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The Internet Communications Medicine Technology

Therapy Over IP Draws the Young, Isolated 93

Posted by timothy from the how-does-therapy-over-ip-make-you-feel? dept.
Lucas123 writes "Psychiatrists say VoIP technology is more popular with patients than even in-person therapy when it comes to counseling — especially for their younger patients who are less intimidated by it. Along with many patients who like the convenience, telepsychiatry is a necessity for others who live in rural areas or are in, prisons, nursing homes or hospital ICUs. 'We've had just over 60,000 patient encounters. To my knowledge, only six have refused to be seen via teleconferencing,' said Dr. Avrim Fishkind, an emergency psychiatrist. 'We're tailor made for telemedicine because we don't check people's livers. We just talk.'" I wonder whether Eliza can be sued for practicing medicine without a license.
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Therapy Over IP Draws the Young, Isolated More

Therapy Over IP Draws the Young, Isolated

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  • VOIP != video teleconferencing (Score:4, Informative)

    by Jawnn ( 445279 ) on Thursday February 09, 2012 @12:00PM (#38982331)
    The summary makes it sound like the shrinks are using an advanced technology, not unlike our present day telephones, to enable delivery of their services.

    • The summary makes it sound like the shrinks are using an advanced technology, not unlike our present day telephones, to enable delivery of their services.

      You should say, "much like your primitive 'telephone' ..." It sounds more futuristic.

    • Re:VOIP != video teleconferencing (Score:4, Interesting)

      by timeOday ( 582209 ) on Thursday February 09, 2012 @12:19PM (#38982623)
      Wow, you are making me feel old for remembering when long-distance calling was cost-prohibitive. In 1984 a long-distance domestic call was about 25 cents per minute, which would be 50 cents per minute or $30/hour now. Now I use an ooma device and, after the initial investment, haven't paid a phone bill at all in about 3 years.

      By the way, while checking my facts I found this humorous article [jstor.org] from the Brookings Institute in 1987 slamming government regulatory action in breaking up AT&T claiming it was causing telephone rates to rise. Ha ha.

      • To be fair, it occurred to me that I am still paying for phone service, since I pay for my Internet bandwidth (to Comcast). In fact, the most basic Comcast Internet package is more or less in line with what a basic phone bill used to be if inflation is considered. So in some sense, costs hold fairly steady, but we're enabled to do much more, such as hang out on the phone for hours with our shrink in New York or Vienna :)

        .

        (Hedonic Inflation [seekingalpha.com]).

      • Re: (Score:2)

        by Anrego ( 830717 ) *

        Man, I remember when long distance plans dominated TV advertising. I remember _George Carlin_ actually doing ads for some calling plan! It was crazy.

      • Re: (Score:2)

        by Jawnn ( 445279 )
        You are not that old, my friend. I can recall interstate rates that were close to $0.60 per minute, and certain odd-ball interstate intra-LATA calls that were almost $2.00 per minute during business hours.

        As for that Brookings article, it was true, sort of. Once deprived of the huge profits they reaped in the monopoly days, the Baby Bells had to (were allowed to?) raise the rates on those services they still offered directly, like dial-tone and intrastate toll-calls. I seem to recall a bump in the cost o

      • Re: (Score:2)

        by Nadaka ( 224565 )

        maybe, my grandparents are grandfathered in with a $9 unlimited calling plan. Though they recently had to replace their rotary phone with a push button one.

    • Re: (Score:2)

      by werfele ( 611119 )
      Someone should point out that the article actually is about Web video conferencing, and not VoIP, despite what the summary may say.

