About I am a clinical psychologist in private practice, providing psychological and neuropsychological assessments and psychotherapy for children, adolescents, and adults as individuals, couples and families. Soon after completing my post-doctoral training in Ohio in the early 1990s, I relocated to Northeast Georgia and established a thriving practice, most of it solo.
What motivated you to start practicing telemedicine? When, in the spring of this year, my wife took a job as a pediatrician with a Federally Qualified Healthcare Clinic in Harrisonburg, Virginia, I told my current and recent clients that I would be leaving in several weeks, and began the arduous task of terminating with more than 60 individuals, couples and families.
Immediately, several of them asked if I would be offering teletherapy, which they had experienced with other practitioners, especially psychiatrists. No, I told them, I was fairly certain that I would never practice over internet video, in that my interpersonal and gestalt orientations rely heavily upon the subtleties of face-to-face eye-to-eye heart-to-heart interaction. A few of my clients challenged that idea, but I was resolute.
About that time, I began regular Skype sessions with my two-year-old and newborn grandchildren who lived in Virginia. I realized after a few sessions that I was connecting emotionally rather richly with them, even over cellphone video, giggling and laughing and crying as if they were in the room with me. Soon after, I started investigating teletherapy from process, technological, and financial perspectives. I decided to try a few sessions with several established clients while I still resided in Georgia, with them sitting in my office and I relaxing in my living room. Even with a rather poor initial quality of video and audio, all said they found our sessions effective and worthwhile.
So, I offered teletherapy to all my established clients, only two weeks before I would move to Virginia, fairly certain only a few would want to try it. Amazingly, well over three quarters expressed something ranging from willingness to eagerness. I moved to Harrisonburg in July, having already leased and set up a fine office in town (where I actually saw no Virginian clients until October), arriving with a nearly full clinical practice comprised of my Georgia clients.
How has telemedicine changed your practice? As I begin to terminate with an increasing number of my Georgia clients (for purely clinical reasons, not because of my geographical relocation), I am just now opening my practice to local clients. I have performed several disability evaluations, and have had a handful of local referrals, all by word-of-mouth. I am having an open house in about a month, where I intend to begin networking and marketing myself to local referral sources. I intend to continue seeing Georgia clients indefinitely, as what will probably make up a minority but significant proportion of my clinical practice.
Over internet video, I find that I focus more on content than on process, and I resort to cognitive interventions more readily (even though I really question the effectiveness of cognitive therapy, believing the empathic relationship is what facilitates recovery, healing and change). Productive sessions have followed my observing this to my teletherapy clients, and inviting them to describe how they relate differently to me over internet video.
What challenges have you experienced practicing telemedicine? How did you overcome them? My previous work often focused on family sessions and interventions, which I find difficult in teletherapy. This is not only a function of the smaller office in which my teletherapy clients sit, but also the difficulty I experience “tracking” several family members on a single screen. I have dealt with this by having two family members start the session with others remaining in the waiting room, and having them move in and out of the teletherapy room as their participation is called for. I’m still uncomfortable with such arrangements, however, and find it discourages me from such family therapy.
The video and audio quality was my biggest struggle, at first. I found myself learning a lot about bandwith, static and dynamic IP addresses, pingtests and latencies, and I realized that the values provided by ISPs are often erroneous, or quite inconsistent. Ultimately, I’ve accomplished the best result with direct ethernet cables (with no wifi connections) at either end, with the highest available speeds, between two computers which do little more than maintain an internet connection. If I’m streaming music or uploading a document, or if my computer is engaged in some other task, the quality suffers.
I find that my clients' experience is much better when I use a quality webcam, perched at the top of the computer screen. The sound and video image are usually improved, but most importantly, I can ensure better "eye contact" (when the client is sitting off to one side of my screen) by sliding the webcam above his/her image.
Please connect with Rees Chapman on his website.