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Notes on Gender Role Transition
Anne Vitale PhD, Editor



T NOTE #17

Using Skype as viable therapeutic media: An Interim Report

Anne Vitale Ph.D.
September 2, 2013


Although I generally use my T Notes to discuss the clinical aspects of gender issues, I thought this would be a good time to write about the fast moving therapeutic impact that technology has had on the gender community. We are all familiar with the utility of listserves, blogs, online forums, informative web sites such as this one, texting and email but little has been written about the advantages of working one-on-one with a gender specialist via online video conferencing.

History--Shortly after my book was published in December 2010, I started to get requests from through-out the United States and Canada, across the European Union and even one Swiss national living in the Middle East, all wanting to know if I would be willing to work with them via video conferencing. For all intents and purposes, and although there are other platforms slowly becoming available, that means Skype.

In all the years I have been in practice, I had never even thought about working online but the surge in requests to work with Skype were too compelling to ignore. Although each person had their own reasons for the request, it was obvious that unless someone worked with them using telepsychology, they would not have access to any help at all. I figured that that someone might as well be me.

Although the field of telepsychology is very much in its infancy, working with individuals world wide via the internet has become a reality. Skype is available every where there is an internet connection. What's more, it is now reliable enough to keep clear visual and audio connections for hours at a time...and best of all, it is free. Other advantages include, mobility (neither client nor therapist need be confined to a specific office. Telepsychology can be done from a car parked in a park, in one’s living room, while on a hiking trip or even at the beach, all of which I experienced.); Without office rent, therapy charges can be significantly reduced ( I reduce the cost of online sessions by one third); Privacy is enhanced as clients do not have to be concerned about being seen visiting a therapist’s office and then have to deal with trying to explain him or herself to people he or she would rather not know about the issues involved (this is an especially important issue for folks living in small rural communities); Clients in rural areas need not have to drive long distances to see someone who is qualified to work with them (in one case in particular that I am working with, the client would have no other choice but to leave the country to find help).

Efficacy-- Skype has proven that it is exceedingly convenient for both therapist and client but is it efficacious? Can a therapist really be able to make meaningful in-depth emotional contact with someone hundreds to thousands of miles away? Will the client feel free to express their very troubled gender issues with a therapist they have never actually met? After several hundred hours of working with Skype across vast distances and across several cultures, I am happy to report that meaningful work is not only possible, it even has a few advantages over face-to-face work; there is a palpable freeing aspect to some client’s presentations. It seems that a virtual presence allows a level of anonymity that is unavailable in face-to-face work. Others have taken notice of this effect and further studies of this phenomenon by other practitioners is going on as I write.

These positive results should not be surprising. After all audio and visual presentation are the two main cues therapist use while doing their work...both of which Skype allow. As a result, the outcome is very close to what therapist and clients have come to expect in face-to-face work.

This report would be incomplete if I did not talk a little about the limitations of working with gender issues via Skype. The most obvious limitations are logistical: the two parties must share a common language, be technologically capable of using the software, and have an agreed upon payment set up such as credit card, international money transfer agreement or have access to a PayPal account.

An important clinical issue is that if the client lives far from a gender specialist there is also a high probability that he of she will live a prohibitive distance from a well versed gender related medical evaluation team. For those distant clients who are ready for cross sex hormones, I have had to enlist family physicians that have no personal knowledge of me (often a touchy issue) or find someone from the WPATH Directory who lives and works as close as possible to the client. Even then cooperation between therapist and physician may be not be all that a long standing in-person therapist/physician professional relationship would have established.

Another limitation is the absence of physical contact. Even shaking your therapist’s hand upon greeting, an appropriate hug upon leaving or feeling human warmed only a few feet away during a session can have its own special healing effect. With this in mind, the online therapist should be aware that what is going on between the two of you should only be considered a temporary opening and the therapist should continue to try and find a qualified gender therapist near enough to the client and facilitate a transfer of care.

So to sum it up, I have found that Skype is not the be all and end all of working with gender issues but it is an excellent starting point for someone who either has no idea who to talk to about their problem or finds the idea of going to a local gender specialist frightening less he or she be outed in some way. Some times all it takes is a few sessions with a therapist that understands the gender dysphoric dilemma to break the tension that comes from living decades long in secrecy. Once installed, Skype and professional help regarding your gender issues is only a click or two away.


Copyright 2013 Anne Vitale Ph.D. All Rights reserved.

Disclaimer: Nothing on this site should be viewed as providing therapeutic advice. No formation of a client/therapist relationship with Dr. Vitale is intended or to be implied or inferred. The information provided in this site is for educational purposes only. I attempt to keep the information current but make no representation or warranties in that regard. You should not rely upon this information as a substitute for consul with a qualified mental health professional.