    • Re: (Score:1)

      by cykros ( 2538372 )
      I think there may be something to be said in regards to this being the field of Psychiatry. This may be weird, but honestly, for both myself and other people I've known, there's a strong disconnect with how we view telephones and VoIP, simply due to the computer element (Don't ask me to explain it; I can't. I know that modern phones ARE computers, but give me a computer to talk through, and I'm fairly comfortable. Make me do it via a phone, and all I'm thinking about is finally getting to hang the damn t

  • VoIP is great for things like this. (Score:1)

    by Anonymous Coward

    I was actually wondering just a few days ago if VoIP was used much to schedule therapy or counseling sessions, mainly because the nearest psych who specializes in my situation is about three hours away, and I simply don't have the gas money (nor do most people). ...so it's really great to see technology being used positively. Yep.

    • Re: (Score:1)

      by Anonymous Coward
      Why do you bother? There's no cure for pedophilia anyway.

  • Assuming that legit therapy can be attained this way of course.

    Actually going to a psychiatrists office seems like a daunting task, but if the whole thing was done over VoIP... somehow it seems easier.

    • Re:This actually seems like a good idea (Score:5, Insightful)

      by g0bshiTe ( 596213 ) on Thursday February 09, 2012 @12:05PM (#38982403)
      Yes but what of things a Dr can't see that a patient is doing. Like fidgeting or picking at ones nails. Subtle hints that lead to some insight.
      • It isn't uncommon (actually quite common) for stroke patients to be done over a video conference . Why should psyche be any different? I would think the doctor would and should be looking for subtle cues and body language just like a Stroke Neurologist is looking for signs and symptoms in their patient to decide a treatment plan. A clot buster drug given when it shouldn't be can be fatal. What if the person likes to cut themselves? He might want to see those signs.

    • Re: (Score:3)

      by Hatta ( 162192 )

      Assuming that there is such a thing as legit therapy. Try looking for experimental data showing a statistically significant effect of therapy. Nearly all the data out there is lacking important controls, and when metaanalysis is done the effect mostly disappears into statistical insignificance.

      The best predictor for success in therapy is the expectations of the client. Not the skill of the therapist or the methods he uses. This leads me to believe that the apparent success of therapy is due to self-sel

      • So back to booze and weed self medication it is then.

        Thanks doc!

        • So back to booze and weed self medication it is then.

          Thanks doc!

          Hey, it works for the majority of the populace.

      • I have to wonder what meta-analyses you have been reading. Aside from the fact that meta-analysis is highly susceptible to agenda biases, [wikipedia.org] there is also this meta-analysis [ama-assn.org]. It concluded that SSRI's like Prozac, at least in the case of severe depression, were not only statistically significant, but reached the more stringent standard of clinical significance.

        • Re: (Score:2)

          by Hatta ( 162192 )

          Here's one [nih.gov] showing that CBT (which is lauded as the most empirically supported therapy) does not work on depression, but has some effects on anxiety. They correct for the file drawer problem, the FDA does not, BTW.

          You're right, your article does show that prozac has effects on the most severe patients. But it also shows that at least half of the patients with major depressive disorder a do not have severe enough symptoms to experience any benefit from Prozac.

      • Re: (Score:3, Informative)

        by ToastedRhino ( 2015614 )

        As someone in the field let me assure you that there is well-controlled research out there that has found clinically significant improvement in client functioning due to talk therapy.

        Also, the best predictor of positive outcomes from treatment/therapy is the quality of the relationship between the client and the therapist. This has been studied and confirmed ad nauseum.

        A quick PsycINFo search, by anyone with access, for "therapeutic alliance" or "therapeutic relationship" will confirm that for you.

        • Re: (Score:2)

          by Hatta ( 162192 )

          As someone in the field let me assure you that there is well-controlled research out there that has found clinically significant improvement in client functioning due to talk therapy.

          I would love to see the data. Can you provide a literature reference?

          Also, the best predictor of positive outcomes from treatment/therapy is the quality of the relationship between the client and the therapist. This has been studied and confirmed ad nauseum.

          Sure, and if the patient doesn't expect to get better, what is his rel

  • Doc... (Score:5, Funny)

    by Oswald McWeany ( 2428506 ) on Thursday February 09, 2012 @12:04PM (#38982393)

    It's all well and good until the psychiatrist has a patient with Webcamophobia.

