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There are more and more psychotherapists who use the Internet in their practice. How effective are webcam consultations? And how can new means of communication help psychologists and their clients?
We type “psychotherapy on Skype”, and more than 300 thousand links appear on the screen, and if you request “psychotherapy online”, there will be twice as many. Hundreds of psychologists offer their services in the virtual space. In some cases, the client first needs to fill out a questionnaire and send it by e-mail, in others it is enough to dial a phone number and arrange a meeting via Skype.
Pass the tests
- What kind of psychologist are you for your loved ones?
In many countries there are large specialized sites that are similar to psychotherapy supermarkets.1. A dozen business cards appear on the screen: a photo of a psychologist, his specialization and a plate with a message about whether this psychologist is free at the moment. Click on the name of someone who interests you in their specialization or whose face seems pretty, humane, and the consultation will begin. We do not have such sites yet, so the selection process will probably take longer for those who are going to contact a psychologist for the first time.
Here are a few clues to better understand what the specifics of virtual sessions are.
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Between coaching and therapy
It can be assumed that virtual communication with a psychologist is more of a consultation, benevolent listening, than therapy in the strict sense of the word. “We work in a coaching registry,” agrees psychoanalyst Olivier Douville, who often uses Skype to consult with patients and supervise psychoanalysts living outside of France. However, he clarifies: – This does not mean that consultations are not therapeutic. They have empathy, compassion.” Even a single conversation with a psychologist can lead a client to significant internal changes, says psychotherapist Alexander Orlov, who leads Skype consultations on psychologies.ru. “Reviews from clients I have worked with on Skype show that the help they receive goes beyond listening and emotional support,” he elaborates. – During the consultation, the client’s attitude towards himself, his view of the problem may change, and this will continue to influence the client’s inner and outer world. In this sense, counseling can become psychotherapy.” More and more specialists conducting receptions in the office are also conducting sessions at a distance. Many of them have their own website, where you can learn not only about their professional path, but also about their “philosophy”: how they imagine help, mental health … This openness reassures clients, because in classical therapy such information is provided only in exceptional cases. Online sessions allow residents of those places where there are few specialists to get advice without traveling tens of kilometers for the sake of one meeting. They also give this opportunity to those whose health does not allow them to travel.
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Meeting conditions
Virtual consultations, like real ones, have their price. Some psychologists prefer to work via Skype with a prepayment (for one or more sessions), which is paid by money transfer to a specified account, often using the Paypal payment system. Someone, as in a regular consultation, receives payment after the end of the meeting. There is no single practice, so the client negotiates with his therapist individually. Most psychologists offer a free preliminary 10-15-minute Skype conversation to establish an acquaintance – of course, if they have not met with the client before in real space. The amount of the fee also varies, on average it ranges from $40 to $100 for a 45-55 minute session. Many (though not all) psychotherapists charge less for a virtual session than a client would pay in person.
The Importance of the Real Body
Psychotherapy is a conversation between two people, an exchange of words. But virtual communication excludes the body from communication. How important is it? “In order to establish psychological contact with a client, it is enough for me to make eye contact, his facial expressions and the information that his speech gives: words, timbre, intonation,” Alexander Orlov answers. “The body is important for body-centered practices, but for me, who works in client-centered therapy, it is less important.” It turns out that in other types of psychotherapy it is possible to discover opportunities to work with the body, despite the limitations of virtuality. “At one of the sessions, I wanted to walk around, I was at a loss – what to do, a laptop on my lap, and the psychotherapist said: put it on the table, get up and walk,” says Elena Bartosh, a Gestalt therapist, about her experience as a client. – And I got up and started moving, and it was very important. I spoke, the therapist heard, he was with me, it was a very useful session.”2. However, for many psychotherapists, manifestations of corporality in the psychotherapeutic process are fundamental. “You can’t get started without shaking the patient’s hand,” admits psychoanalyst Philippe Porret, who only uses Skype to communicate with those who can’t otherwise participate in a consultation. “Therefore, a preliminary personal meeting is important, which allows the client to see that the personality of his therapist is completely real, that he is a person of flesh and blood.”
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Required Rituals
Skype provides impressive time flexibility. Therefore, it is especially suitable for those who, for personal or professional reasons, travel a lot and are not always able to come to the session at the appointed time. In addition, there is no risk of meeting other customers. It is enough to ensure silence by turning off your mobile phone, to make sure that the children do not burst into the room where the consultation is taking place, shouting, and you can start working. Many clients who already have experience in a counseling office find more “informality” with a Skype therapist who, in fact, comes to their home. As if we were inviting a friend to our place… Such informality deprives the therapeutic relationship of a patina of sacredness and is probably convenient and pleasant for clients, but not all therapists find it useful for the psychotherapy process. It is for this reason that it is important “to build frames and rituals that mark the time of the session,” notes psychoanalyst Manfed Kets de Vries. “I go out to meet my patients as if they were sitting in a waiting room. And I always occupy the same place, in front of the bookshelves. When the session ends, I “see them off”. I take my diary and we arrange the next meeting. Then we say goodbye, as in reality. I can’t shake hands with them. Indeed, touch is lacking. But instead, I smile.” According to Olivier Douville, these two realities are irreconcilable: “The study is a magical place where the only reality that matters is the psychic reality. It certainly creates a connection with the therapist’s personality – his books, his carpet, his things, his paintings, his photographs. The place itself creates desires: in particular, to be in the arms of a therapist. A conversation on one’s own couch and on the therapist’s couch evokes different feelings in the client.
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Supplement or main method?
Many psychotherapists find that Skype is a great way to stay on track and keep in touch if the client or therapist has to travel. However, subject to the continuation of meetings in reality at least once every three months. “This is the way to do it when no other options are possible,” concludes Philippe Porre. “But I don’t think it’s possible to do psychoanalysis with this one tool.”
Other experts believe that a full-fledged work on Skype is possible – and their own experience becomes the basis for such confidence. Elena Bartos lives for half a year in Helsinki and Tenerife. Skype helps her keep in touch with clients. “They live in different countries and on different continents, not everyone has the opportunity to find a Russian-speaking psychologist nearby,” she says, “it is important for many that the therapist also lives abroad, knows the realities and understands the nuances of emigrant life. For some, Skype therapy is cheaper, for others it is safer than face-to-face therapy; of course, it is more convenient for everyone (you can not waste time and money on the road). A lot of people come from the site, having read articles and got to know me in absentia, having formed an idea of how I work.
Ultimately, the question is not “yes or no”, but how to use new opportunities. Virtuality is a valuable tool for emergency assistance, preliminary meetings, and even effective long-term psychological support. Including depression. But not for psychoanalysis, which presupposes the presence of an analyst. Many psychologists, they say, work via Skype, not because it’s better, but because they are sure that this is the future.
1 See Wengo.fr or Jeconsulteunpsy.com
2 See also author’s site gestalt.bartosh.org