Adventures in telepsychiatry

I read an interesting blog post in which the author, a training and supervising psychoanalyst shares his thoughts about “online therapy.”

The author was doing research on “techno-ethics” for a workshop he will be doing, and the premise of his blog post is that any online therapy is not “real” psychotherapy.

Of course, psychiatrists do more than therapy (regrettably, some do no therapy at all), so the author’s argument doesn’t necessarily apply to telepsychiatry, but I still find his argument lacking.

He begins by accusing anyone who does any kind of online therapy as “preying on vulnerable people in need of help.” I have no doubt that there are people who are doing a bad job of online therapy, just as there are people who are doing a bad job of face to face therapy, too. Even though the author admits that people have been helped by online psychotherapy,  he discounts any proof by success. Instead, he says that online therapy is a “technologically-mediated simulation of psychotherapy,” sort of like Disney World or a flight simulator.

He goes on to give a couple of reasons why he thinks online therapy is a simulation rather than “real” psychotherapy.

First, he states that “Skype or Email is just not risky enough provide the same context for the development of safety.” He states, without any support, that no therapeutic alliance can be built online. Such a statement can be refuted by one counterexample. Although I certainly believe that technology can change the therapeutic alliance, I think my own experience makes me think that the author doesn’t have any experience upon which to base his opinion. Certainly, I think that there is a therapeutic alliance that gets built when I do telepsychiatry. I wonder what the author’s experience would be if he actually tried it.

Second, he says that mirror neurons are not activated in online therapy, but are in face to face therapy. A brief search through the literature finds no evidence for this claim, and, in fact, other studies would suggest that it would be surprising if mirror neurons were not activated by online therapy, given that many studies show that mirror neurons are stimulated by things like films, videos and pictures.

The author closes by saying:

And for my colleagues out there pushing this new frontier, maybe you want to dial-back on the evangelical fervor, maybe even consider clearly stating that what you are offering is a simulation, not the actual journey that has been subject to decades of research and study.

I would say back to him two things. “Theory is not as important as people getting better,” and “Try it first, then write your article, rather than the other way around.”