  • Or at least Higgins tells me so.

  • Psychic Psychiatrist (Score:3)

    by Oswald McWeany ( 2428506 ) on Thursday February 09, 2012 @12:11PM (#38982485)

    Most people calling a shrink just need someone to listen to them:

    I think I'm going to start up a new business; Pyschic Psychiatrist.

    You don't need to come in for a visit. You don't need to call me using VOIP. You don't even need to know you have a problem. You don't need to know I'm treating you. I'll just listen to your troubles from afar by reading your brain and send you a bill in the mail.

    Just so you know- I've read the brains of everyone on slashdot- you're all screwed up the head- but I've listend to your problems.

    Please send $5,000 each payable to Oswald McWeany, PO BOX 13X, Psychicville, MA

    • Re: (Score:1)

      by Anonymous Coward

      I'm thinking of my Paypal password right now- please feel free to pay yourself using it.

    • Re: (Score:2)

      by Guppy06 ( 410832 )

      Most people calling a shrink just need someone to listen to them:

      Most anecdotes have no basis in fact.

      • OP's statement may not be accurate--I would particularly be leery of "most"--but I wouldn't say it did not have basis in fact.

        I remember a psychology professor in university stating two things about psychology: 1) The mere act of talking about things helps; I don't think anybody would disagree with that one, and 2) most mental illness gets better on its own.

        Boiling that down to "most people just need someone to listen to them" is an oversimplification and possibly an overreach on scope, but it's not bas

        • Even if you somehow ran the entire DSM-5 past somebody and could not come up with SOMETHING i think that the diagnosis reads
          "Does Not Have an Actionable Condition" since "normal" does not exist in the APA.

          Slashdot Mini-Poll how many folks reading this are borderline X (and possibly borderline Y W Z V and T)?

    • Careful, I think this method is patented. It was in early Unix implementations and called /dev/null.

  • he can was football and TV on the other side while listening to you.

  • Psychiatric profession uses medications as well as psychotherapy.

    Psychology does not use medications to supplement psychotherapy.

    If this really is Psychiatric, you can expect Co$ and the Armies of Tom Cruise to assail it.

    • Re: (Score:2)

      by Hentes ( 2461350 )

      They can recommend some medicine, they don't have to send it through the wire.

    • Psy D.'s can prescribe in many states, and psychologist often work in tandem with nurse practitioners in order to provide prescribing services. Also, more than 80% of all mental health care in the US is provided by social workers, not psychiatrists or psychologists.

  • And get recorded on video and audio, just don't plan on running for office or holding any important positions once you do this kids.

  • Obligatory link: Web Therapy (Score:2)

    by Anonymous Coward

    Web Therapy [hulu.com] came up with this idea a looong time ago. Go on, follow the link. I'll wait. You can thank me later.

    • If I only had mod points! I thought of the same thing immediately.

      Remember, stay with Fiona Wallice as your therapist, because going to a different therapist would be a breach of her intellectual property =)

  • Horray! Less effective technology (Score:3)

    by girlintraining ( 1395911 ) on Thursday February 09, 2012 @12:26PM (#38982713)
    VoIP is not as effective as face to face. I'm not saying there's never a reason to use it, just that it's not as effective. A lot of person to person communication is via body language and subtle changes in intonation, etc., that using VoIP will conceal. Teleconferencing would be preferable because it allows the opportunity to communicate with body language as well.

    Body language is huge in therapy, because a lot of what therapy is consists of getting the patient to talk about things he or she finds uncomfortable. Discomfort can be hidden much more easily in a person's tone of voice than in their body language cues.

    • Not to mention, the doctors may be doing more harm to their patients than good, specifically the socially awkward who already have trouble with interpersonal communication.

      If you're an anti-social shut in who just found out you don't even have to talk to your therapist face to face, what incentive do you have to better yourself?

