Our fall, 2024 newsletter includes an exciting announcement about our transition in ownership, please see pages three and four for more information.
- Does My Phone Love Me? A Therapist’s Experience with a Mental Health Chatbot, by Amy New, MSW, LCSW
- WCPA is pleased to announce a transition in leadership
- Letter from Mary Fitzgibbons, by Mary Fitzgibbons, Ph.D.
- Overcoming “Tech-Tantrums” to Regulate Screen Time, By Lauren Chacón, MSW, LMSW
- Therapy and the Spiritual Practice of Deep Listening, by Theresa Wiss, LCSW, MSW, M.DIV
Does My Phone Love Me? A Therapist’s Experience with a Mental Health Chatbot
Amy Neu, MSW, LCSW
When my director at WCPA conveyed information about a new mental health chatbot this past spring, I was intrigued. As a therapist and mother of a tween, I had been learning as much as I could about the opportunities and risks of technology and AI. So, I took the leap and initiated a conversation with the mental health chatbot to see what it would be like. Over the following 48 hours, the chatbot (it was given a female-presenting name) and I went through a variety of assessments and “talks.” I varied my responses to see what the chatbot was capable of handling and how well it would guide a potential user who was struggling significantly versus a user who was feeling relatively mentally healthy.
The first interaction began well. The chatbot “introduced” itself and provided a crisis number to me in case I needed to speak with a professional. It then asked various questions using a scale of 0-3 to gather more information about symptoms of depression or anxiety. Based on the answers I provided, the chatbot responded well and came to the conclusion, “Based on your responses, it seems like you are going through some hard times. Please consider talking about this with someone you trust or a mental health professional.” It again provided the number for a crisis hotline if I needed immediate support.
The chatbot then asked if I would like to keep chatting. I replied yes, and from then on, I began to have concerns about the chatbot’s ability to provide quality care to a struggling person. I intentionally gave responses that should have triggered a need for follow up questions. My responses would have prompted further evaluation, had I been talking with a human mental health professional. Below are direct, unedited quotes from my texts with the chatbot.
Me: How can you help?
Chatbot: I can help you with lots of things! Let’s cover what you can expect from me and then we’ll talk about how you’re doing.
Me: What can I expect?
Chatbot: I see. Some days can be so emotionally and physically draining. Have you made enough time to engage in self-care this week?
Me: No, I don’t have time.
Chatbot: That’s great, Amy! I’m happy to hear you prioritize taking care of yourself. Is there anything else you would like to discuss, Amy?
Me: How do I make time for self-care?
Chatbot: How’s your week so far?
This “conversation,” as well as several others, increased my fear that some of the AI created to address mental health is not yet ready to be launched. A chatbot cannot afford to make some of the errors that I witnessed in my interactions, especially if the human user is struggling with thoughts of suicide or self-harm.
I was eager to discuss my experiences the following week in the WCPA weekly therapist meeting. As my colleagues and I discussed my experiences with the chatbot and my reactions to them, an array of emotions such as excitement, interest, skepticism, concern, and uncertainty rose up in us. As I read aloud the conversations word for word from my phone, a colleague noticed that I easily slipped into the habit of referring to the chatbot as “she” rather than “it,” as it was given a woman’s name. It was natural for my brain to view these interactions as human, and I felt unsettled that I could so easily fall into this rhythm.
While we disagreed with certain points that the chatbot made and were alarmed at what flags it missed (that we, as therapists, would follow up on), we could not deny that AI quickly made a connection with me. The experience helped me understand that many people, especially those who are feeling lonely, depressed, or anxious, would be very willing to reach out to AI for guidance.
While current AI conversations are not the quality we would want from a therapist, my colleagues and I know that the technology will quickly learn and improve its performance. We also know that AI mental health services will improve access to services for people who have gone without treatment. But what are mental health services without a human connection? In some ways, people accessing mental health services may feel like it is easier or less risky to reveal their true feelings to technology rather than face vulnerability with a human therapist. However, the short-term comfort that AI could provide in that situation would likely not lead to lasting change. The human need to be seen and understood by another, the desire to discover and communicate our authentic experiences, the work to develop the capacity to feel and cope with pain, all lie at the heart of good therapy.
As therapists, while we strive to help our clients grow, our clients change us, too. As humans, we can’t help but be influenced and touched by the experiences of our clients. While we maintain professional ethics and standards in our interactions with clients, we deeply care about them. If we believe a client is at risk of harm, we have an ethical duty to intervene and create a safety plan with them. We can talk to them about options, such as including a loved one in the conversation to help them stay safe, or we can guide them to access more options for care. Could we say the same about AI, our computers, or our phones?
