THOUGHTS ON SKYPE-BASED THERAPY
Telepsychology or virtual therapy is not a new phenomenon.
Many therapists assist clients in various ways that do not include both parties working together in the same room.
This includes therapy consultations via phone, email, internet chat, and more recently online teleconferencing applications such as Skype (or similar platforms).
In my practice, I offer telephonic and virtual therapy to patients as these mediums best approximate face-to-face therapy work.
Some therapists use virtual therapy as a way of accommodating existing clients (who might be ill, away on holiday, or away for business) while others may initiate and maintain therapy with new patients online.
More and more guidelines for telepsychology are being published by regulatory bodies such as the American Psychological Association.
These guidelines attempt to protect the client’s rights and quality of care.
Weighing up the pros and cons
If you are thinking about entering into a virtual therapy, here are some things to consider.
As with any form of therapy, there are advantages and disadvantages to virtual work.
- connection problems (it may take a while to find an online platform that works for both therapist and client – incl. Skype, FaceTime, Google Chat, or Viber )
- privacy concerns (Skype is not a 100% secure platform, however secure teleconferencing applications may require higher bandwidth and be prone to more time outs)
- your therapist will not be in the same location in the event of an immediate crisis (it is therefor important that your therapist is informed of other service providers or networks close to you, such as hospitals, general practitioners and clinics), and
- your health insurance may not cover telepsychology with a therapist based in another country (however health insurance is not designed to cover in-depth therapy and the reality is that most clients pay out of pocket for therapy)
- clients struggling with severe forms of agoraphobia or social anxiety might find entering into a virtual therapy helpful as a first step in seeking assistance
- expatriates and individuals living in a foreign country (with a different culture and language) may prefer working with a therapist from the same cultural frame of reference and first language
- people located in rural areas with limited access to psychologists and psychologists with specific areas of practice (such as trans community) will have improved access through means of virtual therapy, and
- exchange rates may make therapy cheaper if you live in a country with a stronger currency to that of your therapist.
Emulating traditional therapy
As far as possible, you and your therapist would want to emulate the structure and frame of face-to-face therapy. This includes:
- keeping the same therapy slot (a minimum of once weekly, same day, same time)
- using a private space with no or limited disruptions
- turning off all cellphones and other interruptions
- abstaining from food or drink while in your session
- ensuring access to tissues
- ensuring that your computer and webcam are on a flat and steady surface and that your therapist can at the very least have a head and shoulders view of your body, and
- consider using headphones for best audibility and privacy purposes.
Given the concerns raised by connectivity issues and technological hiccups, it is important that you allow yourself time to set up your computer and the room you are having your therapy in before your session.
(Do not leave checking your microphone to during the session. If your therapy includes homework exercises and filling out worksheets in sessions, ensure that you have your homework, pen and paper available.)
The above recommendations may seem restrictive but they are in line with the environment most clients encounter in their therapist’s office.
A client’s deviations from these recommendations may help the therapist gain a better understanding of the client’s internal world.
Here are two examples:
- if the client chooses a space that is not private and allows interruptions, perhaps there is a part of them that wants to keep the therapy work to a more superficial and seemingly safer level, and
- wanting to leave the therapy conversation in order to get a glass of water may be masking the fact that when the client discusses difficult material their throat closes up or they would prefer to avoid the topic at hand (vital information for the therapist and client to know).
Virtual therapy is not for everyone – and this includes psychologists.
It is important that your therapist is comfortable with technology, conversing via Skype (or similar platforms), and flexible in terms of connection difficulties that may plague some sessions more than others.
As with any therapy, allow yourself at least four sessions to determine if the therapist-client match is right for you and do not hesitate to raise any questions and concerns with your therapist.
American Psychological Association. (no date). Guidelines for the Practice of Telepsychology (Adopted 31 July 2013). Available online at: http://www.apa.org/practice/guidelines/telepsychology.aspx [Last accessed: 25 November 2015]
American Psychological Association. (05 November 2015). Promoting the practice of telepsychology. Available online at: http://www.apapracticecentral.org/update/2015/11-05/psypact-telepsych.aspx [Last accessed: 25 November 2015]