      • If you're an anti-social shut in who just found out you don't even have to talk to your therapist face to face, what incentive do you have to better yourself?

        The success of the web-only series The Guild comes to mind...

        • If you're an anti-social shut in who just found out you don't even have to talk to your therapist face to face, what incentive do you have to better yourself?

          The success of the web-only series The Guild comes to mind...

          I admit, that's one I have yet to view.

          So many web series', so little free time...

      • Re: (Score:2)

        by Anrego ( 830717 ) *

        Gotta start somewhere...

        In fact, I imagine this could be a good tool to make therapy accessible to people with those sort of problems. Face to face sessions after patient gets comfortable could be a goal in the process?

        • Gotta start somewhere...

          In fact, I imagine this could be a good tool to make therapy accessible to people with those sort of problems. Face to face sessions after patient gets comfortable could be a goal in the process?

          Could, so long as the patient isn't using it as an excuse to avoid said face-to-face sessions.

          All I'm saying is that, used improperly, this technology could inadvertently do some patients more harm than good.

    • I agree with girlintraining, the closer to actual face to face communication the better. My wife is a psychotherapist and she has told me that sometimes she can smell the stress on a client, an indicator that would be missed even on Teleconferencing. So the ideal is to be in the same room with the therapist.

    • Re: (Score:2)

      by Anrego ( 830717 ) *

      I think it makes up for it in accessibility.

      I'm not talking about people who can't physically get to a therapists office... but people for whom doing so is a psychological hurtle.

      I’ve never had the need to see a therapist, but I imagine if the situation ever did come up, this would be a lot more palatable to me that going in person. Can’t really explain why it just seems like a much smaller leap to me.

  • Privacy Implications are Horrible (Score:4, Insightful)

    by mtrachtenberg ( 67780 ) on Thursday February 09, 2012 @12:29PM (#38982771) Homepage

    This is truly a privacy disaster in the making.

    No psychiatrist willing to put their patients in a position this vulnerable should keep their license. Even if the entire session is fully encrypted, the patient has no ability to tell whether the psychiatrist is recording, has other people in the room, etc...

    • Re: (Score:3, Interesting)

      by mitashki ( 1116893 )
      No patient would ever notice if his psychiatrist is recording the live session in their room. The privacy ethic is totally in the hands of the psychiatrist. So now after addressing your paranoia and O/C disorders how about having a beer in a nice relaxing environment and screw the therapy? ;-)

    • To be fair, they also cant be sure that the psychiatrist doesn't have a tape recorder in their pocket, or someone listening at the door.

    • Re: (Score:3)

      by Hentes ( 2461350 )

      In the same way you can't be certain that an IRL psychiatrist will keep his mouth shut. Whenever you go to one, you have to trust them.

    • Re: (Score:2)

      by Matheus ( 586080 )

      The recording part is a complete non-starter as most professional therapists record ALL of their sessions for the purposes of further analysis or mostly just for malpractice/harassment lawsuits. This is done above board and they have no need to conceal it (and as my siblings have already mentioned they could just as easily hide in a live setting if they so wanted anyway)

      Other people in the room is not that far off from the same deal. Therapists are required to have massive amounts of supervised sessions t

      • I'm surprised to hear that therapists record sessions. I hope this is revealed to the patient, and I hope the patient has a way of opting out.

        Introducing telecomm (especially computer telecomm) into the mix potentially enables the therapist's bosses to listen in (legally, they are the therapist's employer, right?), along with people in the IT department, along with anyone able to successfully attack the connection.

        Whether it's already being done or not, it's a privacy disaster. And if this is used for tho

        • Re: (Score:2)

          by fyoder ( 857358 )

          It varies by therapist. Many keep as few records as possible because they don't trust the state to respect client confidentiality. You can't surrender what you don't have.

    • Or a psychiatrist could be secretly recording live sessions, then playing them back with his drinking buddies and they are howling in laughter at your problems.

