN pro-
files, which may be useful for a clinician to question. 
 If  therapists or clients believe that social media 
access would potentially disrupt the alliance or gen-
erate misleading information, then it should not be 
utilized. For those who do not share personal details 
on OSN or are not active users, this instrument of  
investigation may be especially ineffective. There 
is no manual on how to interpret social media ac-
tivity in therapy sessions just yet. There is, howev-
er, ample literature supporting the use of  photogra-
phy and autobiographical storytelling as adjuncts in 
therapy. OSNs seem to be a combination of  both.

Visual Expression in Psychotherapy

 Sharing and viewing photographs and videos is 
one of  the biggest allures of  Facebook. There are over 
300 million photographs uploaded daily on Facebook 
alone, making it the most popular photo uploading 
service on the web (Facebook, S-1 Filing, 2012). Also 
becoming increasingly popular are photo and video 
sharing, organizing and editing applications and sites 
such as Pinterest, Instagram, YouTube and Vine, and 
these could also take on meaning in a therapy session, 
especially because images are subjectively taken and 
interpreted (Banks, 2001; Coover, 2004; Dicks, Soyin-
ka, & Coffey 2006; Lister & Wells 2001; Pink, 2004).
 In 1980, Fryrear surveyed previous research 
on phototherapy and identified 11 document-
ed uses of  photography in psychotherapy: evok-
ing emotional states, developing skills, facilitating 
verbal behavior, modeling, socialization, self-con-
frontation, help in making diagnoses, fostering 
expression and creativity, documentation of  ther-
apeutic changes, prolonging of  meaningful experi-
ences, and helping to promote verbal communica-

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87

tion between the therapist and client (Fryrear, 1980). 
 Recent literature has further suggested that im-
ages can be interpreted as objects of  communication 
rather than just memory (Van House, 2011), and can 
be used as an adjunct in treating an array of  disor-
ders including alcohol abuse (Dollinger, Rhodes, & 
Corcoran, 1993), schizophrenia (Phillips, 1986), and 
eating disorders (Wessels, 1985), as well as popula-
tions including: family therapy (Kaslow & Fried-
man, 1977; Ruben, 1978) and adolescents (Blinn, 
1987; Vardell, McClellan, & Fryrear, 1982). The act 
of  exploring photographs in particular has shown to 
help clients conjure past events and memories, un-
earth emotions about interpersonal relationships, re-
late images from the past to the present, and form a 
better understanding of  identity. OSNs – with their 
emphasis on personal photos – may be of  particu-
lar use in therapy to address excessive concerns or 
idealizations of  body image for those suffering from 
eating disorders or Body Dysmorphic Disorder.
 Psychologist and art therapist Judy Weiser in her 
paper, “ ‘See What I Mean?’ Photography as Nonver-
bal Communication in Cross-Cultural Psychology” 
argues that photography is a form of  nonverbal com-
munication that can be interpreted as the “… con-
scious and unconscious self, moments of  importance 
chosen for whatever personal reasons to be frozen in 
time forever, and if  deemed successful, kept and trea-
sured as items of  value” (p. 245). She later explains 
how photo-exploring techniques, in a phenomeno-
logical and existential model can “guide discoveries 
where words cannot go” (p. 254). Based on her use 
of  photography as a therapeutic tool, she argues that 
clients rarely understand the extent to which they re-
veal themselves in their photographs. In addition, she 
points out that even a lack of  photos is telling because 
people don’t keep photos of  people or moments they 
do not cherish, and these voids of  people and rela-
tionships are areas that can initiate further question-
ing. Weiser’s paper however was written prior to the 
advent of  interactive online photo sharing, which im-
plies that newer, more interactive forms of  photogra-
phy may bring about even more explicit projections. 
Through simple digital communications such as com-
menting, “liking,” “tweeting” and even “retweeting” 
individuals create their perceived stimulus, because 

photos begin to “take on a life of  their own, almost 
apart from our process of  visual perception” (p. 263). 
 In addition, the comments beneath shared pho-
tos or videos on OSNs provide clues as to conveyed 
identity, and can therefore be a lens into a patient’s 
interpersonal feedback (p. 276) – perhaps more so 
than a photograph with no associated activity from 
a network of  friends or followers. In order to better 
understand a client’s interrelating system as a whole, 
it may behoove a therapist to interpret OSN dis-
closure from a narrative psychological perspective.

