Using Skype and Phone with Clients

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Buck Black offers psychotherapy for anger issues through his practice in the Lafayette Indiana area ( via phone, email, and office visits. He ...Read More

There have been several great posts on regarding the use of technology to interface with clients including:

Would You Want to Do Therapy Online?
Using Technology to Treat OCD…A Good Idea or Not? – 
Telehealth Ineffective?  


I would like to share my experiences as a therapist who provides distance services with phone and Skype. First of all, as a therapist, I need to make sure that this is an appropriate medium for the client. If he or she is suicidal or homicidal, distance services are not an option. I also need to make sure phone or Skype will enhance the experience, instead of detract from it. Often, clients will benefit from the flexibility of appointments (getting in during a no-show, or providing a quick session on the weekend, or the client having a session when out of town).

However, some clients are not technology savvy enough to use Skype, are uncomfortable with it, or their connection and/or equipment are unable to give them a quality experience. I have talked with some clients who cannot concentrate on a session over the phone because they are too easily distracted. For these clients, the temptation to wash clothes, surf the web, or watch TV during a session is far too strong. The old-fashioned face-to-face meeting will ensure these clients will devote their attention to therapy (assuming they shut off their phones when entering my office).

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In my experience, I have been able to serve many clients who would not have access to therapy. For example, truck drivers who cannot keep office appointments are able to participate in services over the phone from most anywhere in the world. I have also had professional clients who travel and would go without therapy for weeks or even months if they could not use Skype to continue their services. I have even had people with social phobia who chose to take the first step by talking via phone with the plans of graduating to an office visit (they were in the same town as myself).

I see plenty of positives for distance services every day. I must admit that it is easy to miss body language over Skype and especially the phone. Again, this is why there needs to be a thorough screening process completed by the therapist and that either party can discontinue the service at any time. I have noticed when I do couples therapy, I pick up on those microexpressions (quick facial expressions that last less than a second). This is difficult, if not impossible, to detect from a distance. Also, pauses on the phone seem to be less comfortable. Often, clients need a few moments to process what has been said. The phone seems to set up the expectation that there will be no silence.

When someone decides to do distance services with me, I am sure to send them an email outlining these potential problems of missed body language, the great chance for misunderstanding, and the absolute must for the client to challenge me if they hear something they think sounds inaccurate. There have been plenty of times clients point out that I have said something absurd when it was a result of them mishearing my words due to a bad connection or distraction.

Skype and phone services have their uses and will likely become more popular in the future. However, I believe the human contact of the old face-to-face therapy session will always be king…just as it should be.

For more about my thoughts regarding online therapy and an interview that was done with one of my clients, please visit this interview that was done recently (

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