I’ve just been watching a short advert for Skype therapy, just out of curiosity to see how it works.
The counsellor/therapist describe it as no different to a face to face meeting, and I have to say I disagree.
In my experience of Skype (I have a slow internet connection), the lip sync is slightly off. For Skype via satellite (which is how I receive the internet) , as I understand, the information (pictures and sound) are packaged up separately and sent off along the microwaves and arrive with the consumer more or less intact, with a slight delay and sometimes with a tiny piece of the package (jigsaw) missing. Admittedly, I can only check from my experience, but there appears to be something stilted, jagged and slightly disjointed which would make the flow and intuitiveness of therapy difficult.
The audio stream is then divided into small pieces, each small enough to fit in a packet, which is stamped with the destination address and sent through the network. Since VoIP uses SIP as the means to spread, it is inherently prone to its negative sides, which are quite a few, since it was never engineered to support live conversations; VoIP is susceptible to stutter and latency.
The therapist I watched seemed a little uncomfortable with the medium, or was that because Skype was breaking him up etc. How can I know that what I am seeing is what he/she is projecting, or is it digitally disjointed. These things a very important when working as a therapist. I can see it working in a counselling/short term/brief therapy situation, it’s not ideal but it might work. But when someone has come to work through some distressing issues for long term therapy, I feel that Skype can potentially leave both therapist and therapee feeling slightly short change. Of course the risk then is that the work becomes about the medium and it’s shortfalls, the constant rechecking of what was meant and moves it somewhere it might never have been going originally.
Another of the difficulties is the placing of the camera. On a laptop one has little choice of where the camera is placed. I know from my own exp again that I spend a % of time looking at me and how the camera is making me look rather than my Skyper. It also gets in the way of eye contact which is so, so important. If the camera is badly placed, it almost impossible to have eye contact.
What about body language, a Skype session will not allow the therapist to see my foot tapping or wiggling, or see whether my body is relaxed or tense, or pick up the gestures I might be making with my hands. So much of the work for a psychotherapist is reading the unspoken, seeing the other things not being said and using these as tools to work with their client. This would be nigh on impossible with Skype.
The real problem is simply one of whether the way most people use videoconferencing today for therapy in any way approaches the professional emotional intimacy or therapeutic rapport of a face-to-face session. I would argue it does not, and that most professionals are substituting the idea of intimacy — because both face-to-face and videoconferencing show you a person’s face — with actual therapeutic rapport.
I’m not alone in this observation:
Johanna Herwitz, a Manhattan psychologist, tried Skype to augment face-to-face therapy. “It creates this perverse lower version of intimacy,” she said. “Skype doesn’t therapeutically disinhibit patients so that they let down their guard and take emotional risks. I’ve decided not to do it anymore.”
Indeed, perversely, online therapy done through videoconferencing actually removes one of the benefits of online therapy — increased disinhibition — and replaces it with a handicapped view of nonverbal behavior (someone’s disconnected head). Is viewing a 4 inch video of your therapist’s face on your mobile phone the same as sitting in a room with that person? Does it even come close?
Of course there will be therapee’s who unconsciously turn to this kind of therapy as a means to protect that very vulnerable part of themselves they don’t want anyone to see. Sadly, it’s this very part the therapist needs to work with in order to find some resolution for the client.
Are there are any therapists who use Skype with opinions on this? I would love to hear from them.