In these unusual times, patient health and well-being are my priorities. As of March 20th, 2020, most sessions will be conducted by phone or HIPAA compliant video conference.
Below is a copy of my Telemedicine Consent Form, Guidelines for Remote Sessions and some links about video-conference / tele-conference psychotherapy and video meetings in general.
If we agree to meet by video-conference, I will send you an invitation from Doxy.me, which is a HIPAA compliant platform. You will not have to download any software. Should we encounter any technical difficulties, we can also talk by phone. It is important that you have privacy during telemedicine sessions.
Video-conference sessions differ from in-person and telephone contacts in a number of important ways and can increase a sense of isolation and disconnection.
1) We are not actually looking into each other’s eyes because of the position of the camera.
2) We are looking at a screen with a 2-dimensional image of the other person within that
3) The technology itself (email, clicking links, the computer, the screen, microphones and
speakers) places objects between us, which are usually not present.
4) Slight lags or disturbances in the video and audio disrupt our sense of continuity and
coherence in contact.
5) Such disruptions interfere with our natural ability to perceive many subtle cues, which
we rely on when in-person.
6) Our images are disembodied and partial, which is eerie, and incomplete.
7) Looking at a screen and being looked at may feel objectifying, and/or the quality of the
gaze may feel different.
8) It may feel that there is more pressure not to break eye contact than when in person.
In addition, being on the phone or video-conference includes these issues:
1) We experience multiple senses of loss including the being in person, the familiar
surroundings of my office, being in your home environment, not having commute
time before and after sessions.
2) There may be many more distractions.
3) The ambiguity of the timeline of when we will be able to reconvene is anxiety
provoking and also a loss.
All of these changes may feel frightening, alienating, disconcerting or odd and I am happy to discuss them at any time and in an ongoing way.
Telemedicine has a number of pros and cons. Here are some articles that address some of the issues.
© 2020 Jessica B. Londa, Ph.D.
If we are being advised to limit travel unless absolutely necessary, it might make sense for us to have our session via phone or screen. But a remote session is not the same thing as what happens when we meet in person. Also, it is not the same as a typical phone conversation or SKYPE or FaceTime call.
Listed below are some guidelines for how to get the most benefit as possible from these remote sessions when it makes
sense not to travel to the office.
1. The most important thing is to have privacy. I do my best to provide that when we meet in my office. But now it’s up to you. Please do everything possible to make sure you are in a private space where it is unlikely you will be heard or interrupted. You may need to ask others in your space to respect your privacy by doing things like turning on entertainment in another room or listening to something on headphones.
2. Try to make yourself comfortable, but not too comfortable. If you can, settle into a nice, comfortable chair. A workspace, if you have it, is best. Avoid laying in bed or on your TV-watching couch, as well as sitting on the floor or walking around. Try to arrange yourself in as session-like a position as you can.
3. Put a box of tissues next to where you will be. If you want, pour yourself a glass of water. But avoid having a snack or meal even though you may be reasonably close to your kitchen. Leave that for either before or after the session.
4. Please be sure to dress as you would if we were meeting in the office. Even though I may not be able to see you if the session is audio-only, or all of what you are wearing if meeting via video, a reality is that you know what you are wearing.
5. Turn off or put to sleep all devices other than the one you are using to make the call, including watches, laptops, and other phones. If using a smartphone or computer, do your best to quit from all programs other than the one we are using and turn off all notifications if you can. It is best to leave your hands free by using headphones. If we are using audio-only be sure to put your phone screen-side down. If using a computer for audio-only, please either turn off your monitor or completely darken your screen.
6. Try to leave yourself an additional 15-minutes both before and after the session for a walk, either by going outside and doing something like going around the block (if you are comfortable doing so) or, if staying inside, wandering around your place. If there is no way to take a walk, it makes sense to do some simple stretching. It is not a good idea to leave another remote meeting or call or activity requiring focused attention (either work or play) and then immediately call in to start our session. You will need some time to get ready for the work we are about to do. Similarly, after the session is over, take 15 minutes to do the same thing before diving into your next activity. This will give time for the session to resonate before jumping back into whatever you have next.
7. Location is important. Please do your best to always meet from the same place during this period of time, although that may not always be possible. Also, when we meet in-person, we share the same location. But now we do not. If you find yourself curious about where I am, please feel free to ask. I will do the same so I can imagine where you are.
I recognize that these guidelines make the remote sessions a little less convenient. But the additional benefit will be more than worth the effort. And remember, we will get through this together.
Adapted from Russell, G. I. & Essig, T. (2019). "Bodies and screen relations: moving treatment from wishful thinking to informed decision-making." In Govrin, A., & Mills, J. (eds.) Innovations in Psychoanalysis: Originality, Development, Progress. Routledge, London).
Remote Session Guidelines for Periods of Restricted Travel
From Therapist to Patient
Todd Essig, Ph.D. and Gillian Isaacs Russell, Ph.D.