Approaches to treatment
One of the difficulties in treating children who have been cyber bullied is that they are reluctant to tell others about their victimization. Children and adolescents who are the targets of cyber bullying may be unwilling to speak out for several reasons, including:
- They fail to recognize that they have been cyber bullied.
- They fear that they will be further victimized if the perpetrator gets into trouble and retaliates.
- They fear that their parents will remove their computers or cellular phones in an effort to protect them.
Parents who remove the computer or cellular phone are depriving the victimized child of a lifeline of communication with their peers. In the absence of being directly told, parents, educators, counselors, psychologists, and psychiatrists need to be alert for other warning signs that cyber bullying is occurring.
The most common warning signs of electronic bullying include depression, anxiety, social isolation, nervousness after interfacing with technology (eg, the computer or cellular phone), lowered self-esteem, deficits in school performance, and impaired health.1,3 In a survey of more than 700 participants, those who had been cyber bullied reported feeling depressed, hurt, and confused. One reported feeling “meek and small, very alone, and helpless” (Kowalski and Witte, unpublished data, 2006).
Another survey of more than 900 youths in grades 6 through 12 demonstrated the harmful effects produced by cyber bullying (Kowalski and Limber, unpublished data, 2008). Participants were categorized into 1 of 4 groups based on their victim/perpetrator status (whether or not they had experienced cyber bullying at least once within the past 2 months): victims, cyber bullies, bully/victims (those who bullied others and were themselves bullied), and individuals not involved with cyber bullying at all. Individuals who were bully/victims displayed more anxiety, more depression, and lower self-esteem than individuals in the other groups. Interestingly, however, perpetrators of cyber bullying did not differ in their levels of depression, anxiety, or self-esteem from individuals who were not involved with electronic bullying. In addition, when compared with individuals who were not involved with cyber bullying, both cyber bullies and bully/victims reported more absences from school and lower grades.
As with traditional bullying, bully/ victims appear to be at particular risk for psychological and physical problems associated with bullying. This highlights the need for practitioners to assess the group status (bully, victim, bully/victim, and those not involved) of their patients as a means of determining the magnitude of effects that might be experienced and observed.
At the extreme end are children who commit suicide, in part, as a result of being cyber bullied. Two notable examples of this are Ryan Patrick Halligan and Megan Meier. Following Halligan’s suicide in October 2003, his parents discovered that fellow students had been mercilessly cyber bullying Ryan via instant messaging for months before his death. Unlike Ryan, who was bullied by his peers, Meier was cyber bullied by an adult, Lori Drew, who posed as a young man on the social network site MySpace. Drew, despite knowing Megan’s history of depression, wanted to observe any information Megan might report about her own daughter online. Drew was indicted in Los Angeles for conspiracy and unauthorized access to private computers.
Research into the effects of cyber bullying have yet to address the effects of cyber bullying on a critical third-party role played by bystanders. Because cyber bullying bystanders are often inadvertently drawn into the aggression in a form of cyber bullying known as indirect cyber bullying or cyber bullying by proxy, the effects on them are estimated to be more problematic than those on bystanders to traditional bullying.8 Much of the research on bystanders of traditional bullying has focused on those who are often called “puppet-masters” and who are seen as central in encouraging the perpetration of bullying behavior.14 Clearly, however, witnessing bullying, in the real or virtual worlds, can have detrimental psychological effects.
The first order of treatment is in assessing and treating the immediate psychological needs of the patient (anxiety, depression, low self-esteem). In addition, therapists should focus on strategies that will empower the patient in future situations in which cyber bullying might arise.
Conflict resolution is not a recommended strategy because such programs typically assume that both parties are at least partly to blame. The target needs to be empowered to understand that he or she is not at fault, and perpetrators need to accept responsibility for their actions. With traditional bullying, therapists typically work to teach targets of bullying skills that will enable them to protect and assert themselves should they find they are confronted with bullying behavior again.3 In the virtual world, however, the exact skills to teach are a bit more ambiguous.
Therapists working with patients who bully in either the real or virtual world, should focus on helping their clients understand the consequences of their actions on the victim.3 Particularly in cases of cyber bullying, where perpetrators are often unaware of the emotional impact of their behavior, therapists can work to help their patients develop empathy and insight to deter future bullying behavior. Unless there has been a direct cyber bullying threat against a specific person the therapist does not have a duty to warn. More research and case study reports are needed on interventions with cyber bullies because most of the research to date has focused on those who are victimized.
As of this writing, 36 states have passed legislation specifically related to bullying. Although only 6 of these include specific statutes related to electronic bullying (Arkansas, Idaho, Iowa, South Carolina, Washington, Missouri), the wording related to bullying in most other state statutes could be used to cover many instances of cyber bullying.15,16 Still, the legal tangle that many find themselves in with cyber bullying is defining the line between freedom of expression (ie, First Amendment rights) and protecting the well-being of those who are being defamed.4
In individual therapy, confidentiality issues with reports of cyber bullying can be a bit tricky. Because clinicians are mandated to report child abuse, any cyber bullying that takes the form of sexually explicit images of a minor must be reported to local law enforcement. If the cyber bully is passing along such images, then he is distributing child pornography, which would also warrant a report. As the prevalence of “sexting” (sex texting or the distribution of sexually explicit images via cellular phones) increases, therapists will be faced with increasing instances of the need to report.17
If the cyber bullying takes the form of cyber stalking (involving threats of harm), then parents of a minor would need to be notified in accordance with the duty to warn, as well as the police in most instances. It is often useful in these circumstances to seek the counsel and advice of a trusted mentor or colleague. Most confidentiality agreements signed by patients cover these issues, and patients are informed that particular circumstances may necessitate the sharing of their information with those in positions of authority. If, in therapy, a patient reports cyber bullying at school, then, with the client’s permission, the therapist should notify the school authorities so that appropriate action can be taken.
Researchers and practitioners are still in the initial stages of charting the path to understand and treat victims, perpetrators, and bystanders of cyber bullying. Although research on traditional bullying provides a useful starting point, it is important to recognize that cyber bullying is not the same thing as traditional bullying and that the individuals involved in the 2 types of bullying are not necessarily the same group of people. The effects of cyber bullying are serious and, in some instances, life-threatening. Given the frequency with which youths are engaged with technology, psychologists and psychiatrists need to be alert to the possibility that their patients may be targets, perpetrators, or bystanders of cyber bullying.