Welcome to a blog that aims to be full of insightful ramblings from a licensed psychotherapist, with a specialty in sex therapy and marriage and family therapy. It is my hope that this blog will be of interest to people in therapy, people contemplating therapy, people contemplating being therapists, people about to be therapists and people who already are therapists!
Wednesday, August 17, 2005
Top Ten Reasons For Starting Therapy
10. Your friends and family have tried their best, but they can't seem to help you with your problems.
9. Buying self-help books is growing tiresome and is only slightly helpful (another book on saving your marriage by somebody on their third one?).
8. You don’t trust anybody else to know your innermost secrets and private struggles and have heard that psychotherapists are confidential and private.
7. You and your partner/friend/family member/spouse keep having the same old fight, yet more of the same and LOUDER doesn’t appear to be helping.
6. You can’t stop crying, are either sleeping too much or too little and have either no appetite or can’t stop eating.
5. You’re having trouble making friends and reaching out to people and think therapy might help.
4. You feel lonely, scared and isolated and can’t bear feeling this way any longer.
3. It helped somebody you know, so maybe it will work for you.
2. Getting drunk (or having sex, going shopping, gambling etc) to deal with life’s challenges is playing havoc on your professional and personal life and you don’t know where else to turn for help.
1. You’ve tried absolutely everything else – 12 step groups, support groups, friends, family, books – therapy is your last resort.
It's the third day of my vacation and I'm starting to think about the various plans I've lined up for while I'm here. For the last year I've been in the process of doing the background work that goes into setting up an online therapy website, and one of the steps I've taken was to attend an online training with Elizabeth Zelvin, a therapist whose clinical practice is exclusively online. I've been procrastinating, primarily around the building of the website. Believe me, I have no excuse. I have a wonderful web designer, Nick Wigzell, who is going to build the architecture and design the site, and I have a spouse who is designing the back end practicalities of an online business. The place where I'm mainly stuck is in writing the website itself, the front end description of what online therapy actually is. I thought it would help if I wrote a blog about what I understand and believe about online therapy. Talking to therapy folks who are not online therapy savvy is typically frustrating - it scares most therapists to think about doing therapy online, and many of them don't believe that it can possibly be effective. The research belies this.
Meanwhile, what is online therapy? Are there any benefits to online therapy versus face-to-face therapy? What are the pitfalls of online therapy? Are there folks who seem to benefit more from online therapy versus face-to-face (f2f)? What kind of people should avoid online therapy and why?
Now, despite the fact that I haven't yet conducted an online therapy practice, I have a fair amount of experience conducting online chat rooms, as I worked for AOL many years ago as a chat room facilitator. I understand the dynamics of how relationships develop online, I understand the power of lines of text between people and how easily, unless you are careful and attentive to what you are saying and how you are saying it, your words and the words of others can be misinterpreted and misunderstood. I understand the need for clarity, and also for protocols to define online relationships. What follows comes from picking the brains of those who have gone before, along with my own research. Types of online therapy There are two main types of online therapy: synchronous and asynchronous. Synchronous therapy sessions happen in real time which means that they are immediate and in the moment. For example, chatting via instant messaging or in a chat room would be examples of synchronous therapy sessions.
What are the benefits of chat room therapy? As anybody who has ever talked in a chat room knows, things happen fast. Chat room therapy is no different apparently. It's extremely fast-moving and it behooves the online client to either have or develop the ability to multi-task and follow fast-scrolling text. Just like any chat room, it's possible for the online-savvy therapy client to benefit from a lot of the same qualities that accompany f2f therapy, such as expressive communications, and on-the-spot interactions with the therapist, who is able to respond immediately to what the client is saying. Chat room therapy also provides structure to clients, somewhat replicating the idea of standard, scheduled appointments that happen in f2f therapy. Chat room therapy provides some consistency and a sense of ongoing relationship between therapist and client, and allows for the growth of a therapeutic relationship between participants.
What are the benefits of email therapy? Email therapy is of great benefit to clients whose typing skills are slow. Chat therapy is speedy, but email therapy allows clients to go at their own pace. Without the discipline of a typical 50 minute therapy hour, which is standard for both online synchronous therapy and face-to-face therapy, people have plenty of time to write their therapy email in a reflective and thoughtful way. There's less of an on the spot feel than in face-to-face therapy, and for some folks removing this pressure is an added advantage. For clients who enjoy writing and expressing themselves in the written form, there's an extra familiarity that comes from writing. Conversely, for some clients the emails provide the distance that they need to feel comfortable and safe. They have control over how much or how little intimacy is fashioned and feel that they have more control over the session via email. In a typical f2f therapy session, the therapist answers a client's question or responds to a concern and then the words effectively vanish. In contrast to this, clients are able to retain their connection to the therapist via the written word in email therapy. Communications via email can be read again and again, allowing the online client time to absorb what the therapist has to say in their own time. The speed of therapy via email is a slower. Another benefit is the absence of structure. There is no need to schedule sessions and client and therapists can write and respond at their own pace. Email therapy is typically cheaper than synchronous therapy, and this often guides an online client's choice of the type of therapy they will select.
