Are You Uneasy with Skype Sessions for Counseling Or Therapy?

[David Baxter PhD]

Are You Uneasy with Skype Sessions for Counseling Or Therapy?
by Dr. Maheu
March 14, 2012

Some therapists seem to be inviting their clients to join them online using consumer grade video platforms such as Skype, Google Talk, and a host of other free platforms. Rather than using videoconferencing equipment that meets federal regulations for both protecting your privacy and security (HIPAA), some therapists are choosing to use free platforms up on the open Internet.

These therapists may not have obtained the needed training to understand the difference between consumer grade videoconferencing systems meant for grandmothers and their grandchildren to connect on a Sunday, versus professional grade equipment meant for serious business and/or mental health care. In fact, there are three categories of videoconferencing equipment:

• consumer grade
• health grade
• military grade

The Problems with Consumer Grade Videoconferencing
If you have enjoyed the many conveniences of video contact with your therapist, but not been thrilled with the repeated quality of consumer grade, "free" videoconferencing platforms, you're not alone. Skype and Google talk are notorious for having the image degrade, also known as "tiling" where the image of the other person disintegrates (pixelates) in front of your very eyes, or the image freezes and you end up looking at a still photo.

At the same time, a person's voice might start sounding robotic and eventually just drop out entirely. In fact the entire connection to drop out at any given time, whether you are in the middle of anxiously revealing the biggest secret of your life, or simply talking about the weather. The unpredictability of the connection belies lots of other problems having to do with these systems using an unsecured network.

Microsoft's Solution
Hope is around the corner. Microsoft, the new owner of Skype, has now issued a programmer's"toolkit" which will allow programmers to build more security and functionality into Skype. it gives programmers the tools they need to further develop Skype using the .NET software framework that works primarily on Microsoft Windows and provide important services such as security.

We can expect that will speed seeing many improvements over the current system. Once Microsoft gets behind an initiative, they made it happen! On many other fronts, we can see Microsoft's dedication to health care innovation, so we can expect no less in their further development of Skype.

What else is available today?
In case you're wondering what we can expect, whether it comes from Skype or other types of videoconferencing systems that are ramping up for healthcare, let me give you a peek. Even today, many of the more advanced systems offer features that are designed to facilitate the type of contact needed for mental health. For example, they may include a whiteboard, which allows you and your therapist to share screen and draw pictures, diagrams or other types of images that may help you express something more than is allowed by only words. Some of the more advanced systems allow you to share your desktop, videos that you may have on your desktop, or websites during the videoconferenced session ? all without freezing the screen, or dropping the call. you can expect that if the call is dropped, there is an automatic button to click to resume the call without fussing around.

Many paid platforms have a live information technology professional available in case there's a problem. However, these more robust systems rarely drop calls, primarily because they're built with healthcare in mind.

Why don't professionals use these systems in the first place?
The sad truth is that some professionals have not gotten the professional training they need to know the difference between videoconferencing systems, and which might be most appropriate for professional healthcare. If your therapist is encouraging you to connect with them with any of the bare-bones, free but unreliable and unsecured systems, you may ask them to attend our next webinar on March 27, 2012, or purchase a continuing education unit ($27) and listen to it at their leisure. Details of this webinar can be found here.

 

[wheelchairdemon]

The idea of meeting a therapist through the Internet turns me right off. There's money to invest in all other forms of health care, but for those who need emotional help, the investment is not made.

Social isolation is often already a hallmark of mental illness so why is the focus on using a tool that will isolate people even more?

I couldn't even read the whole article above because the idea of having no live human contact to get medical care turned me right off.... but that's just my opinion.

What do others think?

 

[Daniel E.]

Social isolation is often already a hallmark of mental illness so why is the focus on using a tool that will isolate people even more?

Yeah. But there is a flip side: seeing a therapist online can motivate seeing a therapist in person. Some people with mental disorders -- especially, I assume, those who are male -- never see a therapist in their lifetime.

Also, talking on the "phone" or "video phone" via Skype with a therapist is a form of socialization, and the therapy itself can include behavioral goals such as socialing more in the "real world."

Some other points: Some people are more likely to stick with such online therapy than with in-person therapy due to the inconvenience of transportation, scheduling issues, etc. And for specific disorders like OCD, it's sometimes the only way (without driving for hours) to have a therapist that specializes in one's disorder, e.g. the OCD Center of Los Angeles provides online therapy for people in California and outside of the US.

 

[1sister]

I dislike Skype for regular chats because of the audio and visual time lags, which introduce hiccups/distortions in communication. Given that nonverbal dynamics are kind of critical in therapeutic communication, it'd be a no goer for me.

I can see free programs being popular among therapists, though, in that they are accessible to clients, regardless of individual computer/browser specifications. I should think that any teleconferencing channel that would require the client to do any custom configurations on his/her side would involve ongoing hurdles. Every call would involve at least 5 mins of tech support...

I'm not against telephone therapy (in principle), though. At least the signal is reliable and clear. It's cheap (or can be made to be, using phone cards or plans). Until recently, teenaged girls did just fine with it.

Text-based therapy (email what have you) is ok, but it depends on a basic level of writing ability and attentional focus on the client's part. It's not synchronous - people can leave a website or email alone for a while, and continue to avoid the conversation, if they want to. Immediacy is probably important.

I agree with wheelchairdemon that if distance therapy is offered at a lower price than face to face counselling (as well it should, since it's not established, yet), there's a danger in putting downward pressure on any kind of therapy. Charities and government organizations will always prefer the cheaper option, and people in remote or underserved areas will have to take it. Have heard of services cut and partially replaced by a DVD (not in my area).

Someone experiencing isolation would be better served by being in the physical presence of a human being, no question.

I myself would go for phone or email therapy, but only if I had no other choice.

 

[Banned]

Everyone talks about Skype but what about something like FaceTime thru iPads and iPhones? Are they secure and do they have fewer issues than Skype regarding time lags and such? I think technology has evolved enough that online, face-to-face (is that an oxymoron) should or could be as freely available as an in-person office visit and provides a much greater network of providers and clients (my opinion based on nothing scientific).