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Psychotherapy, Skype and Videocam Technology

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Modern technology has made possible the fact that people can see their psychotherapist using Skype or video cam psychotherapy. In other words, the patient sits at home, at the computer and has a therapy session without ever leaving their home. Is this a good or bad thing?

On the pro side of the argument over video psychotherapy is that people who live in remote areas, far from psychotherapists, can reap the benefits of getting psychological help for their problems. In addition, people who prefer to see a certain therapist who lives far away can do so via Skype if the therapist is willing. There is also the problem that, when therapists move away from where they were practicing, patients have the option to continue therapy via Skype if they wish to. This gives the benefit of continuing therapy with the same therapist uninterrupted. 

In most respects, therapists and patients can continue to do the same therapeutic activities online just as in the office. Practices such as the use of cognitive behavior therapy are fully available via working on Skype. Supportive psychotherapy, based more on the psychodynamic model than CBT, is fully available online. Many patients who use video cam psychotherapy find it very helpful, useful and equally effective as in the office therapy.

On Skype, face to face communication is present very much as it is in the office. Patient and therapist can see one another’s faces, facial expressions and hear one another’s tone of voice with its various intonations and expressions. Much of this is as it is in the office.

Yet, there are negatives to Skype psychotherapy. For one, there may be licensing issues if the therapist lives and is licensed out of state from the patient. This is an especial problem for clinical psychologists who must be licensed in the state in which the patient lives when using Skype. For some of the other mental health professions, this requirement is, as yet, not so stringent. Of course, it is vitally important that any therapist, whether online or in the office, be fully licensed in at least one state. Many mental health professionals are now licensed in multiple states in order to be able to use Skype in their practice.

One of the most serious concerns about Skype has to do with following HIPAA laws. These are the laws designed to protect consumer privacy especially when electronic communication is involved. Therefore, when doctors electronically transmit patient charts or when any electronic transfer of patient information is use, the privacy of the patient must be protected at all times. The company, Skype, wants no part of legally guaranteeing HIPAA privacy even though the site is secure. There are other video companies that are compliant with these laws but they often come at extra cost to the therapist who then passes the cost on to the consumer.

Because Skype and other video providers connect patients with therapists from distant places it can be more difficult for therapist to work cooperatively with psychiatrists and other medical doctors who treat the patient near home. That is why it’s important that the therapist get all the information needed to conduct therapy. This information includes people to contact in case of emergency, names and phone numbers of doctors and patient permission to contact those practitioners when needed, especially in the event of a possible suicide.

It is the opinion of this therapist that, if all the criteria are met for licensing, reputation and emergency contacts are met, it may be a good idea to use Skype. Of course, the major benefit of this is that it connects people from remote places with therapists that might not otherwise be available. In my mind, Skype is the next best thing to being there. However, the best thing, in my opinion, is for therapist and patient to be there, in the office.

What are your opinions?

Allan N. Schwartz, PhD

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