Technology has transformed what was once one of the most intimate of local services into both a global commodity, and something accessible to people who, in the past, may not have had this outlet available.
In addition to a traditional clientele, I have clients all over the world - quite literally from Bali to Boston...New Zealand, France, Spain, the UK and all over the United States. They find me both via the Internet, as well as through more conventional means, and I connect with them utilizing a variety of technologies.
Initially, I was skeptical of a therapeutic process that wasn't going to happen face-to-face. I am an empath and an intuitive by nature, and I can often, in an immediate sense, tell more about a person by "feeling" them as they walk into my consulting room than by what they are initially saying to me, especially if I am familiar with them.
Then, of course, there are the more conventional "tells" around things like ADLs (activities of daily living), uncharacteristic agitation or stillness, relative degree of eye contact, personal organization, etc. that are always useful in acute assessment. So, while I am not someone who relies at all on body language - it's entirely too ethno-culturally specific -- to give me hints, there is something to be said for the opportunity to observe the subtlties of social presentation.
What I've discovered, however, is that interaction with tele-clients (a made up word) is wholly different than face-to-face interaction. It's somewhat less conversational and more "down to business". Presentation often becomes irrelevant, as the cards get laid on the table and the work gets done with more vigor and intensity. My experience is that this is true even when doing the occasional phone session with a regular client.
In addition, tele-clients tend to be more forthcoming and direct. I suspect that this is because of the perceived indirectness of the interaction. Interestingly, this quality is consistent even when that interaction is via webcam. For once, the false intimacy engendered by electronic communication becomes an advantage. Again, one presumes that the means builds in perceived interpersonal distance.
Which leads us to some questions...how do you this? What rules apply? What rules don't?
The most conventional and convenient tool for what I am referring to here as tele-therapy (another made up word) remains the telephone. Cell phones tend to allow greater flexibility in this area than land lines in that clients can now talk during their morning commute, while traveling on business or even, as was recently the case with one my New York clients, from the beach!
Skype is also a terrific device -- whether voice or voice/video - and, although it ties you to a computer, it cuts down on overhead for both the client and the provider, which is a boon when working internationally.
IM and video chat provided by standard software add-ons or bundles are inadvisable means of communication as they are, by way of their internal protocols, less secure. This is because these applications have a server pass-through that Skype, wireless and land-based phone connections do not. The data stream lives somewhere during the transmission interval, even if only for a brief moment. I honestly can't speak to things like NetMeeting, etc. although I believe that these, too, are server-based.
From a pragmatic standpoint, the telephone thing is actually pretty easy; it just takes a little re-tooling on the part of the therapist. I do suspect, however, that therapists with a more transactional style - or those who could muster a more transactional style -- are better suited to this type of interaction. The "Mmm, hmm...", "I see...", "Tell me more..." style, or, worse yet, the silent, all about the process style -- without the benefit of container or presence - would probably lend themselves less readily. Choosing to provide services in this manner demands a certain willingness to proactively shepherd the process.
The video webcast version presents yet another set of considerations. On the one hand, I read an article some time back about a psychiatrist working with women in Alaska from a base in Seattle via video webcast. This was pre-Skype, so she was using a regular camera and a VPN (virtual personal network) line. She employed conventional wisdom, as it were, seating herself behind a thoroughly non-descript desk, wearing non-descript (and consistent) business attire, using a plain white sheet as a backdrop. Based on traditional, rigid notions of boundaries and non-exposure, this seems to make sense.
On the other hand, some of my colleagues have offices in their homes -- especially in New York City, where commercial rents are prohibitive - and, although it would never occur to me, personally, to see clients in my own home -- tele-clients are somehow an entirely different story. Again, this is presumably based on something of an inversion of that experience of interpersonal distance.
When working in this more organic fashion, consistency remains, as always, an important consideration in creating the container of experience, although not necessarily the physical container, for the client. Playing devil's advocate to the traditional wisdom of hyper-impersonal distance, going through the trouble of setting a stage or creating an artificial container would seem to defeat the intention of flexibility and availability to which the tele-process subscribes.
The bottom line here is that electronic venues provide the opportunity for people to access services that they might not otherwise have available to them, whether because of location, time, other commitments or whatever. By the same token, these venues provide clients with a greater degree of flexibility with regard to not only the when and where, but with whom it is that they work. Everybody wins.
© 2009 Michael J. Formica, All Rights Reserved
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