rolf wroteToufic, thank you for everything you wrote here. I appreciate you taking the time to answer my post and also replying to other participants.
You sound like a reasonable, knowledgeable professional.
Yet there isa thing that I found unconvincing. I am not sure that I understand your opinion on online counseling. I know a friend who has been doing that for a while, and he says it does him well. It might not be enough to prove me right, however, why would it not work?
After all, the most important vehicle in therapy, as I understand it, is speech. Body language might also be important, and that can also be (partly) conveyed by video chat.
People use phones, Skype, etc. just like they used letters in the past, to express feelings and talk about intimate or important things.
So to me, it looks like online therapy should be possible.
It was a pleasure to share the information and if anyone needs anything further, please do not hesitate to ask. I believe people are becoming more and more aware of this crucial aspect of overall health care though in Lebanon we are still far away from reaching the standard. (latest schooling education programs abroad are starting to include some kind of mental health teaching for children by the age of 7-8 focusing on the explanation of emotions and thought processing: what they mean and how you think when you have a positive emotions or a negative one and why we react/behave in a certain way)
Thank you for the kind words. I do my best and I still got a lot ahead of me (After all you are taking about the single most complex and constantly changing/evolving object of science in the world: human beings and their mind/brain within their environment)
Regarding your question, I do happen to agree with you that online therapy is possible. However there a bunch full of conditions/criteria in order for that to take place:
1) Type of therapy needed/conducted
2) Mental stability of patient (in an online session, if you get frustrated or angry over something you click a button and it’s done. Meawhile in face to face session, it’s something that needs to be addressed and it has an important meaning because the patient would have projected something on the therapist and they would need to analyze that and see why it happened and what it means)
3) Commitment to therapy in terms of actually going there physically: part of therapy is engaging yourself to invest a time + effort to actually go to the clinic and all that comes before arriving and after leaving that place. The notion of “safe place” or “confidential space” has a crucial value.
(For some depressive patient it’s the thing that makes them leave their house/rooms and for rape victims it’s the only place they can talk about the trauma because in other places they might be “heard” or “judged” or “shamed”)
4) Most important I would say (Wish is a continuation about the previous point) : setting !
In a clinic, the therapist is in control; meaning they can channel things and take control when needed (we did a 4 month trial activity where I work. Went to homes doing mental health support for patient with chronic illnesses. You had noises from the building, children running around, the patient himself at some point would go to the kitchen and grab something, telephone ringing etc.…). Meanwhile in an appropriate clinical setting, no one is allowed to interrupt, call or make noises when a patient is in session.
You can’t have those uncontrollable variables: the 40minutes to 60minutes session is strictly for working on your mental health state and wellbeing. The setting can either make that happen or break that.
5) As one of the previous posts mentioned, there is a need to have clear objective using tools sometimes
(For instance with children we use toys, stories, boards and all sorts of material. As for adults, there are charts we might need and flip chart to write down something concrete with the objective of allowing the patient to a) project b) assume ownership of his thoughts/emotions c) make things tangible d) record on paper and with his handwriting what it is happening/being done)
6) Let alone the logistics (good internet, camera, electricity etc.)
I could easily state some other reasons but I don’t want to bore you some more. Now I did say it’s possible if you are dealing with patients that are :
1) Stable enough. Who are not at a high risk. Who are considered to be severely suffering (suicidal patients, addiction patients, bipolar or schizophrenic patients, borderliner that are decompensated or prone for decompensating)
2) Needing a type of counselling called “talk therapy” or just support / guidance
3) Cognitively competent to pursue treatment via skype or any other mean
4) Advanced in therapy and no longer need the face to face dynamic to pursue the established basis of work you were able to build with them.
I’ll share a personnel experience that might clinch it for you (or at the least that online therapy is a case by case issue) :
Just 2 days ago: I found out that a psychologist told a girl on twitter she has “dissociative identity disorder along with depression and anxiety”. I didn’t go into details with her, simply explained that it’s not necessarily true and she might be better off seeing someone face to face because what the guy did was highly unprofessional. She didn’t take that as I thought.
Now I can’t stress enough on how fucked up that is. Not alone does this kind of diagnosis require skills, expertise, and a definite FACE TO FAC encounter to see if medication is needed and what kind of dissociation are we talking about (if there was any before to begin with).
It no joke nor is it something to take lightly (it’s blasphemous and the 21 year old girl has been living with that conviction doing research online and introducing herself as having that. All due to an amateur’s online diagnosis with 0 ethics or actual knowledge of the kind of damage online diagnosis can do.
What is worst here is when I tried to explain it to her she defended him because there’s some kind of cyber emotional bond that was formed given you can’t neutralize any emotions that arise from patients the way you could neutralize them in a face to face encounter. This happens often because a patient comes weak and vulnerable, needing emotional support and active listening. Hence again, proper policies are super needed in order to ensure that people like that guy are well educated/formed. I mean that girl might actually develop some mental disorder through identifying to some idiot’s diagnosis…
The human interaction/dynamic that arises from a physical encounter is essential in life overall for the best possible understanding between people.
Take for instance a girl you meet on the internet, you could talk for hours, days, weeks and months. When you meet one another, everything you pictured (the imagination part of your psyche) will face/clash with what is in front of you (the reality part of life) and those two might not be concordant and hence, rejection disappointment resentment etc. Face to face encounters allows you to see micro reaction, feel something that you can’t feel over a screen, see if a smile, cry, laugh, shouting is actually real or it’s a mask/strong face. It’s what we call in French “metapsychology” (you can’t touch it but it’s present there)
Hence, if I was to conduct such follow up, it would be exactly that: FOLLOW UP online therapy.
First assessment sessions always face to face unless im a 100% certain that it’s just for basic counselling or directing someone towards a certain kind of therapy or therapist.