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Therapy Over IP Draws the Young, Isolated

timothy posted more than 2 years ago | from the how-does-therapy-over-ip-make-you-feel? dept.

The Internet 93

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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93 comments

VOIP != video teleconferencing (3, Informative)

Jawnn (445279) | more than 2 years ago | (#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.

Re:VOIP != video teleconferencing (2)

OakDragon (885217) | more than 2 years ago | (#38982531)

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 (3, Interesting)

timeOday (582209) | more than 2 years ago | (#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.

Re:VOIP != video teleconferencing (1)

timeOday (582209) | more than 2 years ago | (#38983025)

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:VOIP != video teleconferencing (1)

Anrego (830717) | more than 2 years ago | (#38985167)

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:VOIP != video teleconferencing (1)

Jawnn (445279) | more than 2 years ago | (#38985969)

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 of basic service about that time.

Re:VOIP != video teleconferencing (1)

Nadaka (224565) | more than 2 years ago | (#38986123)

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:VOIP != video teleconferencing (0)

Anonymous Coward | more than 2 years ago | (#38988763)

In 1984 a long-distance domestic call was about 25 cents per minute, which would be 50 cents per minute or $30/hour now.

I remember trying to place a phone call in 1984. I tried calling a friend in Eurasia, but the operator informed me that they were now my enemy, had always been my enemy, and I should make friends in Oceana.

Re:VOIP != video teleconferencing (0)

Anonymous Coward | more than 2 years ago | (#38983223)

Funny I was thinking Intellectually Property when I first read the title. I thought appropriate as most of us worry about it in some way.

Re:VOIP != video teleconferencing (1)

werfele (611119) | more than 2 years ago | (#38986289)

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

Re:VOIP != video teleconferencing (1)

cykros (2538372) | more than 2 years ago | (#38990985)

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 thing up). Now, that probably can't be all that universalized, but to say that there's no difference may be to ignore the nuances of the human psyche. Technologically speaking, of course, you're correct. Both are merely transporting voice communications.

VoIP is great for things like this. (1)

Anonymous Coward | more than 2 years ago | (#38982337)

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

Anonymous Coward | more than 2 years ago | (#38986661)

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

This actually seems like a good idea (1)

orphiuchus (1146483) | more than 2 years ago | (#38982349)

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 (4, Insightful)

g0bshiTe (596213) | more than 2 years ago | (#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.

Re:This actually seems like a good idea (1)

clm1970 (1728766) | more than 2 years ago | (#38984129)

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:This actually seems like a good idea (2)

Hatta (162192) | more than 2 years ago | (#38982705)

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-selection by patients with good prognoses

As for the alternative, prozac is similarly ineffective when the literature is viewed metaanalytically.

Re:This actually seems like a good idea (1)

orphiuchus (1146483) | more than 2 years ago | (#38982867)

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

Thanks doc!

Re:This actually seems like a good idea (1)

CanHasDIY (1672858) | more than 2 years ago | (#38983291)

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

Thanks doc!

Hey, it works for the majority of the populace.

Re:This actually seems like a good idea (1)

jpstanle (1604059) | more than 2 years ago | (#38983873)

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:This actually seems like a good idea (1)

Hatta (162192) | more than 2 years ago | (#38985837)

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:This actually seems like a good idea (3, Informative)

ToastedRhino (2015614) | more than 2 years ago | (#38984779)

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:This actually seems like a good idea (1)

Hatta (162192) | more than 2 years ago | (#38985433)

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 relationship with his therapist going to be like?

Doc... (4, Funny)

Oswald McWeany (2428506) | more than 2 years ago | (#38982393)

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

ELIZA has a license (1)

Robert Bowles (2733) | more than 2 years ago | (#38982399)

Or at least Higgins tells me so.

Re:ELIZA has a license (1)

OakDragon (885217) | more than 2 years ago | (#38982561)

"Oh, I have a license?"

