For years, my friend who lives in Israel asked me to get Skype and I didn’t.   When I did get a Skype account in the late spring of 2010, I could have kicked myself for waiting so long.  It was great seeing my friend and his wife.  My wife and I have talked to them multiple times since then and not only is it free, it is great to be able to see our good friends who are halfway around the world whenever we are all near a computer.

Then, when I got a referral from a therapist for an out of area couple to do phone therapy, I had a novel idea; at least for me.  What about Skype?! Little did I know that this was not a Todd Creager original idea!  When we did the initial phone therapy, I asked if they wanted to Skype.  Their daughter had a Skype account so they used her account for our second “visit,” and by our third visit, they had their own account.

Face to face visits have been the traditional way to do therapy, but these days, virtual therapy is  becoming more common.  As far as I know, at present, insurance companies do not cover anything but actual office visits.  However, many people either do not have insurance for mental health or choose not to use it.  So the real question is: Is phone or Skype therapy effective and has it been effective for me with this couple and now a 2^nd couple that I am “Skyping” with?

I have done phone therapy and coaching increasingly more over the last five years.  Currently, I am working with an agoraphobic client (someone who has anxiety issues) by phone and working with her to be able to drive the 25 minutes it takes to get to my office.  I have done life and business coaching by phone.  I even have done couples therapy by phone.   Parents sometimes have babysitting emergencies and rather than miss an appointment, we do it by phone.

With increased business travel, clients have found phone therapy a way to stay consistent with their therapy and can continue their investment in their emotional wellbeing from a distance.  I have found phone therapy to be very effective.  There is much I pick up by the voice tones, inflections and of course words.  Couples even report a benefit that doing the work from the comfort of their own home can be powerful in its own way.  When I have them try a new way of speaking to each other from the very part of the house that they have reacted and had escalated conflict in the past, it can be a positive anchor for new, improved behavior patterns.   When I did an initial phone therapy visit with what turned out to be my first Skype couple over the summer, we made a positive therapeutic connection that paved the way for their relationship work in subsequent sessions.

The Disadvantages of Phone Therapy

There is a disadvantage to phone therapy especially when working with couples.  There are many visual cues that help me as a therapist tune in to what is going on.  As much as I have worked on honing my phone counseling skills, I cannot see a partner pull back physically after an emotional button has been pushed.  In phone therapy, I may hear silence; face to face, I might see the body language of a silent partner as a “loud” expression of anger, hurt or fear. Coaching is often more goal oriented and seeing the individual is probably less important than in therapy when the emotions of the client are paramount.  (I believe that there is often a coaching dimension in therapy but goals are not always the focus; healing is as important as reaching goals in therapy.)  This makes it a little less advantageous to cut out the visual dimension of assessing clients as well as having the client see the therapist.  There are more possibilities for a healing connection between client and therapist if there are visual cues and eye contact.

Skype Counseling: If face to face therapy is a 10, Skype is a 9.

 

Skype counseling corrects this sensory deficit.  When I saw my first Skype couple for the first time on my computer screen, it was thrilling for me.  I was able to see how they were with each other.  There was information I picked up from visual cues that helped me understand their “disconnect” and how much pain they were currently in.  Clicking on “Full Screen” on the Skype software, my couple took up the whole screen and my experience of them seemed as therapeutically effective as them being right with me in my office.  They could also see my visual cues.  They could see me smile warmly and encouragingly with them as well as my look of empathy and curiosity as they spoke.  I had them do exercises just as I would in my office.  I would see their disconnected posture and ask them to shift to more open postures with each other.  I would not have been able to work on this level by phone.  I have had a similar positive experience with the other couple I have Skyped with.

Face to face counseling is most definitely the full package; you get the visual, auditory and kinesthetic senses working together.  (The olfactory sense is not usually that important; of course clients don’t have to shower after working out if we are doing phone or Skype therapy!) Despite the fact that face to face has the most potential for impactful and helpful therapy; I have found that I have been able to work with the three main sense modalities just as well with Skype.  If face to face therapy is a 10, Skype is a 9. Since we lose the visual cues in phone therapy, it may only be a 7 in terms of potential for a full therapy experience.  However, good phone therapy with an effective therapist is definitely preferred over mediocre therapy with a professional in person.

Personally, I plan to continue doing more phone therapy and I am guessing even more therapy via Skype.  Besides the fact that you can see each other, Skype is free and signing up for Skype could not be easier.  All three modalities, in person, phone and Skype can be effective and for me, not only do I enjoy the variety, I understand that different people have different preferences. My main interest is helping individuals and couples lead happier, more fulfilling lives and however they want counseling delivered, it needs to be delivered with understanding and support with the right amount of loving confrontation.

You can find me on Skype under “todd.creager”