The Skype Psychologist

What video-chat therapy sessions offer that in-person visits don't

As I prepare for my first session of the day, I settle down at my computer, log on to my Skype account, and review the completed questionnaire emailed to me by a prospective client. The hour ahead will be an initial consultation. It’s early morning in my time zone, late in the evening for him: Because of the time difference between Sydney, Australia, and the east coast of the United States, this was the only hour that worked for both of us.

At 8 o’clock on the dot, I initiate the Skype video call. I can see my client’s face clearly, though the picture is a bit dark. He lives in a shared flat, he tells me, and doesn’t want to disturb his flatmates so late at night, so he is speaking to me from his parked car via iPad. A nearby streetlamp spills light through the windshield, enough to let me read his facial expressions. All in all, it’s a good first session. We connect.

Since I began working by Skype three years ago, I’ve grown accustomed to “meeting” with my clients in various locations. Kitchens, bedrooms, living rooms, basements, private offices, hotel rooms. One session took place in a client’s childhood bedroom when he went home to visit his parents for the High Holy Days. And my new Sydney client was not the first to speak to me from his car. One of my former clients occasionally propped his iPhone on the dashboard and spoke to me while driving long distances from one city to another. Sometimes if he knew cell coverage would be spotty, he’d pull over and finish our session in a parking lot or on the side of the road.

None of this is ideal, of course. 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.

Consider the situation of the American expat in Japan. Given where he lived, he wasn’t able to find a therapist able to understand not only his language, but his cultural values and attitudes as well. Immersed in a foreign culture, expats often struggle to adapt; they may feel anxious, alienated, and depressed. People forced to move when a spouse is transferred to a foreign country, with no job and only the expat community for support, may have an especially hard time. They often search in vain for a local therapist to help, particularly in countries where psychotherapy is undeveloped as a profession.

My colleague Anastasia Gire—a Russian émigré married to a Frenchman and currently living in Madrid—specializes in addressing the particular psychological needs of expats. Fluent in Russian, English, French, and Italian, she works by Skype with a diverse group of clients whose jobs (or their spouses’) carry them far away from their home countries. If you were a Russian speaker married to a Spaniard whose company transferred him to Dubai, what are your chances of finding a compatible in-person therapist?

For some people who choose a distance therapist, convenience is often an issue. Ever since Freud invented talk therapy more than a century ago, driving or taking public transport to your therapist’s office has been a time-consuming part of the experience. You must fight traffic or brave the subway to get there. In order to make sure you don’t arrive late, you need to allow time for unexpected delays. After the session is over, you waste more time traveling home or getting back to work.

With the advent of Skype therapy, clients don’t have to allot more that 45 or 50 minutes for their sessions. I’ve worked with a number of busy professionals living in New York, Zurich, and London where there is no shortage of qualified therapists. All of these clients came to me after following my blog, After Psychotherapy, but convenience probably factored into their decisions, too. Many of them also travel as part of their job; in the pre-Internet days, this would have meant lots of missed sessions. Now they take me along on their business trips.

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.

With the impending arrival of Oculus Rift, Facebook’s virtual-reality headset, we might be on the verge of a yet another new age for distance therapy. While video gaming will of course be the major investment focus for this technology, maybe one day the engineers at Skype will update their platform to incorporate it, crafting a program that allows me to enter a shared space with a new psychotherapy client. At the appointed hour we will don our virtual reality headsets and greet each other, convinced by this amazing new device that we’re actually face-to-face in the same room. I might even be able to invite him in from a virtual waiting room at the beginning of the session and show him out through an “exit door” at the end.