Re:ELIZA has a license (3, Funny)

ackthpt (218170) | more than 2 years ago | (#38982579)

How do you feel about that?

>

Psychic Psychiatrist (2)

Oswald McWeany (2428506) | more than 2 years ago | (#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:Psychic Psychiatrist (1)

Anonymous Coward | more than 2 years ago | (#38982601)

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

Re:Psychic Psychiatrist (1)

Matheus (586080) | more than 2 years ago | (#38983111)

You're gonna need some bacon to go with the egg on your face when he actually does... !

Re:Psychic Psychiatrist (1)

Guppy06 (410832) | more than 2 years ago | (#38983049)

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

Most anecdotes have no basis in fact.

Re:Psychic Psychiatrist (1)

Dhalka226 (559740) | more than 2 years ago | (#38984123)

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 baseless. The mere act of talking to somebody, and the time periods over which it happens, are a significant part of the healing all by themselves.

Also, it's not clear what the OP meant by "shrink." There is a difference between a psychologist (a doctor of psychology) and a psychiatrist (a medical doctor specializing in the mind). Psychiatrists can prescribe drugs, which if nothing else increases their possible effect on their patients. Psychologists can not (in almost all cases), and so talking and their advice is all there is to their therapy.

Part of the issue may also be that "mental illness" has become a pretty broad term, so much so that I have heard things like 25% of people have mental illnesses. When you cast a wide net, the fact that things usually get better on their own catches more people.

Everybody is "crazy" to some degree (1)

RobertLTux (260313) | more than 2 years ago | (#38987659)

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)?

Re:Psychic Psychiatrist (1)

rrohbeck (944847) | more than 2 years ago | (#38983559)

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

my therapost has the split-screen version (1)

peter303 (12292) | more than 2 years ago | (#38982501)

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

Telepsychiatry vs. Telepsychology (1)

ackthpt (218170) | more than 2 years ago | (#38982529)

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:Telepsychiatry vs. Telepsychology (1)

Hentes (2461350) | more than 2 years ago | (#38983193)

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

Re:Telepsychiatry vs. Telepsychology (1)

NeuralSpike (968001) | more than 2 years ago | (#38984051)

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.

Just talk (1)

koan (80826) | more than 2 years ago | (#38982595)

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.

Re:Just talk (2)

Stormthirst (66538) | more than 2 years ago | (#38983437)

And then sue for breach of patient confidentiality laws. Either way, you make money.

Obligatory link: Web Therapy (2)

Anonymous Coward | more than 2 years ago | (#38982657)

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.

Mod parent up (1)

Zinho (17895) | more than 2 years ago | (#38983297)

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 (2)

girlintraining (1395911) | more than 2 years ago | (#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.

Re:Horray! Less effective technology (1)

CanHasDIY (1672858) | more than 2 years ago | (#38983229)

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?

Re:Horray! Less effective technology (1)

girlintraining (1395911) | more than 2 years ago | (#38983741)

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...

Re:Horray! Less effective technology (1)

CanHasDIY (1672858) | more than 2 years ago | (#38984081)

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:Horray! Less effective technology (1)

Anrego (830717) | more than 2 years ago | (#38985365)

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?

Re:Horray! Less effective technology (1)

CanHasDIY (1672858) | more than 2 years ago | (#38985685)

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.

Re:Horray! Less effective technology (1)

Deb-fanboy (959444) | more than 2 years ago | (#38984275)

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:Horray! Less effective technology (0)

Anonymous Coward | more than 2 years ago | (#38993235)

...
So the ideal is to be in the same room with the therapist.

"Ideal" is not even frequently possible. Consider the patient in county jail, tiny hospital ER, backwoods clinic, etc. who simply don't have th option of a face to face. Seriously, they (or several campus-mates) might be dead before that "ideal" situation is available to them.