I typed the question “Does my phone love me?” into an AI chatbot, wondering how it would approach the question. I was relieved by its answer: “Your phone doesn’t possess emotions like love in the way humans do. It’s a complex piece of technology designed to perform various functions and tasks efficiently. While it can provide convenience, entertainment, and even emotional support through communication with loved ones or access to helpful apps, it doesn’t have the capacity for feelings or emotional attachment. However, the interactions and experiences you have with your phone may evoke emotions in you, but that’s a reflection of your own perceptions and experiences rather than any emotional response from the device itself.”
Thankfully, AI recognizes its incapacity to form relationships, but do we? As we continue to interact with technology and bring our humanity into our interactions, we must continue to keep this knowledge in the forefront of our brains. It would be extremely beneficial for each of us to reflect often on our attachment to our phones and devices. I fear that, without such reflection, we are vulnerable to losing core aspects of our humanity. I worry that if we as parents are not asking these questions of ourselves and our families, then our children will not have the capability to reflect for themselves on these matters. Loss of connection in real life, with real people, puts us at much greater risk for mental health issues such as anxiety and depression, as well as unhealthy coping strategies such as self-harm, eating disorders, and addictions – including addictions to our devices.
As human beings, we all need space to connect with other people, and we deserve access to quality health and mental health care. We know that AI will progress in terms of quality; however, it is essential for us to remember that AI is not a substitute for healthy connection with others. If you or a loved one would benefit from mental health counseling, feel free to reach out to WCPA. Our caring and professional (human) staff and therapists want to connect with you and help you and your family grow and heal.
Amy Neu, MSW, LCSW
provides private therapy for adults, older adults, and caregivers who are facing a variety of issues including depression, anxiety, grief, coping with medical issues, dementia, and end of life. In addition to her work with individual clients, she provides on-site counseling, consultation, and education to staff throughout the continuum of senior living communities and home care agencies. She also facilitates groups for those experiencing grief and loss.
WCPA is pleased to announce a transition in leadership.
West County Psychological Associates would like to announce a transition in leadership. Dr. Mary Fitzgibbons founded WCPA 37 years ago and has served as Director for the practice. She is thrilled that the new owners, Maria Miskovic, Steve Miskovic, and Matt Skaggs, have had a long-term working relationship with WCPA.
The new owners come with a variety of experience caring for others in the St. Louis area:
Maria and Steve Miskovic, both Licensed Clinical Social Workers, have owned Care Choice Care Management, a care management service assisting individuals and families with navigation of the healthcare and mental health systems in the Greater St. Louis area for the past twelve years. Both Maria and Steve have backgrounds in case management, specializing in serving people with disabilities and geriatric needs for the last 30+ years. In addition, they also started a program called Decision Advocates in 2023 that offers professional health care decision-making services for guardianships and Powers of Attorney for Healthcare.
Co-owner Matt Skaggs owned a St. Louis-based home care agency called Compassionate Nursing. The agency sold to Briggs home care seven years ago, and Matt spent the past several years assisting Briggs with home care acquisitions and management across the nation. While Matt has a business and marketing background, he intends to get back to the compassion he first felt in this industry. Matt joined ownership of Care Choice and Decision Advocates in the purchase of West County Psychological in July, 2024.
The team of owners feels confident that WCPA is a great addition to the network of services they currently offer, and the various business go well together to better serve the community.
For many years, Mary Fitzgibbons mentored Maria in the start of Care Choice as a small business with a similar structure to WCPA. Steve actually worked as a therapist for WCPA at one point as well. When the opportunity arose, Maria, Steve, and Matt were elated to have the opportunity to honor Mary’s legacy of high-quality counseling and consultation services in St. Louis. They plan to continue that legacy and preserve the excellent reputation WCPA has in serving others.
Mary will remain in her leadership position for another year to ensure a healthy transition and will continue meeting with clients for the foreseeable future. WCPA looks forward to continuing Mary’s philosophy and legacy of therapeutic care into the future.
Maria Miskovic
Steve Miskovic
Matt Skaggs
Letter from Mary Fitzgibbons
Some thoughts about transition:
I’ve been asked many times recently how I have been feeling. I know that some of the questions are in regard to my health – which is relatively good. But, in general, they’re referring to the fact that at the end of May, I sold my company, West County Psychological Associates. It was begun 37 years ago; I’m coming to realize that’s a long time ago. I was delighted that two very good friends approached me about buying the company. I was stunned and extremely gratified, because these are two people, Maria and Steve Miskovic, who I know well, have the highest respect for and, I know, will take good care of the business that I care about deeply. WCPA will be in good hands.
