Are High-Risk Clients Suitable for Online Psychotherapy?

Are High-Risk Clients Suitable for Online Psychotherapy?

by Anastasia Piatakhina Giré & Joseph Burgo, PhD

Two psychotherapists seasoned in long-distance Skype therapy discuss the unique challenges—and advantages—to treating high-risk clients online.
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Into the Virtual Unknown

When we first began practicing online via the Skype interface, each of us felt a similar trepidation. Four or five years ago when we started, online psychotherapy was in its infancy and there were no supervisors or established authorities to guide us, so there was an understandable fear of the unknown.

We also worried about mastering the technology, as neither of us is particularly skilled in computer matters more complicated than word processing and email composition. Should we use built-in or external cameras? Should we use headsets with boom microphones? How fast of an Internet connection did we and our clients need? And perhaps unnoticed at the time but inspiring a subtle anxiety:

Would we be less skillful as therapists, less confident in our abilities, when we no longer met with a client within the authoritative confines of our own offices?
Would we be less skillful as therapists, less confident in our abilities, when we no longer met with a client within the authoritative confines of our own offices?
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Anastasia Piatakhina Giré  &  Joseph Burgo, PhD
Anastasia Piatakhina Giré was born and raised in Saint Petersbourg (Russia), and, before moving to Paris, lived and studied in Italy, Great Britain and Spain.

Her experience of evolving abroad, together with her multicultural marriage and trilingual family, makes her particularly sensitive to the sort of issues experienced by people living in a different country than that of their origin, or those who are part of a mixed couple. Life away from home and family brings along quite specific psychological challenges. An expat herself, she is passionate about fellow travelers. As a writer, she has been writing scenarios since 2006 for television and cinema, and has always felt fascinated by people’s stories.

Joseph Burgo, PhD, has practiced psychotherapy for more than 30 years, holding licenses as a marriage and family therapist and clinical psychologist. He earned his undergraduate degree at UCLA and his masters and doctorate at California Graduate Institute in Los Angeles. He is also a graduate psychoanalyst and has served as a board member, officer and instructor at a component society of the International Psychoanalytic Association. He is the author of Why Do I Do That? Psychology Defense Mechanisms and the Hidden Ways They Shape Our Lives (New Rise Press, 2012) and The Narcissist You Know: Defending Yourself Against Extreme Narcissists in an All-About-Me Age (Touchstone, September 2015).

He currently writes the popular blog, After Psychotherapy, where he discusses personal growth issues from a psychodynamic perspective. Working with clients all over the world, he also practices face-to-face video psychotherapy on a secure internet platform.
Great insight into the pros and cons of online therapy.
Micheline
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