© On Good Authority, Inc. ! SKYPE THERAPY Interview 1: ³Introduction to Skype Therapy´ Stephan Tobin, Ph.D. Interviewed by Barbara Alexander, LCSW, BCD (Edited slightly for readability) " ! Stephan Alexander Tobin, Ph.D. 19025 Nixon Ave., West Linn, OR 97068. 2106 NE 40th Ave., Portland, OR 97212 503-699-5534 [email protected] www.doctortobin.com Blog: www.doctortobin.com/blog INTRODUCTION " :HOFRPHWR2Q*RRG$XWKRULW\,¶P%DUEDUD$OH[DQGHU You are listening to or reading LQWHUYLHZLQ2Q*RRG$XWKRULW\¶Vcontinuing education program about Skype Therapy. Recently, an outrageous comedy made its appearance on the Showtime cable TV network. 6WDUULQJ/LVD.XGURZDVZKDWRQHUHYLHZHUFDOOHG³$QLPSUREDEOHSUDFWLWLRQHURIWKH LPSRVVLEOHSURIHVVLRQ´.XGURZSRUWUD\VDPHJD-diva therapist who can scarcely take her mind off herself, so she gives her patients 3 minute computer video sessions in a Skype-like situation. +HUVHVVLRQVDUHVKRUWEHFDXVHVKHVD\VVKHGRHVQ¶WZDQWWRGHDOZLWKGUHDPVDQGIHHOLQJVDQG memories and things like that. Her scheme is to harness the power of the Internet to dispense ZLWK³WKHVHOI-indulgent blather that occupies a 50-minute session.´ It is, to quote the reviewer, ³$FRPHG\RIHPEDUUDVVPHQW´ZKLFKKDGPHlaughing hysterically and cringing at the same time. ! Nonetheless, Skype therapy has become one of the most widely available online digital therapies. The Psychotherapy Networker PDJD]LQHZULWHVWKDW³ZHKDYHQRZD\RINQRZLQJ how many therapists have at least occasionally used e-mail or video-based platforms such as Skype to conduct psychotherapy, but the numbers are growing quickly. As electronic FRPPXQLFDWLRQKDVEHFRPHLQWHJUDOWRHYHU\RQH¶VOLYHVPDQ\FOLHQWVKDYHEHJXQWRH[SHFWWKDW their therapists will connect with them occasionally via computHU´,QFUHDVLQJO\FOLHQWVDUH !" " demanding electronic therapy and twelve states now have mandated that insurance companies pay for telehealth. The magazine, Scientific American Mind, listed as ³fast facts about distance therapy,´ that Research demonstrates that psychotherapy delivered via e-mail, video, chat, voice or texting can effectively treat cognitive, emotional and behavioral disorders, and that even brief therapeutic communiques using mobile phones can help combat eating disorders, alcohol abuse, cigarette smoking and anxiety. Although numerous studies show that video-based therapy can be as effective as in-person therapy, needless to say, there are many complex clinical issues to consider, as well as legal and ethical issues. In this program, first, Dr. Stephan Tobin will explain to us how he uses Skype Therapy. Next, Kevin McMahon, LCSW, will describe a long-term therapy done using Skype. Now to our interviews. INTERVIEW Stephan A. Tobin, Ph.D. has been practicing as a clinical psychologist, teacher of psychotherapy methods and theories of psychotherapy for over 35 years. He received his Ph.D. in Clinical Psychology from the University of Michigan. He was certified as a Gestalt therapist by Fritz Perls and Jim Simkin and was also certified in EMDR ZKLFKVWDQGVIRU³(\H0RYHPHQW 'HVHQVLWL]DWLRQ5HVSRQVH´ He founded a growth center; was co-founder and director of a mental health clinic; and was co-founder of the Gestalt Therapy Institute of Los Angeles. He has taught in the departments of psychiatry and psychology at UCLA and part time at other universities. He has trained therapists in the fundamentals of Gestalt Therapy and psychoanalytic Self Psychology throughout the United States, Canada and Europe, and has presented workshops at numerous professional conferences. He has published articles on Gestalt Therapy, on the integration of existential-humanistic psychology with psychoanalysis and on the integration of Gestalt Therapy and EMDR. Dr. Tobin is also on the editorial board of the Journal of Humanistic Psychology. He has been practicing and teaching in the Portland, Oregon area since 2003, having moved there from Los Angeles in that year. 