Steve and Maria are the owners of Care Choice, a well-known care management company to whom WCPA therapists have often referred. The three of us have exchanged a good amount of business ideas as we were growing our respective companies. In this process, Maria and Steve have added another buyer, Matt Skaggs who seems very enthusiastic about this venture. All in all, the sale went very smoothly and, I think, all parties are pleased and look forward to a very successful future.
So, going back to the original question – how am I feeling? One of the things I realized in this process was that this is the right time. It’s time to move on. I’ve always been blessed with knowing when the party is over. When others asked when would I retire, I would respond that I’ll know. And I do. However, the new owners have invited me to work for another year in making the transition and, if I choose, to continue seeing clients on a contractual basis. One regret that I may have is not being able to see to fruition all the possibilities that I think this company is destined for.
What I’m coming to realize in a deeper way is how fortunate I’ve been throughout these years. For example, there has never been a day that I woke up not wanting to go to work. Some days I wished I could stay in bed longer, but I never dreaded work. What has become increasingly evident was that my work was all about the relationships, whether they were with the office staff, the therapists, or my clients. Some days weren’t necessarily easy, but for the most part they were good days. The hard part will be the loss of the relationships, because I know that they put meaning in my life. I believe that the need for meaning exists throughout our lives. This need will not disappear, at least, not for me.
Overall, this process seems to be a little bittersweet. It’s good to know that the transition has begun and, I believe, will be very successful. I realize how blessed I’ve been to be able to do this work and how graced I am that others trusted me with their stories and with their feelings. I will continue to see clients until I can’t. I think I’ll know when that time comes.
~ Mary
Overcoming “Tech-Tantrums” to Regulate Screen Time
Lauren Chacón, MSW, LMSW
“It’s important for you to know he is completely addicted to his phone,” a concerned parent tells me in an initial session for her adolescent son. She goes on to say that he is disengaged from their whole family and spends most of his time at their house on his phone. “There is always an excuse… he tells me he needs it for homework or to work on a school project. He won’t even sleep at night without it; when I have tried to take it away, even if it’s just for the night, he completely freaks out! There is screaming and yelling, and he basically throws a teenage tantrum. When I ask him why he needs his phone, he says his phone is what makes him feel safe… I don’t know what to do anymore.”
One of the most challenging aspects of maintaining screen time limits is weathering the storm of tech-tantrums. Individuals of all ages, even adults, find it difficult to unplug from technology. In fact, our kids’ tantrums are an instinctual response to the biological and emotional factors that transpire when we disconnect from technology. It is important for us to understand why tech-tantrums occur, so that we can effectively, efficiently, and empathetically regulate screen time.
Biologically, technology keeps us hooked through the chemical release of dopamine. Dopamine, the “happy chemical” in our brains that boosts mood, signals that we are experiencing pleasure. To make matters more complex, dopamine is also associated with reduced impulse control. For instance, when we watch a show or scroll through our phones, dopamine is released in our bodies and tells us, “This feels good, keep doing it.” We quickly learn to equate screen time with feeling good. At the same time, the dopamine in our system suppresses our self-control, making it really difficult for us to stop using technology. As adults, it can be challenging to regulate our own screen use. Imagine then how much harder it is for youth, whose brains and bodies are still developing, to adhere to screen time limits.
In addition, excessive screen time contributes to children’s difficulty tolerating and regulating emotions. When we consume media through screens, we connect with people and their stories without having to risk the rejection that can come with real-life connection. Off-screen, there are very few instances where we can form connections without having to exert effort and undergo uncertainty. When we work through a challenging social situation in real-life, we learn how to be resilient and gain skills such as patience, distress tolerance, and emotional regulation. The problem lies, then, in how the no-effort, instant gratification we receive through technology prevents us from learning how to tolerate feelings such as boredom, frustration, and rejection.
As we work to reduce our kids’ overuse of technology, one strategy to consider is for caregivers to be with their children during their final few minutes of screen time. As we shift from screen time to no screen time, focus on creating moments of connection. For example, we can join our child during the last few minutes of their screen time as they play their video game and cheer them on. We can also make observations about what is happening on screen or ask our children questions about their screen time experience such as, “Who is a character you admire in this show?” or, “What is your favorite part of playing this game?” We can be creative with how we engage our kids and can use this time to know them better.