OSNs as Narrative

 Another important component of  Facebook, 
likely unbeknownst to its over one billion users, is 
that it is an emotionally-laden, narrative-generating 
tool. In many ways, psychotherapy is also the pro-
cess of  guiding people in formulating their life sto-
ries. Psychologist and writer Nancy McWilliams 
(2004) spoke to the narrative capabilities of  psycho-
therapy, “...we regard the project of  psychotherapy 
as a joint effort to develop a narrative that makes 
sense of  a person’s subjective experience and per-
sonal problems” (p. 139). On Facebook in particu-
lar, a new generation is quite literally constructing 
their life timelines. While visiting the profile of  a 
“friend” one can scroll through – chronologically – 
all of  the pictures, comments, quotes, “likes,” going 
back to the very day that they signed up for the so-
cial network (depending on the specific aspects of  
their profile that they choose to share). Facebook 
has become an interactive autobiography of  sorts. 
This is powerful, and considering the amount of  
time teenagers and adults spend on Facebook, these 
online self-presentations may play a role in shaping 
self-identity (Valkenburg, Schouten, & Peter, 2005).
 So what does this collage of  social activity – 
friends, family life, interests – actually mean, and 
how can it effectively be harnessed in a clinical set-
ting? Psychotherapists might glean a more compre-
hensive conceptualization of  their client if  they do 
so from a narrative framework. As psychologist and 
legal expert Jerome Bruner (1991) wrote in his pa-
per Narrative Construction of  Reality, “…we know 
altogether too little about how we go about con-

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88

structing, and representing the rich and messy do-
main of  human interaction” (p. 4). Narratives rep-
resented on OSNs may provide a clue. Psychologist 
Theodore Sarbin (1986) believed that narrative was 
a root metaphor for psychology and that human 
functioning is inherently contextual (Sarbin, 1986). 
He argued that narrative is so embedded in human 
functioning that it is easily forgotten as a metaphor 
for psychology. Similarly, OSNs are becoming em-
bedded into the culture of  a new generation, be-
coming root metaphors for psychology. Even the 
founder of  Facebook and former undergraduate 
psychology major at Harvard University, Mark Zuck-
erberg described his company as being “as much 
psychology and sociology as technology” during a 
2011 speech (Larson, C. Desert News. Mar 25, 2011).  
 Psychotherapists can play a critical role in help-
ing shape their clients’ personal narratives through 
joint investigation of  their OSN profiles. One pro-
posed method of  doing so is to examine online 
photographic narratives (photo albums) through 
the lens of  gender and sexual identity (Kaufmann, 
2007). Kaufmann describes distinct layers of  inter-
pretation in analyzing online photographic narratives, 
one of  which is the message itself. When an individ-
ual views an image on a computer screen, they are 
“actively and subjectively” building meaning, more 
so than in movies because there is more interactiv-
ity on the web and the viewer can be in “one, two, 
or a hundred different places at once… focus turns 
inward and internal fantasy becomes ‘real’, and the 
outer world diminishes” (p. 10). In some ways, as 
tangible as thoughts and images are on OSNs, they 
are also representations of  fantasy. Another ques-
tion to consider is why certain photos are chosen as 
profile photos and others as large cover photos (the 
long images spanning the top of  the newly-designed 
personal Facebook profiles.) Facebook and Twitter in 
particular are constructed in such a way that allows 
users to emphasize certain idealized images over oth-
ers, to emphasize and promote biographical details, 
attitudes, and interests. On Facebook, one photo is 
the profile image, a representation of  a person. The 
larger background photos are additional space to pro-
vide context and further expressions of  individuality.
 Narrative psychology, a field of  study and practice, 

