It is well known that New Yorkers rely dependently on their shrinks. Not so long ago, people used to nervously joke about how New York became a crazy and dangerous place in August because so many psychotherapy professionals left town at once for personal vacations, leaving their clients lost without their established schedule of counseling. Even though patients were given phone numbers of covering therapists, the panic, sense of abandonment, and real desperate need was palpable.
Today, in a time of ever-increasing globalization, the new communication technologies that have greatly influenced our culture are also increasingly influencing the doctor-patient relationship in psychiatry. In a nutshell, the old therapy-deprived days of August can be over with a click. Any person with access to a laptop can now find telemental treatment, and Skype—computer-to-computer Internet video calling—and other desktop VCs, are expanding in use in both private and institutional practices because they allow for real-time audiovisual sessions to be conducted from anywhere in the world.
For business executives, the use of communication technologies like video conferencing has long been part of the basic infrastructure for conducting business. It’s not surprising that people in such professions have been the early adapters to the use of Skype in counseling. Dr. Anne-Renee Testa, a relationship psychologist and author of the book, The Bully in Your Relationship, said, “Skype is a practical, time-saving answer for busy executives.” Because of the accessibility it allows, it helps her keep up with her patients and clients when either party is traveling. “I work with people who travel a lot and many of them are just too busy to come in. People have different levels of problems, and some require sessions twice or three times a week.”
Dr. Testa says that within the framework of her “psychoanalytically oriented behavior therapy,” she helps clients “go back to their childhood and find the hurt and pain, and [they] discuss how this impacts their current relationships.” For this, “I need to see their face, I need to understand their feelings.” Even though she likes phone sessions, Skype allows for her to perceive more meaning. With 20 to 25 percent of her sessions conducted on Skype, she is able to meet the needs of established clients in different international locations. She says, “No matter where one is in the world, it's really about learning to live in the moment.” At the end of each session she helps her clients “come back to where their feet are.” To be present mentally, physically, and emotionally. “The crowded mind is not an effective mind,” she says. The use of this helpful insight and technique seems to be one that busy business executives desire to be reinforced. More mental space means an increase in the ability to reason. There is a competitive advantage in that and it can’t be underestimated.
New York based Psychologist, Dr. Robert J. Lee, Ph.D. specializes in leadership development and executive management performance. With a large international practice, he, without a doubt, prefers the face-to-face aspects of Skype to phone sessions. With a little laugh, he says, “That way I know if they are doing other things at the same time.” As much as half of our understanding of someone can come from spontaneous visual cues—even simple nodding reflects a level of attentiveness, which could be interpreted as disengagement in a phone session. Pauses in conversation have visual content through Skype, so video sessions are richer and more informative than phone sessions.
HIPAA-compliant telemental mental health care has been in use for decades to help individuals in locations with a shortage in mental health care providers or with no providers in a particular specialty. It has also been invaluable for urgent evaluations needed for disaster situations. Today, over a dozen telepsychiatry websites that provide wide-scale, online e-therapy are easily found. Of course, it is possible that correct psychiatric evaluations might suffer at the hands of online-only care, and there is also the possibility of easy prescription drug abuse. However, there is a lot of comfort and convenience to patients in having this type of accessibility to therapy and for people to have a way to access a caliber of a mental health professional not available locally. Plus, telecommuting to the therapist can reduce stress: no travel, no parking problems, and no business trips that cancel appointments.
Technological and social developments, along with the abilities of psychologists to respond to the changing needs of their clients, are evolving the way psychology is being practiced. Future careers in the field will be guided by the research done at dozens of universities with telemedicine centers, along with explorations in new models for therapy engagement being explored in virtual life environments like Second Life. In the meantime, old videoconferencing technology is bringing fresh connections. There are some problems to overcome, such as the psychological effect of the spatial gaze perception in virtual space, as eye contact is so important to visual communication, but this is being worked on.
The Internet has changed the way we share ideas, exchange information, and conduct business, and now Skype and other VCs are evolving psychiatry toward a world without geographic borders, crossing cultures and increasing the types of people using it. As a powerful mass communication system with potential to revolutionize mental health care, the distance an average client needs to travel to a session need only be mental, not miles.