Families with scattered members stay in touch, thanks to WeChat, Facetime or Skype. Why not use the same technology to give patients access to a good analyst? That is not so simple. Insurance companies may not reimburse for teletherapy. States may not grant an exceptional license to an out-of-state provider for one patient (although many states are now forming an interstate licensure compact). Skype and Facetime cannot claim to be HIPPA-competent: A breach in confidentiality could occur. We could do harm. These are all real concerns and could lead therapists to say no to a patient’s request for treatment at a distance.
But, denying access to treatment may also do harm. What about the person who lives in a remote part of the country where there is no analyst? What about the busy professional who lives in Los Angeles where there are lots of analysts but where it can take more than an hour to drive to the analyst’s office? Or the man who travels for work, the pregnant woman on antenatal bedrest, and the mother who is nursing infant twins? What about the analyst who feels well enough to work but is immobilized after a car accident?
The patient can continue treatment if the therapist provides a secure, HIPPA-competent online connection and can arrange temporary or restricted licensure across state lines. The patient must be well informed of the risks of conducting treatment over the telephone or Internet, acknowledge them, and consent to the virtual treatment setting, which is still experimental at this stage in the evolution of our experience. If the analyst can listen well, and the patient can talk freely, and both augment the sense of connection imaginatively, then teletherapy can work as well as in-the-office sessions.
We certainly want to do no harm. We cannot afford to have false confidence in the privacy of the virtual setting. But we can use technology safely to provide patients in psychotherapy and psychoanalysis access to care and continuity.
That is the message of the Karnac book series Psychoanalysis Online. Volume 3 focuses on the teleanalytic setting to help therapists get started with a responsible ethical approach. The next volume in preparation will deal with the (as yet) rather limited research available to us. More research and more clinical accounts are needed to give confidence in this method. As therapists we are rather settled, contemplative people and need time to get used to new ideas. But younger people are living globally, connecting constantly, their relaxed attitudes to privacy a surprise. They are asking us to adapt to their lifestyle. Whether we like it or not, teletherapy is a rapidly evolving field, and we must prepare ourselves for the challenge.
Jill Savege Scharff, MD, FABP (USA), is Co-founder of the International Psychotherapy Institute; Supervising Analyst at the International Institute for Psychoanalytic Training; Clinical Professor of Psychiatry at Georgetown University; and psychoanalyst and psychotherapist with individuals, couples and families in Chevy Chase, Maryland. Jill is an author, editor, and series editor of many books, several co-authored with David E. Scharff.