provides principles that may inform the integration 
of  OSN and psychotherapy. In his paper “Metaphor 
and Medicine,” psychiatrist Jack Coulehan describes 
patients as understanding their suffering in a “nar-
rative way whether their physicians realize it or not” 
(Coulehan, 2003, p. 87). Coulehan further argues that 
narrative should be an essential aspect of  contempo-
rary medicine and be bound to the tools of  medicine. 
He says that words, images, metaphors and symbols 
are integral in day-to-day practice and that medicine 
is not above or beyond culture. Perhaps the tools of  
narrative may be even more adeptly applied to clinical 
psychology, a healing practice rooted in emotion, em-
pathy and disclosure. OSN profiles offer insight into 
the experience-near language, metaphors and sym-
bols of  a client’s interpersonal world. When utilizing 
OSNs, it may even be useful to question and test for 
accurate understanding and perception of  content, a 
process of  reflection pioneered by Carl Rogers (Rog-
ers, 1986). Hypothetical examples of  such questions 
might include:  Am I correct in saying that you are telling 
others with this photo album that you are fun loving and adven-
turous? Or, Based on your sarcastic or negative status updates, 
it seems like this week was pretty tough for you, am I right? 
By better understanding the story an individual pres-
ents on their profile, a therapist may glean a better 
understanding of  their interpersonal world and how 
they order events outside the confines of  the clinical 
office. Richert (2006) states that the goal of  psycho-
logical treatment is to help a person actively construct 
healthy narratives where the person – as opposed to 
outside forces – is the author. Yet the question re-
mains: in what larger theoretical framework might 
a psychosocial media approach effectively work?

Modes of  Psychosocial Media

  In their review of  technological adjuncts in psy-
chotherapy, Clough and Casey (2011) note that there 
has been “very little research examining the suitabil-
ity of  technological adjuncts to different types of  
therapy” and argue that “future research should ad-
dress whether particular therapies are more amena-
ble to making use of  adjunctive technologies than 
others” (p. 290). Perhaps Richert’s  (2006) mode 
of  integrating narrative psychology into psycho-

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therapy may provide clues as to how OSNs can be 
integrated into psychotherapy using a larger psy-
chodynamic or cognitive-behavioral framework. 
 Based on the tone, language and mood present-
ed, the nature of  the client’s story may reveal itself  
and can be used as a basis for selecting a therapeutic 
approach (Richert, 2006). In his paper on the inte-
gration of  narrative psychology into psychotherapy, 
Richert argues that a useful way to categorize client 
stories is by distinguishing between their “agency” 
and “communion” (Bakan, 1966),the former being 
the sense of  individuality and pursuit of  personal 
goals, and the latter signifying the pursuit of  “shared 
goals of  the common good” (Richert, 2006, p. 91). 
Richert labels an individual’s sense of  agency or com-
munion as “relatedness” – how a person positions 
himself  toward others – and believes that it has an 
impact on the therapy relationship. Essentially he dif-
ferentiated how individuals rely on external informa-
tion or rely more on their own inner experiences and 
intuition (Richert, 2006). Both seem to be present 
in OSNs. Perhaps some client’s relatedness towards 
others lean more towards agency over communion, 
and vice versa. Although OSNs are generally built to 
share information publicly, they are not always mech-
anisms for the act of  sharing in the “common good.” 
 Despite the public-nature of  Facebook, much 
of  what is shared contains Richert’s (2006) notion 
of  agency i.e. preferred news articles, group affilia-
tion, self-image, and self-identity and other personal 
attitudes. Richert fits various theories into “agentic” 
and “communal” classifications. In particular, he ar-
gues that the analytic, behavioral, person-centered 
and Gestalt theory fit within the “agentic” bucket be-
cause they focus almost exclusively on the individual, 
whereas cognitive, narrative, existential, solution-fo-
cused and interpersonal therapies fit best in a more 
communal classification because they focus more 
on connectedness with others (Richert, 2006, p. 99). 
 There seems to be a number of  ways to interpret 
an individual’s OSNs. Each clinician could incorpo-
rate or apply his or her own therapeutic framework 
in helping to utilize OSN client profiles. For exam-
ple, a psychodynamic framework may connect a cli-
ent’s maladaptive online behaviors with past familial 
relationship patterns, allowing for a more visual un-

