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More is somewhat more complicated: Online Psychotherapy with more than one patient demands new concepts for family therapy.

Paper presented at the World conference of cognitive and behavior therapy, Berlin 2019

Nilly Zohar, Shoshan Helman and Arnon Rolnick

A presented at the World Conference of Behavior and Cognitive Therapy.

In recent years there is an increase of online therapy provided by clinics and therapists but mostly for individuals. Very little was written about online family therapy.

There are specific issues for couple therapy and use of video therapy. This poster includes some consideration for remote couple and family therapy.

 

Seating arrangements: Should the couple use the same computer and camera or should they use separate computers?

Most approaches consider the seating arrangement as very important: On the one hand, we want the couple to talk to each other. On the other hand, we want the couple, as a unit, to face the therapist as well.  Apparently, the school of thought in couple and family therapy determines the seating arrangement online:

In general, video therapy enables the therapist to observe the couple’s faces in a very detailed way. Each of the partners sees the therapist’s face in detail as well. Therefore, there is a unique advantage in sitting close to the camera. However, sitting like this prevents perceiving the body expressions.

Who the therapist refers to?

In an in-person setting, where everyone is in same room, it’s very clear whom the therapist is referring to. The therapist’s head and body face either one partner or the other.  Using video, the therapist should be aware that the couple cannot perceive where he or she is heading, so the therapist should find ways to indicate it, sometimes simply by mentioning the name of the person s/he is addressing.

Real life and crisis situations:

The fact that therapy can be conducted at the couple’s premises, opens the opportunity for the couple to demonstrate real life situations and crises even more than in the therapist’s office, and allows the therapist to intervene while seeing these real-life situations. However, in extreme cases (e.g. when violence or real threat is involved), the therapist should prepare in advance someone in the couple’s neighborhood to intervene.

When there are two therapists.

Some times we prefer to have two therapists: The therapists represent different voices and sometimes prefer to argue among themselves. Enabling patients to refine their own attitudes and insights. The fact that therapists are of a different gender enables the heterogeneity of views.

This combination is even more challenging in a distance. Should the two therapists be in the same room?  How can they interact with each other?

Family therapy:

Classical family theories suggested to involve in the therapy all members of the family. The ability to work from a distance allows the inclusion of grandparents and other members who live far away. Yet, sometimes there might be some problems with the elderly members ( not used to internet communications) and with the children (It is hard also to keep children’s attention for longer periods of time, especially online).

In sum, online family and couple therapy opens new possibilities but also present some challenges.  in this presentation we will describe some examples, problems and solutions.