Modern communication technologies, how are they changing practice?

Using video conferencing in therapy…

I am sometimes asked to consider using Skype for a therapy session with an individual or a couple, or for consultations. I have thought about this at some length and explored the issue with colleagues. A group of us are embarking on a study to look at the advantages and pitfalls. 

It may seem that the pitfalls are obvious, and that is true. Video conferencing is emotionally less engaging, it is less intimate and it is very much harder to gauge mood and body language. As emotional attunement is perhaps the most important elements in the effectiveness of therapy, this is a big pitfall.

There are technical pitfalls, too. The image can freeze, and the technical issues such as who dials who get in the way of relating properly.

There are other pitfalls.

Some are due to the intrusive aspects, for example videoing into a client’s home, or dealing with interruptions by children, other householders or pets. What are the disadvantages of a couple trying to share a monitor? Do they need to have a screen each?

There is also controversy over the integrity and confidentiality of Skype, it is public knowledge that Skype allows law enforcement agencies to monitor calls. This means that Skype must have some way to listen in.

An apparently safer alternative is VSee, a Skype-like piece of software with a number of important distinctions. It can be downloaded for free, it installs and starts working simply and easily (as easily as Skype, at least), and it performs the simple task of providing a video and audio connection for 2 or more people. The VSee software bypasses the Skype security problem because calls go directly from person-to-person without any intervention by the VSee company. It is your computer and the client’s computer doing all the handling of information and no third party is involved. In addition, VSee has a much higher level of encryption than Skype.

VSee also seems to be more stable and less prone to glitches.

Despite the pitfalls, there are also advantages. I find that using a video link to consult a colleague who I already know well is extremely helpful, and allows me to access or offer professional support on occasions when it would otherwise be impossible.

This has led me to wonder about what circumstances it may be worth using with a client or a couple? At the moment I think the loss of intimacy means that I would restrict use to very particular sets of circumstances. For example, times when it seems really important to have contact, but the ususal session is not possible for some reason. And I already know the person or couple very well and have a sense that I am able to ‘read’ them fairly accurately, or that any lapses can be repaired fairly easily and quickly.

Others have found that it is a very useful way to engage someone who is very avoidant and shy, easily shamed for example, and can feel so accessible that it can access very different client groups to those who readily consider a psychotherapy. It also offers access to therapy of some sort to those who are  geographically isolated or whose physical condition means going out to a consulting room is not possible, or who are housebound due to caring duties. The therapy will be different, but how different?

The web reveals many counsellors who use Skype or similar, and we do not know whether their clients are happy with what they receive. Some counsellors / therapists / may like the chance to work without renting rooms or traveling to work.

However! Therapy is a very difficult process to choose, it is behind a closed door, and the risk is that the client or couple will not be aware that there are hidden costs of using something that is convenient but may not be effective. The debate will continue!

I helped to author an article recently published in the British Journal of Psychotherapy, looking at how these new modes of communication are affecting therapy in private practice.