      RIght? There's a million ways to be violated. Choose one and flavor with your brand a paranoia.

      Either the doctor is a professional, or he or she is not a professional. If they are a professional, the integrity of the confidentiality of a therapy session is something they will ensure and stand behind with their reputation. Or they won't engage in the

    • Don't be absurd.

      How do I know my obgyn isn't recording my exams?
      How do I know that my plumber didn't install a spycam in my shower?
      How do I know my lawyer isn't gossiping about my case?
      How do I know my therapist isn't having someone at Kinkos xerox her notes about me?

      The answer is that I don't, but I can be pretty sure that if they did do this and it ever came to light, in every single case they would be ruined beyond imagining financially, professionally, personally and likely judicially.

      Psychiatrists and

    • The patient has no ability to tell that IRL, either. I dunno, seems a week argument.

  • This was my senior project (Score:3)

    by Nadaka ( 224565 ) on Thursday February 09, 2012 @12:34PM (#38982833)

    This is one of the things we did for for senior projects at my university before smart phones became popular.

    We developed a system for audio-visual telepresence for counseling and rehabilitation for people unable to visit a facility either from disability, lack of transportation or by legal restraint.

  • Stephen Hawking is here for his 11 o'clock.

    • Re: (Score:2)

      by Jawnn ( 445279 )
      Ah..., the eminent Dr. Sbaitso. I see by your 5-digit ID that you may have actually been a patient when he was still "practicing".
  • Oops, didn't mean to post anonymously before... Check out her web series. It's pretty funny actually at times. - http://www.lstudio.com/web-therapy/ [lstudio.com]
  • given that a "psychologist" provides talk therapy, and "psychaitrist" proscribes medicine, does anyone else see this as a little funny.

    Does this sound like fly-by-night operations setting up new pill-mills. like the old Florida "Pain Clinics". http://www.cbsnews.com/8301-501263_162-2872835-501263.html [cbsnews.com]

    from Xanax, to prozac, to Ritalian, psyciatric drugs are especially prone to being used and abused recreationally. All of which are rountinely advertised in spam mail. Is this really any diffrent than illeg

    • Psychiatrists provide more than just medication. A good psychiatrist provides a balance of counseling and medical services.

  • Shrinks aren't really practicing medicine.

  • It's not really about the technology because using the phone is absolutely not new, it's about the re-purposing of it. Usually phones are only used for business or personal conversation and less often they're used for the practice of medicine because if it were any other field of medicine, it would be considered inexact and risky to not physically be seeing a patient. Even in psychology, I'm aware of it being seen as a less intensive way of seeing a patient because the doctor can't physically see the patien

  • The therapy industry is shooting itself in the foot with this. If therapy can be done remotely, it can be outsourced. They're turning their business into a call center job.

    (This is probably the future of medicine. You'll talk to somebody in a call center, and if it's a serious problem, you get escalated to second or third level support.)

    • Re: (Score:1)

      by gv250 ( 897841 )

      If therapy can be done remotely, it can be outsourced.

      "Hello, my name is ... Peggy. How are you feeling today?"

  • Therapy over Internet Protocol?

    THoIP?

    I hope to God that this term doesn't take off.

    Thoip, thoip, thoip, thoip. Gah! It sounds so ridiculous right now I can't stop saying it!

    "Hey Nancy, hold all my calls. I've got a two o'clock thoip coming up."

    "Yes, our standard fee is one hundred thirty dollars an hour and we do have the ability to thoip."

  • As a service "patient confidentiality laws" may or may not be included or legally enforceable, are you going to read the EULA before you agree to it? The person on the other end may not be a licensed shrink, buyer beware.

    It's ripe for abuse, if not from the person offering it then from the "man in the middle" which could be anyone from a Chinese hacker to the government, you're a fool to use Facebook, you are a TOTAL ass to use this and confide your deepest darkest.

    No matter how far technology goes there is

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