A Long Distance Relationship … With Your Therapist

Joseph Burgo shares his experiences using telemedicine in his therapy practice:

No doubt it would be better if my clients and I were able to meet in my office week after week, me inviting them in from my waiting room at the beginning of each session and ushering them out through the exit door at the end. But for people who live in remote locations where qualified professional help is scarce or entirely unavailable, connecting with a therapist by Skype is often the best option. Over the last few years, I’ve worked with an American expat living in Japan, a Ukrainian émigré in Israel, and the scion of a wealthy family in Egypt. I’ve held Skype sessions with people located in remote corners of the United States, England, Australia, and other countries. They had few options for getting the help they needed. …

The legality of Skype therapy is a gray area because most state laws require the professional to hold a license in the state where the client resides. Because I was trained as a psychoanalyst, and psychoanalysis is not a regulated profession in most states, I skirt such licensing laws by offering my services in that capacity. Some therapists call themselves “life coaches” when they work across state lines; others simply ignore the law. The arrival of distance therapy and telemedicine is rapidly rendering state-by-state licensure impractical. As usual, the law lags far behind technical innovation.

Todd Essig points out drawbacks to Skype therapy:

Are being bodies together and technologically-mediated simulations of being bodies together functionally equivalent, at least for the purposes of the psychoanalytic psychotherapy practiced by both Burgo and me?

According to a soon to be published book by Gillian Isaacs Russell titled Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy the answer is a resounding no (disclosure: I wrote the Foreword for this fine volume). In fact, after this book hits the shelves patients and therapists alike will need to be attentive both to the obvious gains from screen relations based treatment and the inevitable losses. Russell effectively demolishes the myth of functional equivalence using her ethnographic study of therapists and patients who have experienced Skype therapy along with lab findings from cognitive and neuro-science, communication studies, infant observation, and human–computer interaction, as well as a deep dive into clinical theory,

According to Russell, in an exchange we had about the Burgo article, when you eliminate the experience of being bodies together you constrain and limit what is therapeutically possible to “‘states of mind’ rather than ‘states of being.’” As a result, reflective introspection gets narrowed. How reflective can one really be when talking to a dashboard iPhone on a long drive?

Previous Dish on telemedicine here. In other therapy news, Tina Rosenberg flags research on providing mental health care to those in developing nations:

Two years ago, I wrote about a research study in 2002 that provided group interpersonal therapy, led by college students and high school graduates with two weeks’ training, to depressed women in Ugandan villages. The treatment was so effective that six months after starting this therapy, only 6 percent of those treated still had major depression.

More recently, similar work has gone on in South Asia. In rural Rawalpindi, Pakistan, the Thinking Healthy Program taught basic cognitive behavioral therapy for only two days to female community health workers with a high school education. The trainees, called Lady Health Workers, then integrated the therapy into their regular visits with pregnant women and new mothers. … Six months later, only 3 percent of those treated were still depressed. The largest study was in Goa, India, where local people with no health background were given an eight-week course in interpersonal psychotherapy and worked with physicians to treat patients with mental health disorders. This, too, was very successful.

These studies were proof that depression could be treated in poor countries by lay people. Now these researchers are trying to figure out how to streamline these interventions to the minimum outlay of resources needed to maintain excellent results.

Lastly, some somewhat lighter fare – Amanda Bloom covers a popular podcast from comedian Paul Gilmartin:

Gilmartin, 51, is the creator and host of The Mental-Illness Happy Hour, a weekly two-hour trudge to the darkest—and most joyful—corners of the human condition. He records the podcast in his hometown of Los Angeles, and the show is built around interviews with celebrities, artists, therapists, and podcast listeners; anonymous surveys; and Gilmartin’s narration of his own struggles with depression, addiction, and overcoming sexual abuse. Thirty-five thousand people download the podcast each week, and some episodes—interviews he’s held with Marc Maron, Maria Bamford, and Adam Carolla, for example—have been downloaded more than 80,000 times. The Mental-Illness Happy Hour website is home to an active listener forum, and the show’s 200th episode aired on November 21.

The podcast serves as a place of community and affirmation for those who struggle with mental illness, including Gilmartin, who has been undergoing treatment for clinical depression since 1999 and has gained clarity on his own issues through talking with his guests and corresponding with his listeners. It was while interviewing comedian Danielle Koenig during episode 16 of the podcast that Gilmartin realized on-air that he had been molested by a neighbor as a young boy, and the revelation that he was a survivor of incest began its slow simmer while talking with radio personality Phil Hendrie on episode 59. …

Levity and humor also keep the podcast from being overwhelmingly heavy, and listeners can expect a dick joke every now and again, in between tales of binge eating, drug dealing and coping mechanisms.