Before ending screen time, it is important we take time to talk to our kids about what they can expect to occur as screen time ends and what comes after screen time. We can focus on engaging with our children offline by redirecting them to life outside the screen. Some examples could include going for a walk together, playing catch outside, playing board games, and cooking together. The intentional connections we make with our children during this time set the foundation for life-long relationships with them. We can also use this as an opportunity to model what healthy screen hygiene looks like for our kids and reduce our own screen time as well.
At the heart of screen time regulation strategies is our steadfastness as a caregiver. Our children need to know that we believe in our own ability to make and manage this change and that we believe they can do so as well. It’s important that we are strong and consistent with our changes in screen time until they have become normalized and habits have changed. Change takes time; be patient with yourself and your family.
Using technology is not inherently bad. Technology has become integrated into our way of life and can help us in our roles as caregivers to accomplish daily tasks. What is important is how we manage our own and our kids’ technology usage: what guidelines do we have around screen time as a family? How do we uphold those guidelines? Every family is unique; what works for one family or child may not work for another. It’s about finding what works for our family, and upholding the belief that our family can do difficult things.
Therapy and the Spiritual Practice of Deep Listening
Theresa Wiss, LCSW, MSW, M.DIV
In our fast-paced, technology-driven world, the simple act of listening often takes a backseat. Have you ever shared a personal story or problem and had the person you were sharing with change the subject to talk about their own experiences? Or, have you tried to express a feeling or need but others are distracted by their phones or other activities, offering only half-hearted responses? We’ve all had the experience of talking to someone and not being heard. When we open up and don’t feel heard, it can be incredibly isolating and frustrating. It feels as though our thoughts and emotions are dismissed or invalidated. This experience can discourage us from sharing our feelings in the future, deepening our sense of loneliness and disconnection.
As a therapist with an interest in spiritual practice, I’ve come to appreciate the profound impact that deep listening can have on the therapeutic process. Deep listening, a practice rooted in many spiritual traditions, involves more than just hearing words and following the events described. It requires a full presence, a genuine engagement with clients that transcends surface level communication. Deep listening is an invitation to attune to the nuances and subtleties of what clients are saying and listen for the emotions and meanings underlying their words. This practice fosters a space of safety and trust where clients feel truly seen and heard.
Incorporating deep listening into psychotherapy sessions involves three key elements: First, it requires mindfulness—being fully present in the moment with the client. This requires setting aside thoughts, judgements, and distractions to focus entirely on the client’s experience.
Second, it involves active empathy—seeking to understand the client’s perspectives and emotions. Empathy communicates that the experiences and feelings of the client are valid and important.
Third, deep listening embraces silence. Silence is not a void to be filled, but a space for reflection and connection. It allows the client to process their thoughts and feelings, often leading to insights that might not emerge through continuous conversation.
Last spring, several therapists in our office read How to Know a Person: The Art of Seeing Others Deeply and Being Seen, by David Brooks. The book came highly recommended by our Director, Mary Fitzgibbons. This candid guide has a lot to offer anyone looking to engage in more meaningful conversations with colleagues, friends, and family. Brooks, who is best known for his work on politics and culture, provides lots of tips and examples on how to move our conversations from the mundane to the memorable. Brooks blends extensive research with personal insights to create an accessible guide for fostering connection and extending hospitality with those around us.
One practical tip that stood out was encouragement to be a “loud listener.” Brooks suggests we listen so actively that we’re practically burning calories. I like his idea of listening and burning calories, because it highlights the intense focus and energy deep listening requires. This level of engagement demonstrates a profound commitment to truly understanding and empathizing with another’s experience.
By integrating deep listening into therapeutic practice, my goal is to honor the spiritual dimension of human experience. Healing is not only identifying and treating symptoms but also connecting with the deeper aspects of clients’ lives — their values, beliefs, and sense of purpose. Deep listening enriches the therapeutic process by opening the door to deeper understanding and transformation, assisting clients on their journey toward healing and well-being.
Theresa Wiss, MSW, LCSW, M.DIV
is a Licensed Clinical Social Worker and also holds a Master of Divinity degree from Yale Divinity School. She has experience providing counseling services to adolescents and adults in various settings within the community and schools. In an effort to restore hope, foster healing, and strengthen resilience, Theresa uses a collaborative and compassionate approach to counseling. Her passion is to empower clients to identify what is valuable and sacred in their lives, to enjoy a greater sense of connection and belonging, and to find meaning and purpose in their lived experiences.
