Skype, Zoom .... Using Video or Voice-over-internet (VOIP) applications for therapy and supervision sessions (plus another possibility)
  • Familiar Apps - When therapists and supervisors think about online practice, they often go for what they are familiar with. Many of us use skype and Whatsapp for video calls with family and friends, and some of us use zoom for meetings and CPD etc. It can seem attractive to switch sessions over to the application that we are most familiar with. However, there are several considerations to take into account when making decisions about "online" sessions.

  • Holding the "Frame" -Karen Sugrue, a psychotherapist and lecturer in LIT, researched the topic of online supervision for her masters dissertation. She highlights the problem of provenance in the online provision of supervision (and by extension, psychotherapy). When we offer a skype or zoom session, for instance, do we know what we are offering, who is providing it, and what other uses they are making of our and our clients' data? In face-to-face sessions we work hard at being clear about all the parameters. The same is required for online or phone supervision and therapy. Some thoughts on these issues follow:

    • When we change from face-to-face therapy/supervision to online or phone sessions we are making a major change to the contract so clients must have a real opportunity to give explicit informed consent to this. We need to give clients clear and accurate information so that they can make an informed choice.

    • It is clear that Skype and Zoom are not completely secure or fully private - they both have different security issues. We should acknowledge this in general terms with clients when we are changing the contract with them.

    • They are internet-based services and are often routed through our home or workplace wifi, which may not even be protected by a password (we should ensure that we do not take any online sessions over an unsecured internet connection). Home wifi can be shared with several people who may have unwittingly imported viruses (teegagers and young adults are a major source of this). So we should run a scan on our shared home networks if we use our home network for internet access for sessions.

    • In Zoom and Skype it is advisable to book a  scheduled "meeting" for slighly longer than your scheduled time for the session so that the connection isn't broken before the end of the session.

    • On internet-based calls bandwidth is a problem and many therapists are reporting dropped video and voice contact during sessions. In face-to-face sessions we would always "handle" any interruptions that threaten to impact on the session, and online sessions require the same holding of the frame. This is not easy with online sessions in many homes and in many parts of the country network access can be unstable. At the very least, we should ringfence our claim on bandwidth on our home network; this could involve asking other house occupants not to use wifi during sessions if bandwidth is a problem. This can even be necessary where there is fibreoptic broadband as many wifi routers only allow a few users at one time and split the signal between them. Sometimes using your own mobile phone as a hotspot exclusively for your use is the best option. Essentially the ethical issue centers on holding the frame, which includes attending to predictable frame issues such as bandwidth, what is in the view of the camera, what is within "earshot" of your microphone and what contact and platform arrangements are to be made (i.e. who initiates the Skype or zoom call. 

    • Online sessions using social media platforms such as Facebook, messenger or Whatsapp is very problematic. Because we tend to use these platforms for personal matters we may have given permissions for high levels of  data sharing and the risk of unintentionally sharing client data is high. Furthermore, in using these platforms we may be giving clients a window into our personal lives that may self-disclose to the client in a way that is not therapeutically useful to the client.

  • In Summary - we need to assess whether video or voice over internet sessions (Skype, zoom and the like) are suitable for psychotherapy and supervision. They are not fully secure and, at the very least, we should tell our clients that. Clients should be able to give free informed consent to any changes in their contract. If we do opt for these ways of offering sessions, we are still bound by our code of ethics including the responsibility to hold the frame (this means attending to predictable interruptions of service, interruptions from people, and anything within the fame that would diminish the therapeutic space in any significant way). So it might be worth thinking about phone sessions including using mobile phone apps such as DUO by google.

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