Re:Horray! Less effective technology (1)

Anrego (830717) | more than 2 years ago | (#38985317)

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 (3, Insightful)

mtrachtenberg (67780) | more than 2 years ago | (#38982771)

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:Privacy Implications are Horrible (3, Interesting)

mitashki (1116893) | more than 2 years ago | (#38982973)

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? ;-)

Re:Privacy Implications are Horrible (1)

orphiuchus (1146483) | more than 2 years ago | (#38983015)

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:Privacy Implications are Horrible (2)

Hentes (2461350) | more than 2 years ago | (#38983143)

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:Privacy Implications are Horrible (1)

Stormthirst (66538) | more than 2 years ago | (#38983983)

I've been fortunate enough to not need therapy - don't they record their sessions anyway?

Re:Privacy Implications are Horrible (1)

NeuralSpike (968001) | more than 2 years ago | (#38984247)

They have to inform you if they do. Most just take notes.

Re:Privacy Implications are Horrible (1)

Stormthirst (66538) | more than 2 years ago | (#38984691)

If that's the case, what's to stop the shrink from telling they are recording the session over VoIP? Sounds like an non-issue to me

Re:Privacy Implications are Horrible (0)

Anonymous Coward | more than 2 years ago | (#38983235)

...the patient has no ability to tell whether the psychiatrist is recording, has other people in the room, etc...

That's equally true in someone's office.

Re:Privacy Implications are Horrible (1)

Matheus (586080) | more than 2 years ago | (#38983277)

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 to get and maintain their licenses. Also professional consultation is often allowed (and even encouraged) and may be assisted by either live or post-via-recording viewing of sessions. Doctor-Patient privilege does not keep your doctor from seeking assistance from his/her peers.

The only thing the remote/digital conveyance of the session degrades in terms of security is the ability for someone external to the situation completely to gain access to the information. The patients knowledge of that risk should be considered no different from the risk taken when they call and talk to their therapist over a normal phone which is already a fairly regular practice.

Re:Privacy Implications are Horrible (1)

mtrachtenberg (67780) | more than 2 years ago | (#38984231)

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 those behind bars, I'd be really surprised if the authorities didn't listen in, legally or illegally. That in itself should make this illegal for use with those whose movements are constrained.

Re:Privacy Implications are Horrible (1)

fyoder (857358) | more than 2 years ago | (#38986783)

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.

Re:Privacy Implications are Horrible (0)

Anonymous Coward | more than 2 years ago | (#38983485)

Live video psychotherapy and telepsychotherapy already exists and has been used for many years. The VA system is actually conducting a study seeing whether video psychotherapy vs face to face psychotherapy has a significant difference in effectiveness. In particular, video psychotherapy can be useful because many vets do not live near a VA center.
Many medical systems are making use of online features that promote physician to patient communication, for example, logins to a web system where patients can access their lab results, make appointments, and send messages to the clinic.
By your argument, should it be prohibited that any psychotherapy occur because there is a possibility that someone other than the psychotherapist is in the room or there is a hidden video camera? Maybe you've been watching too many episodes of Dexter!

Re:Privacy Implications are Horrible (1)

circletimessquare (444983) | more than 2 years ago | (#38984377)

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 telepsychiatry session.

There are people in this world whose problem is they trust too easily. Then there are people in this world with a deficit of trust: they are too careful. You need to get over your hangups.

Re:Privacy Implications are Horrible (0)

Anonymous Coward | more than 2 years ago | (#38984697)

There is no guarantee he's not recording if you are in his office ether, if you think about it. Either way he'd face serious legal sanctions if he did, probably the least of which would be losing his license. Of course, that's probably no comfort to the paranoid who need his services.

Re:Privacy Implications are Horrible (1)

thesandtiger (819476) | more than 2 years ago | (#38985831)

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 psychologists and licensed clinical social workers see patients who are in extremely vulnerable situations all the time; vulnerable to the point where it could be potentially life-endangering if the patient in question were simply found out to be seeking counseling, even if the actual information conveyed during counseling sessions isn't disclosed.

