Skype therapy: real help or illusion?

Over the past 10-15 years, online life has become commonplace for us. “I work and communicate with friends mainly on the Web and do most of my shopping there,” says Oleg, a 32-year-old programmer. — Naturally, when the idea came to me to consult a psychologist, I was going to do it in the same way. But those friends to whom I informed of my intention began to assure me that real therapy is possible only in the case of a personal, physical presence. And I doubted.»

These doubts are understandable, because communication with a psychologist is special, it differs from both friendship and love. We admit the therapist to those corners of the soul, where the path is sometimes blocked for the closest people. This is a secret process. And for decades, strict rules and conditions have been developed in psychology under which this process can safely unfold. And online sessions change, correct or completely cancel these rules, which seemed unshakable. So can virtual work with a client be effective?

Make-believe or seriously?

“When I first started working online in 2006, many respected colleagues said that it was impossible, there could be no help on the Internet,” says client-centered psychotherapist Viktor Menovshchikov. — I myself doubted: counseling, that is, assistance in resolving specific problems, was going well, but wouldn’t there be difficulties with psychotherapy, because it involves deeper work with the personality? But when I started trying different methods — client-centered therapy, symbol drama, eye movement desensitization — it turned out that it works the same way over the Internet as it does in the office. Now I am convinced that this is an independent type of psychological help.”

Psychologist Andrei Vishnyakov agrees with this, who, as a student in the mid-2000s, tried his hand at telephone and email counseling, and then began to use Skype for work. “What is the most important thing a psychotherapist can give a client? he muses. — What is called «psychological presence»: I hear you, I accept and share your feelings, I support you. This feeling can arise both in person and in correspondence, even if we are talking on the phone, moreover, even if we are only texting. But this requires a high level of professionalism, stresses the psychologist. The skill of presence must first be trained in personal sessions. Sounds promising, but what about the obvious limitations that virtual communication imposes?

Far and near

The first of these limitations is that we do not feel the physical presence of a psychologist nearby. “Yes, no camera, the best, can convey this energy,” Andrey Vishnyakov agrees. — But not all clients need it! And for some, for example, those who have experienced violence, meeting “in real life” is burdensome, for them it is an emotional overload.” For those who find it difficult to discuss painful topics sitting directly in front of a psychologist, it is easier to do this on Skype.

And then there’s the problem of anonymity. “Some clients,” notes Viktor Menovshchikov, “do not dare to go to a face-to-face appointment for fear that someone might see them near the psychologist’s office, and they would like to keep the visits secret.” Online consultation provides such an opportunity to the fullest.

The art of seeing and hearing

The second limitation is that we cannot see each other in full height on Skype. But non-verbal body language is very important for mutual understanding. The client reacts to the gestures, postures, movements of his counterpart mostly unconsciously, and the body language gives the psychologist a lot of important information about the state and psychological characteristics of the client. On the monitor, we only have access to a “bust” or “half-length” portrait of the interlocutor. Image quality also often leaves much to be desired. But for a professional, this obstacle is surmountable, Andrey Vishnyakov believes: “Yes, in Skype I don’t see the whole body of the client, I don’t see how he breathes, whether he crosses his arms, and so on. But I know, for example, that if his stomach is clamped, then his jaws are clamped, his face freezes. Facial expressions will tell me everything if I have trained to read it in study groups and face-to-face sessions.

It happens that customers ask not to turn on the camera. Our experts are not embarrassed by this: they both worked for many years in telephone psychological services, in particular on the helpline, and it is customary for them to use only the audio channel of communication during the session. “What replaces non-verbal cues? Voice! Andrey Vishnyakov says. — It contains a huge amount of overtones. Tonality, pauses, phrase construction — all this carries important information for a specialist. Working only by ear, he simply pumps up another «muscle» of perception, he develops the skill of listening. And he himself uses his voice more skillfully during the session, simply because in this case he has no other instrument.

On the same spot

Those who have been to face-to-face sessions know that the psychologist’s office is a special space: getting into it time after time, we almost instantly disconnect from the outside world and completely immerse ourselves in the process of communication. We know for sure that no one will enter the office, no one will interrupt the session. But during a Skype session, the psychologist’s office is on the other side of the monitor. We are sitting, for example, at home, in a familiar, not at all special space, households can walk outside the door, children can make noise.

“I always set a condition: the client selects a place for the session where no one will interfere with him, he can close the door and be left alone for the whole time we are working,” says Viktor Menovshchikov. Most often this is a room in his house. A permanent location is of great importance. The client gets used to it, and then it is easy for both him and me to get involved in the process every time. For those who want to work via Skype in a cafe or on the street, I refuse. Nothing and no one should distract the client.

Andrey Vishnyakov agrees that “the walls help the client at home”, but he believes that nothing bad will happen if the session is interrupted, for example, by a small child: “Usually, the mother will find something to occupy him in a few minutes, and our conversation will continue without problems with the point where we were interrupted.» He does not mind if the client decides to change the place and during the session he will be in the car or in the office, if the situation at home does not allow him to be left alone.

I’m going in search

Many people need Skype sessions today: both business people who do not have time to get to the psychologist’s office, and mothers who have no one to leave small children with, and our compatriots abroad who cannot find a Russian-speaking psychologist nearby, and residents of small towns, where there are no serious specialists, and for people with disabilities, and those who suffer from social phobia and cannot travel in transport.

But how do you find a truly qualified psychologist? In Russia, there is the Federation of Psychologists-Consultants Online, created by Viktor Menovshchikov, everyone who is part of it has been trained by him, and he is ready to vouch for them.

Finally, there is such a thing as reputation, reminds Andrei Vishnyakov: “You should not contact a psychologist at the first advertisement that comes across. Take an interest in reviews about him in social networks, look for his website, see what kind of education he has, read his articles, if any, and only then make a decision.”