Learner Therapist (63) … How real can Skype therapy be?

Torrey Orton*

July 20, 2015

Last year I was called by a colleague in Europe chasing up a therapist for the CEO of a digital start-up. I had come to mind because, aside from my family violence case-load, I have a broad spectrum of business experience internationally and, by chance, occasionally in IT. I have used Skype for various private and public relationships for years, including executive coaching, therapy and peer supervision.

More recently, I was encouraging a reluctant friend to do some connecting with me on Skype which he resisted on the grounds it just couldn’t be real. It can but that, like many matters of fact, cannot be disputed into existence by arguments from conflicting faiths. Here’s my experience in fact.

I took on the offer and met the CEO face-to-face for the first time three weeks ago, having done four months of twice a week Skype therapy sessions from September to December ’14. What follows are observations about the medium from this experience and subsequent work in the company.

 Some Skype virtues -

1)      It really is just like being there with the patient. All the non-verbals are accessible and to some extent more so than in ‘live’ therapy because the cameras bring us closer than my normal seating distance live (which is about 75 centimetres knee to knee). So we were there together for those hours. The proof of this sense was that when we finally met face-to-face it was almost unreal; it was no surprise; it was as if we had always known each other ‘live’!

2)      The real time, ‘live’ nature of Skype also allows real time SMS communication within the Skype system. This is particularly useful for short chats between normal longer sessions prosecuted by keyboard in real time but only in type. A decision to go to video can be made without starting at full exposure, and commentary and sharing of data can accompany the fully live event. One can see if the other is on deck from the contacts list down the left side of the Skype screen.

3)      Skype allows an out of time SMS service, too, through which I can leave a comment about some matter relevant to that relationship, propose a formal meeting (live, video, etc.). This can serve to ‘ping’ the contact without forcing them to reject a live call if it is inconvenient. Often it’s a matter of negotiating a few minutes leeway to prepare this or leave that.

4)      Then there’s the video message option which arises about ten rings into a connection attempt, which is the same presentation as a live event, but for viewing at the receiver’s preferred time/place. The message’s 3 minute time limit is short enough to prevent any ranting tendencies in the messager.

5)      Skype allows multiparty meetings of which I’ve done quite a few too, with remarkable clarity, etc. A good headset and higher class camera mounting is important to get best mileage out of the service.

Skype shortcomings

It is highly sensitive to bandwidth problems, which advanced practitioners can mitigate by selective deletion of functionality, notably turning off video while audio stays live, as does the SMS feature. These mitigations can be negotiated between participants live, with one turning video off and the other keeping it on, etc. This also makes the administration of the event a joint responsibility not just that of the therapist, coach, boss…

Skype also seems to have a therapeutic hour self-concept…it begins to threaten the process with performance warnings around the 50 minute mark. Longer on Skype, especially in group sessions, is strenuous for some reasons I suspect having to do with too much unbroken screen time.

*I am a 72 year old, AHPRA registered male psychotherapist with a large caseload out of family violences. There the question of what is ‘live’ in real life is the central existential challenge and how to live better the central developmental one.