Online counseling and coaching are typically done via a platform such as zoom, skype, or doxy. Although I have known others to use facetime and/or just plain phone without the video component. So . . . video v. phone?

Sam, who lives in a rural town some hundreds of miles from his psychologist, has reached out for advice with a brief history of erectile dysfunction. The resources in his area are limited, and with this, he can have access to trained and experienced season people, particularly in the area of sex therapy. With his work, his sessions are more geared towards coping and not uncovering work since the firewall prevents the intimacy needed in order to go deeper.

I have used all and certainly resort to phone with in-between session contacts, crises, and on the rare occasion when someone has limited or no access to the internet. I’m not a fan of phone sessions where you lack the option of making that visual engagement with someone, particularly someone with whom you have a relationship and know. The ability to tap into facial expressions, breathing changes, and overall energy, is virtually absent. Further, a video option requires someone to sit and be still whereas phone does not; distractions are anticipated and not just for the patient but for the therapist as well!

The firewall with both is exponentially greater.

With the explosion of coaching in recent years, therapists opt to be justified in crossing state lines where therapy is not possible in states where the therapist is not licensed. Yet there are those who coach, and these are primarily those with appropriate training and/or experience that is limited to a few. While an option for some, coaching by definition hovers on the surface and does not dig deep as therapy does; they are different in many ways, too many on which to elaborate here. Yet bottom line. . coaching is directive and works on the surface while therapy is the exploration of the psyche, sometimes advice-giving, a much deeper process. Nevertheless, coaching to advance the loophole may be less needed once PsychPact (psychologists only) is enacted and up and running, of course, depending upon how many days one wishes to work in another state.

Working through actual pain is not without its downsides. It is the epitome of the ‘no pain no gain’ in that there exists all too often an emergence or worsening of symptoms when the core work is being processed. It is for that reason that touching that pain point without a solid relationship and access between patient and therapist can emerge into a virtual nightmare. It is at times a challenge to help someone via online video chat and near impossible to do it with someone in a dyad in which the relationship lacks safety and security, as in texting therapy.

It is important to note that online therapy and/or coaching should be limited to issues with no ongoing symptomatology, such as a mood, psychosis, or dissociative disorder.

Check out Dr. Winter’s online therapy offerings here.

Check out the next blog in this series here.

Check out the last blog in this series here.