4.4 Clinical considerations

In Activity 11 you read that the research on digital therapies confirms its effectiveness. Research focused only on synchronous videoconferencing counselling is similarly positive, suggesting that it is effective for a wide range of client issues, with good user satisfaction, and similar clinical outcomes to traditional face-to-face psychotherapy (Simpson, 2009; Backhaus et al., 2012).

Research on therapeutic alliance also suggests that strong alliances can be formed in videoconferencing counselling (such as Simpson and Reid, 2014), although questions remain about the extent to which alliance is different or differently important than in face-to-face counselling. For example, one recent meta-analytic study that examined therapy alliance in video-based counselling compared to face-to-face therapy found that although alliance was high in video counselling, it was still lower than that reported in the face-to-face equivalent. Despite this, however, there was no difference in outcome of counselling: both therapy types were equally effective (Norwood et al., 2018).

Pause for reflection

Think about your own experience of videoconferencing with clients, friends or family. What is your experience of relating to others through videoconferencing? Are there things that your like or things that you struggle with?

Activity 14: Clinical considerations in video counselling

Timing: Allow approximately 30 minutes

Read the following extract (from Vincent et al., 2017, p. 72) and answer the questions below.

(Note that ‘VOIP’ means ‘voice over internet protocol’. ‘VOIP’, or ‘VOIP software’, are alternative terms for ‘videoconferencing’.)

So, for example, there was a concern that this way of work limits the therapist’s confidence in feeling that he or she is sufficiently well attuned to the client’s emotional state (Scharff, 2012) and, in parallel, can trust their counter‐transference. Loss of image definition and distortions to voice quality play into this problem. Moreover, the abrupt beginnings and endings of sessions mean that important information is lost about how clients enter the consulting room, talk of their journey to therapy and then exit the room at the end of the session. Tao (2015) explores the impact of the VOIP setting on the analytic frame in detail, discussing whether such a connection can provide a ‘good enough’ setting for therapy. He describes how VOIP (or ‘teleanalysis’, as he terms it), reduces the journey to therapy to just one click of the computer mouse, making it seem more like a magic game than making a real, serious connection. Once a computer session is started there are questions about how we as therapists relate to the computer screen and to this ‘virtual space’ (Balick, 2014, p. 32) imagined to exist between us and our clients. There is a self‐consciousness associated with using a video camera reinforced by simultaneously being able to see a picture of oneself on the screen as one talks. The experience of feeling less emotionally attuned to the person at the other end of the line coupled with the self‐consciousness that comes from observing oneself can heighten the feeling that the conversation tends towards a narcissistic or solipsistic exchange. Balick (2014, p. 32) makes the point that in feeling less emotionally connected to the person at the other end of the line, there is a greater opportunity for participants in computer‐linked conversations to experiment with projecting different identities. One respondent thought that the couple he worked with using VOIP used their screen to present an over‐idealized image of themselves to themselves and to their therapist: that of being a linked couple (they used one video camera and sat closely intertwined on a sofa at home), which was at odds with the reality of their non‐relating. Another colleague reported that a web camera exchange involved seeing her client in her night clothes and sitting up in bed. These presentations of self and couple were possible because of the clients’ control of the web camera location and use. In both cases, the therapists pondered hard on whether these presentations helped or hindered the therapeutic task.

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You should now move on to Topic 5: Audio-only and phone-based counselling [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .

4.3 Learning to use Zoom