derstanding of  relational functioning. Alternative-
ly, a cognitive behavioral approach may challenge 
the cognitive distortions a client expresses about 
the comments or feedback he or she is receiving 
on their profile and implement behavioral modifi-
cations, i.e. changes in the frequency of  OSN use. 
 In his 2001 paper, Davis introduces a CBT 
model for treating Internet addiction and ex-
plores the way exposure therapy and behavior-
al changes can potentially bring about positive 
psychological outcomes for Internet addiction:

Exposure therapy might include keeping the cli-
ent away from the Internet for a period of  time, 
having the client observe that nothing negative 
actually happens if  they are offline, and finally, 
having the client observe his or her own cog-
nitive reactions to the Internet by multiple ex-
posures to various Internet functions (p. 194). 

After observing a client’s OSN behavior alongside 
them (exposure to various Internet functions), a 
client may be more receptive to making behavioral 
changes. In general, when it comes to technological 
adjuncts, therapists with cognitive behavioral back-
grounds more frequently endorse new technologies 
in psychotherapy (Mora, Nevid, & Chaplin, 2008).

 
Other Examples of  Technology Used 

in Psychotherapy
 
 It is important to note that psychotherapy has 
not completely spurned new media. Clough & Casey’s 
review (2011) identified six key areas in which tech-
nology has been used in psychotherapeutic practice: 
mobile phones, Personal Digital Assistants (PDAs), 
biofeedback, Virtual Reality (VR), computer games 
and electronic questionnaires. A number of  recent 
studies have found that Internet-based interventions 
– particularly for CBT (cognitive behavioral thera-
py) – are promising in reducing symptoms of  mild 
to moderate depression (e.g. Foroushani, Schneider, 
& Neda, 2011), anxiety (e.g. Craske et al., 2009) and 
panic disorder (e.g. Klein, Richards, & Austin, 2006). 
 Mental health professionals today often pro-
mote the use of  video conferencing tools such as 
Skype or email to correspond with their clients, al-

PSYCHOSOCIAL MEDIA



90

though most practitioners agree that it is best used 
as a supplement to face-to-face meetings. Still, OSNs 
constitute a different media platform. Most estab-
lished psychologists rarely use OSNs themselves, 
and lack knowledge to provide a supervisory guid-
ance (Taylor, McMinn, Bufford, & Chang, 2010). As 
mentioned, Internet-cognitive behavioral therapy 
(iCBT) has proved to be a useful vehicle for CBT, 
and in many instances is as equally effective as face-
to-face CBT. While these advancements are positive 
utilizations of  emerging media, they are mere facilita-
tors, as opposed to remnants of  human interaction, 
attitude, emotion and personality. While burgeoning 
mechanisms such as Skype, email, chat, virtual real-
ity exposure therapy, iCBT and mobile applications 
can grease the wheels of  disclosure and enhance the 
therapeutic process, they do not generally contain 
the elaborate content of  unconscious emotions and 
conscious expressive representations found in OSNs.

Conclusion

 The 2009 Presidential Task Force on the Future 
of  Psychology Practice (American Psychological As-
sociation, [APA], 2009) recommends that psycholo-
gists be trained “to use and integrate technologies to 
provide quality services” (p. 5). Social scientists are 
being encouraged to utilize and tap into the psychol-
ogy behind the digital landscape, but the question 
remains: what implications do these self-disclosures 
and self-presentations on OSN have for clinicians?
 Social tools such as Facebook, Twitter, Tumblr, 
Instagram, as well as dating sites and apps have col-
lectively attracted billions of  users who have creat-
ed billions of  virtual interpersonal connections and 
shared countless articles of  personal information. 
These points of  contact and presentations are filled 
with clues as to how individuals express themselves 
and manage relationships in a digital ecosystem. In 
addition, it has raised questions about how people use 
OSNs and how personalities are reflected in its usage. 
While OSN personality data remains inconclusive, re-
cent findings indicate that personality processes are 
salient on OSN and, more often than not, parallel the 
processes in direct, face-to-face environments (Gos-
ling, Augustine, Vazire, Holtzman, & Gaddis, 2011). 