A friend of mine had a patient beaten nearly to death by their spouse when the spouse found out the patient was seeking help. Another friend of mine had clients they couldn't meet at their usual office because the office in question was inside a health center serving the LGBTQ community, and the clients were not out and could have faced serious issues (including violence) were they found out by people in their lives (usually parents who would have had extremely negative reactions to finding out their kids are queer).

Sometimes people who need help aren't able to get help face-to-face or in a traditional setting, and rather than just deny them help entirely, it's preferable to get them help that may come with more risk than typical. The people who are worth being licensed, however, will take every step they can to minimize the risks, inform the patient of the risks, and be as aware as possible of the ways they themselves can reduce the risk.

Is it ideal? No. But please, dispense with the hyperbole.

Mod parent up (1)

Calvinbert (595650) | more than 2 years ago | (#38987501)

I wish I had mod points for you.

Re:Privacy Implications are Horrible (1)

snarfies (115214) | more than 2 years ago | (#38987301)

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

This was my senior project (2)

Nadaka (224565) | more than 2 years ago | (#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.

Paging Dr. Sbaitso... (2)

TBedsaul (95979) | more than 2 years ago | (#38982965)

Stephen Hawking is here for his 11 o'clock.

Re:Paging Dr. Sbaitso... (1)

Jawnn (445279) | more than 2 years ago | (#38985699)

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".

"Therapy Over IP" (0)

Anonymous Coward | more than 2 years ago | (#38982995)

Therapy over IP is nothing new. It's called "Internet Relay Chat", the original social network.

More of the same racket! (0)

Anonymous Coward | more than 2 years ago | (#38983181)

Psychiatrists have long since given up on therapy. They figured out some time ago if you reduce everything to a "15 minute med check" that you can run people through your office like cattle and keep charging full price for it. This is just another way to turn the crank faster.

Lisa Kudrow Has a Comedy Web Series About This! (0)

Anonymous Coward | more than 2 years ago | (#38983219)

It's actually pretty funny at times! Check it out if you have time - http://www.lstudio.com/web-therapy/

Lisa Kudrow Has a Comedy Web Series About This (1)

Nomad313 (949733) | more than 2 years ago | (#38983335)

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]

Another use for EMACS! (0)

Anonymous Coward | more than 2 years ago | (#38983391)

meta-x psychoanalyze-emo

Anyone else see the potential for abuse (1)

davydagger (2566757) | more than 2 years ago | (#38983415)

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 illegal online pharamcies, except a grey veneer of legality provided by licensed doctors selling prescriptions(see above).

This is putting a new fancy name on an old dirty scheme.

Re:Anyone else see the potential for abuse (1)

NeuralSpike (968001) | more than 2 years ago | (#38984279)

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

No worries about Eliza's license (1)

shaitand (626655) | more than 2 years ago | (#38983511)

Shrinks aren't really practicing medicine.

Re:No worries about Eliza's license (1)

buback (144189) | more than 2 years ago | (#38984427)

If you want to get paid by insurance, you'd better have a license.

Re:No worries about Eliza's license (1)

shaitand (626655) | more than 2 years ago | (#38986239)

That doesn't make psychiatry actual medicine.

Now, it's not high-tech... (1)

larys (2559815) | more than 2 years ago | (#38983523)

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 patient's expression, their mannerisms, etc. and those are helpful for diagnosing a patient -- especially one who may be suffering from a disorder involving loss of contact with reality or difficulty distinguishing the truth because in those cases, sometimes you can't know whether a patient is giving the information needed unless you're looking at them. The use of this method for therapy is important because not every patient can make it in person. The elderly who are depressed having watched all their friends pass and possibly their spouse may be too fragile to make the trip once or twice a week. Other terminally-ill patients -- regardless of age -- may need to be undergoing serious treatment such as dialysis, IV medicine treatment, or other intensive treatments basically anchoring them to a hospital where their psychologist -- or one most appropriate to treat them -- may not work. This is a great use of a technology which has otherwise been abused as a means for bad customer service, incessant telemarketing, and having someone call you when you're 100mi away to ask you where the milk is.

