Psychotherapy on Skype or the telephone?

Psychotherapy on Skype or the telephone?

Psychotherapy occurs within a relationship that is created by two people in a space that is private, stable, quiet and comfortable, at set hours. It is not a technique that can be applied independently of the people that use it in any place at any time.

The physical presence of the other is an important factor in the establishment of this relationship since it conveys a great deal of information about the other person, amongst other things the fact that the person is physically there. The stability of the space in which the sessions develop is also important because the familiarity with the space in which there is a growing trust creates a feeling of security associated to it.

Therefore, doing psychotherapy by Skype or telephone is not the ideal situation because some of the elements of the setting cannot be maintained and it is difficult for the quality of the relationship to be as real, as emotionally engaged as face-to-face sessions.

When it may be indicated

However, sometimes what is ideal can stop us from seeing what is good and one has to discriminate in what situations it would be indicated to do psychotherapy using these means and one also needs to think about certain specificities associated to them.

Both Skype and the telephone will involve variations in the contact between the psychotherapist and the patient; the fact that one can see the other person or not changes the interaction; being able to hear the other’s movements does, too; there can be interruptions and cuts in the connection, etc.

There are some circumstances in which a patient may have not access to a psychologist for geographical of linguistic reasons and the only way to begin a treatment or to continue one that is in course is to use Skype / telephone. In the great majority of these cases it is better to use these means than for the patient not to receive any help. If a patient also has to be away for a relatively short period of time it is also preferable to continue through Skype / telephone.

When it is not indicated

However, if a patient has to move somewhere far away for a prolonged period of time and there are psychologists there that speak her language it is preferable for her to see someone where she is. Needless to say, each case must be assessed individually, taking all the variables into account.

The specificties of the psychoanalytic setting ––high frequency of sessions, patient lying on the couch–– do not lend themselves to the use of Skype or the telephone due to the enormous subtlety of the work and the lack of physical presence of the analyst. Psychotherapy can be done reasonably on Skype or the telephone, psychoanalysis cannot.