'U7RELQ¶VZHEVLWH, www.drtobin.com, sets out very thorough information about various methods and other considerations for the use of Skype Therapy. ALEXANDER: Dr. Tobin, here is what I would like to cover in this interview if we can; I want to talk generally for a few minutes just about the technology that you use doing therapy over Skype. TOBIN: Okay. #" " ALEXANDER: What are the equipment requirements and some system requirements? What do you think is most vitally important if a person were going to try to do this; if a therapist were going to try to do this? TOBIN: Well, the most important feature is the high speed internet on both ends. Both the client and I have to have a high speed internet, and then the other thing is, obviously, a camera, a video camera. $/(;$1'(56R\RXFRXOGQ¶WGRLWZLWKGLDO-up? TOBIN: Well, dial-up would be without sight. ALEXANDER: Oh, true. TOBIN: Now you could do dial-up, you could do voice and I guess Skype, you know for the picture and dial-up for the voice, but I usually find that Skype is fine for both. ALEXANDER: So, what kind of security safeguards do you have or are necessary? TOBIN: Well I was concerned about that and I have a consultant, I have Macintosh and I have a website and a blog, so I have somebody that administers that and helps me like when I set up my blog, and she said that Skype is quite, quite safe. $/(;$1'(57KDW¶s good, and what about the physical layout of the room that you use? Are you in your formal office, are you in your dining room? Where do you do this -- or does it matter? TOBIN: ,GRQ¶WWKLQN\RXZRXOGZDQWWRGRLWLQ\RXUEHGURRP,¶YHKDGFOLHQWs who ZHUHLQWKHLUEHGURRPVEXWWKDWGRHVQ¶WPDWWHU,GRLWLQP\UHJXODURIILFHREYLRXVO\LWKDVWR look professional. ALEXANDER: What could they see in the background, because pretty much the screen would be filled with faces, right? Talking heads? TOBIN: <HDK\HDKWKDW¶VPRVWO\ZKDWWKH\VHH,KDYHD0DFERRNDQG,DFWXDOO\KDYH a 24-inch monitor that I hook the Mac book up to, but the monitor does not have a camera on it, VRZKHQ,¶PZRUNLQJZLWKSHRSOHRQ6N\SH,MXVWWXUQP\FKDLUVRWKDW,¶PIDFLQJP\0DFERRN LW¶VD-inch Mac book, so the screen is fine. ALEXANDER: Are you looking them in the eye or, if the camera is off to the side of you, how do you do eye contact? TOBIN: 2KZHOO,¶PORRNLQJat P\0DFERRN,¶PORRNLQJWKHPLQWKHH\HORRNLQJ them head on in other words. If I were looking at my monitor then they would see me from the VLGHZKLFKZRXOGQ¶WEHDQ\JRRGREYLRXVO\ $" " $/(;$1'(5,¶PKDYLQJWURXEOHYLVXDOL]LQJWKLV TOBIN: Okay, I have a desk and I have a 24-inch monitor. Off to the right is my Mac ERRNVRZKHQ,DPGRLQJD6N\SHVHVVLRQ,¶PORRNLQJDWP\0DFERRNVFUHHQUDWKHUWKDQP\ monitor and I just swivel my chair. ALEXANDER: So you have been doing this quite a while? I mean through many iterations of software? TOBIN: <HDK\HDK,¶YHEHHQGRLQJLWIRUDIHZ\HDUV ALEXANDER: Did you start out doing telephone therapy and then switch over to video/ Skype therapy or did you go straight to the