What’s with this Skype therapy anyway?

It’s really interesting how many people are curious about therapy over Skype and how many questions I get about it. Admittedly, it was tough at first to decide whether or not to offer video-based counseling. I had many of the same questions myself. After 8 months of providing therapy over Skype, I want to offer some of my (developing) thoughts.

First of all, the most obvious question concerns the lack of personal connection. This question goes much deeper into an issue about technology and relationships that I won’t cover here. I do want to say though that because I primarily practice a type of therapy known as “Interpersonal Therapy,” the relationship is very important to the therapeutic process. Therefore this is an extremely important concern. I prefer to provide therapy in person when possible, and only see local patients over Skype as an exception to the rule or to help out with unusual scheduling conflicts.

There are many ways though that the therapeutic relationship is already a very unnatural type of relationship. Having been in the patient seat myself, I know there is no other experience where you sit down with an almost complete stranger and start spilling your guts about deep personal thoughts and feelings. If you want to know the truth, it’s also a little strange hearing a complete stranger sit down to spill their guts to me!

The therapy office provides a “space” where the seemingly unnatural becomes natural. The office tells you that you are in a place where this is the sort of thing that happens. It is very similar to a medical doctor’s office where you might walk in and take off your clothes in front of a stranger. It’s not natural to do that anywhere else.

I have found though, that the comfort level of what is natural in the relationship is less about the office and more about the title of the professional and the circumstances under which two people are meeting. As we are preparing for our son to be born into the world, my wife and I recently spoke to our OB over Skype. Although I talk to family and friends over Skype, as well as my own patients, it felt very different talking to our doctor. We might as well have been in his office. The relationship was clear, as were the boundaries involved, and we were able to have our needs met without the 45 minutes it would have taken to get to the office. I also find that working with people over Skype in therapy is just as comfortable. People report that it is more comfortable to share the deep issues from their own home. Part of their problems might include difficulties with sharing deeply with others in person, but this is simply more content to discuss in the session.

While there are many concerns and I do prefer therapy in person, ultimately there is one principle that guides my decision and enjoyment in offering therapy by video. Most of the people who seek me out are Catholic and are seeking a doctor who can treat them in a way that is consistent with their beliefs. Although the APA and just about any training program in psychology will insist that a clinician has the ethical duty to respect a patient’s worldview, the majority of psychologists do not. When the issues get pushed to their limits, a clinician’s bias will come out. There are more ways than you can imagine that our Catholic beliefs are tested in practice. Most psychologists would be able to come up with a situation when contraception should be encouraged, abortion should be ignored, or marriage vows should be reinterpreted. (Just a few examples.)  They might facilitate an understanding of the human person that does not respect our God-given freedom or vocation to ultimate love and happiness. Most of the time, secular psychology works toward vague goals of happiness based on subtle and insidious philosophies of self-centeredness.

For good reason, Catholics around the world are fed up with psychology and crying out for something better. Every single priest I’ve met since going into this tells me how much he needs Catholic Psychology.  Slowly the secular institutions are opening up to the idea that religious belief might be acceptable in the psychological realm, but we are still a long way off before a Catholic worldview is specifically acceptable. For now, while Catholic Psychologists are very few and very far between, we can reach those who are suffering and in need with the aid of technology.

There are many ways that we are called to “offer up our crosses,” but God does not ask us to suffer needlessly. He provides members of the body of Christ that are trained to help other members carry their crosses. Whether this means seeking help for a broken arm or a broken marriage, it is never God’s will for us to needlessly suffer. Ideally, psychological or relational help would be attainable always in person, but then again, ideally no one would need psychological or relational help in the first place. In an imperfect world, an imperfect means of obtaining healing is better than not obtaining it at all.

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