Psychotherapy in the 21st Century through Skype

Hello, come on in. I’m Dr. so and so. Yes, you can sit there. Would you like some water or coffee? What brings you here today? If you’ve been to psychotherapy, these therapist openers are familiar to you. With the new trend of doing psychotherapy online, these therapist openers may change.

I recently became aware of a new trend in psychotherapy that is online therapy and counseling through Skype. When I told my psychologist sister about this trend, she exclaimed with shock and concern: “OMG what about attunement with clients?” I started to ROFL (roll on the floor laughing). It was such a therapist thing to say. And, I said in response with my tongue in cheek, “What are you talking about Dr. Deana? You’ve got the video camera and PayPal, to make sure your processing of payments is secure and meets HIPPA standards. You are attuned! Now, she was ROFL.

But, she was right—what about psychological attunement? Attunement is an important psychological issue if you are considering doing or receiving psychotherapy through Skype. So, before you think about Skype-ing away your living problems, consider what I have to say here, before you make your decision.

Okay, what is psychological attunement? It’s about the therapy relationship that is likened to the same bond a mother must form with her child in the early days of their relationship. All good things result, if the bond is strong enough. To meet a child’s needs well, a good, helpful mother must be aware of, attuned to, all the subtle sensory experiences in her child’s world. She must use her own self intuitively to pick up and attend to the child’s experience on many levels. This is what great therapists can do. A great therapist is a highly-skilled tuning fork, able to sense experience in self and others very deeply.They bring what they find into the therapy relationship, so that clients become what Carl Rogers called a fully functioning person. Let the healing begin!

I’ve suggested in my definition of attunement the potential problem with Skype Psychotherapy. Videocam therapy may be better for one type of treatment than others. Dr. Peter Strong in the following article link says online therapy is good for treating anxiety disorders and for more structured problem-solving therapies( Relationship concerns that use the therapist more directly as a repairing or healing agent fit uneasily into therapies that offer quick symptom reduction formulas.

Videocam therapy is so new that the field of psychology has to collect a lot of data before they understand its impact on clients fully. For me, today, I’d like to treat videocam therapy as an option only when the client cannot come into the office, for good reason. We’ve used phone therapy in lieu of face-to-face sessions in the past for this reason. Skype, because I can see my client, does win out, for me, if my client cannot come into the office.

I’m not against Skype for a therapy session, but for today, my education, experience and intuition tells me that the best therapy cannot be done this way. I am a relationship therapist. And, although I can see a person through a videocam, I want to feel their energy, sense their world fully. This is how invested a therapist should be in the therapy process.

I encourage you to link to the Psychology Today article by Dr. Peter Strong. If you’re considering a videocam therapy relationship, he gives you five checkpoints that will help you to make the right, online therapist choice.


One Response to “Psychotherapy in the 21st Century through Skype”

  1. Debbie,I too would much prefer to have a client in my office, face-to-face. I've done a fair amount of phone sessions, but only with clients that I've had a number of in-office sessions with first. The phone sessions seem okay, but for me a second best when the client can't make it into my office. I find that I lose a significant amount of my ability to be "attuned" and fully present with my clients when they are not in my office.


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