video? TOBIN: Well, I actually did some sessions on the phone. When I moved up here from the Los Angeles area, I had a client that I saw in L.A. and she was very resistant to seeing any other therapist in person down there. I thought that would be better for her, but she refused. So we did phone therapy for about a year. ALEXANDER: And also did you do chat or email therapy? TOBIN: 1RQR,KDYHQHYHUGRQHHPDLOWKHUDS\,GRQ¶WWKLQNWKDWZRXOGZRUNRXWYHU\ well. ALEXANDER: What would be the difference for you? Just the live contact of a voice or a face? TOBIN: Working with somebody over the phone -- I mean you are losing visual contact, which I think is very important, but if you even lost auditory contact, to me that would be even OHVVJRRG,ZRXOGQ¶WIHel enough contact with the client to know really what is going on. At least with the voice I can hear gradations in their voice. ALEXANDER: How does it work in terms of the energy? When you are in the room with somebody you have a certain energy that develops between people. Does that transfer, do you find, with the Skype? TOBIN: Well not completely. I think it depends a lot on who the client is and who the therapist is. I would say that in general, in-person therapy is superior to doing therapy over the internet through Skype because there are more cues, there is more of a relationship, but in certain cases that is just not possible and then I think Skype is a good substitute. ALEXANDER: Which brings us to how do you decide which cases would this be appropriate or not appropriate for it? How do you decide for whom this would be appropriate? TOBIN: Because I have video therapy as a possibility on my website, I do get mostly emails from people who are interested in doing some therapy with me. I find out something %" " about them: what their issues are; what their history is with therapy; why they want to do therapy with me over the internet rather than seeing somebody in person? Based upon their responses, I will either consent to see them or not. ALEXANDER: This is over the telephone, right? Or maybe even email? TOBIN: Preferably it would be telephone, talking with them in person. I had a man call me from Europe and he emailed me. This is a man who had been hospitalized a number of times, was very grandiose, told me he was ready to make some deal where he would make billions of dollars and I could profit. This is obviously somebody I would not see on Skype. I told him that he needed to have some in-person therapy with a therapist who could have access to KRVSLWDOL]DWLRQLIKHQHHGHGLWDQGWKDW,MXVWZRXOGQ¶WVHHKLP6RWKDWLVNLQGRIDQH[WUHPH H[DPSOHRIVRPHERG\WKDW,ZRXOGQ¶WVHHRQ6N\SH $/(;$1'(57KDW¶VDYHU\JRRGH[DPSOHEHFDXVH\RXMXVWQHYHUNQRZZKRLVJRLQJWR« TOBIN: Right, right. I have actually never had an agoraphobic that I did Skype with, but that is a good example of the NLQGRIFOLHQWWKDWZRXOGEHJRRGIRU6N\SHEHFDXVHWKH\GRQ¶WKDYHWROHDYHWKHLUKRPH ,DOVRKDYHQ¶WKDGDQ\DOFRKROLFVZKHUH,KDYHGRQH6N\SHWKHUDS\:KHQ,¶PZRUNLQJZLWKDQ alcoholic in person, my approach is not to try to make them stop drinking, but to try to help them ILQGRXWZKDWGULQNLQJGRHVIRUWKHP6RLWZRXOGQ¶WPDNHWRRPXFKGLIIHUHQFH,IDFOLHQWFDPH in in-persoQDQGZDVREYLRXVO\GUXQN,ZRXOGSRLQWRXWWRWKDWSHUVRQWKDWWKHUHZDVQ¶WPXFK XVHLQXVKDYLQJDVHVVLRQWKDWGD\EHFDXVHLWZRXOGQ¶WPHDQYHU\PXFKWRWKHP,VXSSRVHLI, had an alcoholic client and I was seeing them over Skype, I could probably get some sense about whether they were drunk or not.