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The following is a therapist’s perspective on conducting counseling online vs. in person. He describes how his online counseling tends to be more transient and short term than his in person counseling. As I have been doing research on the side about the uses of technology in all forms of therapy, this is an interesting additional element to the equation. In addition to the perceived pluses and minuses, the notion of the virtual also being temporary is something to ponder. Perhaps it is a symptom of the fast paced instantaneous world we now inhabit.

Online vs. In-Person Psychotherapy — One Major Difference

When I first began working with clients by Skype, I was surprised (and relieved) to find how similar it is to working in person. Once I began learning more about affect theory and how facial expressions communicate feeling states, I came to understand why I’m still able to empathize so well with my clients.

Now that I’ve been practicing via Skype for over a year now, I’m also understanding one important way that it differs from conventional face-to-face work: psychotherapy relationships via Skype tend to be much more transient. I suppose it’s a feature of many “virtual” relationships that are quickly formed and easily ended. Despite all the caveats in my disclosure statements, no matter how clearly I state that I don’t do short-term work and believe it takes time for a psychotherapy bond to develop, I still have clients who come for a few weeks and decide to quit because they don’t feel they’re making sufficient progress.

Even more surprising to me has been the way some clients simply disappear. No final session, not even an explanatory email. I was working with a physician, prominent in her field, who disappeared without a trace. I knew I was doing good work with her. Our final session stirred up significant anxieties about the state of her marriage, so when she sent me an email cancelling her next appointment, I viewed it as understandable resistance. But my follow-up attempts to reschedule received no answer. She vanished without a trace. Another client recently terminated therapy with no warning, also because of anxiety stirred up during session: concerns about unconscious rage and violence had come to the fore in our prior session.

When you work in one specific location, the clients referred to you often know your colleagues or other people with whom you work. Another therapist may send you the spouse of a client, or one of your former clients might refer a friend to you. Such connections usually inhibit people from simply disappearing, as some Skype clients seem to do — at least in my experience. Over the years of my practice, I almost never had a client no-show and then fail to return my calls. Someone who lives in another state with no personal or professional connection to me doesn’t worry about what other people might think if they decide to disappear.

Still, over the last year, I’ve been fortunate to develop strong bonds with a growing number of Skype clients. In a way, it reminds of when I first began in the profession: many people started treatment but most of them didn’t continue for long; over time, I formed strong relationships with more and more of them until I finally had a stable clientele. Maybe it’s not simply due to the transience of virtual relationships but a function of building a virtually new practice.