Call center shrinks (1)

Animats (122034) | more than 2 years ago | (#38984195)

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:Call center shrinks (1)

gv250 (897841) | more than 2 years ago | (#38984881)

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

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

Re:Call center shrinks (0)

Anonymous Coward | more than 2 years ago | (#38991909)

Read about the original Eliza program.

I Can't Take This Seriously (1)

The Wild Norseman (1404891) | more than 2 years ago | (#38985321)

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."

Ugh forget it. (1)

koan (80826) | more than 2 years ago | (#38985913)

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 something to be said for face to face conversation, and in the area of psychiatric help it is critical.

Disclaimer: I am against most anti-depressant drug use, I feel cognitive therapy over the long term has better results without the nasty side effects, why do they use drugs then? Because it's cheaper, faster for the Doctor and longterm cognitive therapy is expensive and no one wants to cover it, plus for the patient it takes patience (no pun intended)
Now for the idiots among us, I do feel SSRI's and other drug therapy can be helpful, so before you prattle on about that read and comprehend.

Eps!? (-1)

Anonymous Coward | more than 2 years ago | (#38986771)

of chaalenges That culture of abuse

Well where is your chat site. (0)

Anonymous Coward | more than 2 years ago | (#38988167)

www.crazy.com

Alright, this is why it's actually a good idea... (0)

Anonymous Coward | more than 2 years ago | (#38989187)

As no one actually focuses on the good here so far... Have you ever been so depressed that you cannot leave your bed for *weeks* on end? I have. I would of loved it if my therapist would do a session via skype. Sure they can miss the subtle signs of depression and anxiety, but the *not leaving apartment* is a pretty big flag that they won't miss....
 
  Then there is the pain of when you move, or your therapist moves, and you have to change your shrinks. After years of opening up to one person, it's so hard to open up to a different one that skype would be magnificent. At least it would aid the transition period.
 
  These, and other examples are where VOIP services would shine: providing therapy where the patient otherwise would not receive *any*. Its so easy to fall though the cracks when you are depressed. And for those that say practitioners who suggest it should lose their liscense because it isn't "secure".... You do know a lot of sessions are taped, right? All of mine are, and I'm alright with that. Somewhere there is a file full of tapes, CD's, and a few video DVD's out there with my name right on it. And that is in many ways less secure than someone cracking into the stream and finding out what makes me tick. If it's the police, then it's not admissible in court. If it's someone stalking me/ doing extralegal research for some reason, then if they hadn't cracked into seeing my sessions, they would morally be just as likely to break into my therapists office and steal the file itself. Security is never absolute, after all.

It works very well (0)

Anonymous Coward | more than 2 years ago | (#38993181)

We use something similar in our ER now. It allows patients to be observed via camera so the psych doc can visualize subtle actions. Most importantly, the patient doesn't have to wait a few hours (or days) for the doctor to be "in". It allows relatively quick assessment and disposition recommendation. The ER doc is advised of the recommendation and the patient is on their way home with a psych appointment, or on their way to the psych hospital under legal detention, or anything in between. Under the previous system, if a counselor was not immediately available we would have a psych patient in an inappropriate medical bed waiting to be transferred when the counselor/doc was able to come to our hospital and make a recommendation (next day).
This is a wonderful implementation of technology that is long overdue. I'm amazed at how little basic technology we use in daily health care.

Ah psychotherapy (0)

Anonymous Coward | more than 2 years ago | (#38995147)

Ah psychotherapy, where you pay someone to pretend to give a shit about you for a short period of time. It's like prostitution except more expensive and without the sex.

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