 Going back in timeline fashion on Facebook, 
there are traces of  personality, previous love inter-
ests, political affiliations, attitudes about current 
events, words of  wisdom, biographical information, 
the crowd-sourcing of  advice from ones network, 
displays of  frustration, aggression or perhaps even 
cyberbullying or suicidal behaviors. All of  these con-
tain hints of  individuation, agency, and interpersonal 
styles or communion. While these traits and behav-
iors exist on a continuum of  therapeutic importance, 
all are uniquely significant. In essence, while OSNs 
are filled with trivialities and banalities they addi-
tionally contain abundant exclamatory material that 
color the emotional well being of  clients and may 
provide greater therapeutic context and content. 
 As social media technology has advanced and di-
versified over the past several years, the number of  
OSN users has expanded beyond college campuses. 
This is especially true of  Facebook. Yet questions 
also remain as to how Facebook use differs from 
everyday face-to-face communication, or from oth-
er media sources such as television, radio or video 
games (which are also expanding their services to the 
web and becoming more socially-oriented). Some re-
searchers argue that Internet-based communication 
is a combination of  many past media advancements 
(Bargh & McKenna, 2004), but given the addic-
tive- and interactive-nature of  Facebook – over 250 
million photos uploaded daily and over 100 billion 
friendships (Facebook, S-1 filing, 2012) – it is clear 
that OSNs are a much more public and measurable 
medium seemingly ripe for utilization in therapy. 
 Understandably, some clients and therapists will 
view this proposed psychosocial media intervention 
as a breach of  privacy or a shallow endeavor. It may 
indeed be true that only those mental health profes-
sionals and clients already conversant in OSNs would 
profit from this joint exploration. Another appre-
hension is that a client’s social activity would include 
comments and/or photos from unwitting friends 
or followers. Presumably, these friends and follow-
ers would consider their OSN interactions private 
or, at least, limited to a controlled following. Per-
haps even more concerning is the possibility that a 
clinician personally recognizes individual(s) who are 
visible on a client’s OSN. This could create a con-

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91

flict of  interest and raises further questions regarding 
how client privacy issues differ in the digital space.
 Nonetheless, in the same way a fireman must 
find the location of  a blaze, a therapist must tirelessly 
work to locate the core of  emotions. If  the emotion-
al fire rests somewhere in a person’s digital domain, 
then there a therapist should cautiously turn. How-
ever even if  a direct OSN approach is not feasible, a 
more indirect, hands off  approach may be more com-
fortable. It seems reasonable to inquire about OSN 
activity in therapy, especially for adolescents, young 
adults, or those individuals who spend an inordinate 
amount of  their time using this technology. Ques-
tions might include: How much time do you spend online? 
Are you on Facebook or Twitter? How many friends/followers 
do you currently have? Are you ever bullied online?  These 
questions can open a new path into the unconscious, 
as well as bring to light present cognitions, emotions 
and maladaptive behaviors. In doing so, they may 
strengthen the therapeutic alliance. An individual’s 
personal OSN profile may be safer being explored 
alongside a trained mental health professional who 
maintains perspective and a pulse on their emotion-
al sensitivity and overall functioning versus friends, 
family or acquaintances who are not clinically trained. 
 The “likes,” posts, pokes, pictures, comments, 
group membership, friendships, re-connections of  
the so-called Facebook Generation will become part 
and parcel of  their social and emotional schemas 
as they grow into adults. Likewise even older adults 
will assimilate new social technology into their ex-
isting interpersonal schemas. Understanding and 
exploring the psychology behind these often-seem-
ingly trivial social tools can be beneficial to the 21st 
century therapist. In coming years, clients will be in-
creasingly shaped by their online ecosystems. While 
remaining careful, clinicians should understand and 
embrace this technology if  and when appropriate. 
 

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