What kind of people seek out online therapy? All kinds of people can benefit from online therapy. For example, busy parents who can't find babysitters or have very little time in which to leave their homes for therapy. People with disabilities who can't easily access transportation or accessible therapy offices. There are people with facial/bodily disfigurements who do not feel able to leave their homes or feel reluctant to be seen in public due to the social stigmas attached to physical differences. There are people with stutters who do not feel encumbered by their stutter online. Not everybody lives near places providing mental health services, and the online therapist is their only possible resource. Some sexual abuse survivors, both male and female, have significant anxiety about seeking face-to-face services with a therapist. These and other folks wary of face-to-face contact have the option to pursue online therapy.
Who is best suited for online therapy? As I've already written. people who do well communicating via the written word are good candidates for online therapy. Plus it helps if you are able to maintain online relationships. It also aids in rapid communication if you have nimble fingers and are fairly internet savvy. Who is ill-suited for online therapy? Online therapy is not a good option for people who are very depressed and suicidal, or those who refuse medication or face-to-face therapy. It isn't usually possible using online therapy to create and sustain adequate therapeutic supports for them. Having said that, Azy Barak has an online practice specializing in services for suicidal clients, but he is a rarity. If you have big trust or safety issues, it's harder to develop a trusting therapeutic relationship with a therapist online, which means that it's also more challenging to be effective as a therapist. Not impossible, just more challenging. Some of the challenges that surface in any online relationship, will surface too in online therapy, but the ante is upped. For example, if you are dependent on the internet for contact with the outside world, this means that losing your modem, a dial tone, or the server going down creates hardship for a while. But this becomes an even larger challenge in therapy, where it's easier to feel abandoned by your therapist, even though he or she has no contact over the vagaries of errant IP's. This means that sometimes time needs to be spent on explaining why the therapist wasn't at the chat room at the appointed time, or why the email didn't get through that you were depending on for solace and support. Online therapy is not covered by most Health Insurance plans, so unless you have credit cards or a regular income it can be prohibitively expensive.
About 18 months ago I joined the International Society for Mental Health Online (www.ISMHO.org) to get up to speed on all the current thinking and research being conducted into online mental health services. For those of you who are interested, it's worth checking out their website. You can also watch for my eTherapy site, coming soon to an internet near you, at www.JassyTimberlake.com.
Finally, I am on vacation. The last 10 days have been exhausting and busy, with new clients beginning therapy in my practice and the external stressors of pieces of my own life. I’m tired and ready for a break. I haven’t had the time or energy to write my blog for a while, and am looking forward to writing a great deal while on vacation.
The last time I had a real vacation was September 11, 2004 when my new spouse and I took a one week Honeymoon to Martha’s Vineyard, with my beloved mother in tow. She came over for the wedding and stayed for the honeymoon. It was definitely not a romantic, or even restful, trip, despite the beauty of Aquinnah (formerly known as Gay Head). My mother dislikes “moving air” and is therefore miserable in the convertible that is so perfect for touring around the island roadways. She, like many other Brits, considers a long car ride to be anything more than an hour. Remember. Britain is a country that isn’t much more than 850 miles from one end to the other so a Brit’s idea of a day trip is a one hour drive each way tops. Anything more than that is considered re-locating.
But this time I am spouse-less and driving towards Western Mass, where I will be spending ten days with my best friend, Kathy, at the foothills of the Berkshires, and on top of a mountain. I drove here on Friday morning, with a stop off to do a therapy home-visit with a couple who used to see me for therapy before they moved out to Western Massachusetts, and who wanted a therapeutic check-in on the state of their marriage. While discussing my vacation plans with Kathy (also a sex therapist) I told her of my planned visit and that I was very much looking forward to seeing the couple again, in part because they are so fun and spunky and work so hard at being good people. She said, “Tell them that. It’s an important part of therapy that a couple knows that they’re approved of, that they’re great together.” I hope that I adequately communicated my affection for them while I was there. Home visits are a wonderful way to get a bird’s eye view of a couple’s life together, and this was no exception. If getting to do couples therapy in my office is an honor, doing the same thing in a couple’s home is a supreme privilege. I think we did some good work together. I also think Kathy is right. We humans like somebody from the outside to say that we’re doing a great job. Being half of a couple can seem really hard and it occasionally feels like an impossible feat to do it well. Being told that you’re doing a good job from somebody whose opinion you respect goes a long way towards smoothing a small part of a bumpy ride. Self-validation is an important skill to develop, but occasionally a simple, “Way to go! You’re doing great!” is just what the doctor ordered.
Most of my day to day life consists of driving less than a mile between my home and my office. So this vacation is an opportunity to drive my red convertible fast on the highway with the rag top down. I have come to consider a convertible de rigueur on vacation. On this occasion, I’m accompanied by my 6 month old puppy, Ziggy. He is new to the delights of convertible driving and spends most of the trip sitting on his haunches, looking backwards over my shoulder as we zoom down the highway, his little 9lbs of doggy fluff leaning companionably against my right arm as his white fur is whipped around like so much frenzied candy floss. There is what I imagine to be a look of sheer joy on his doggy face as we zoom past fields of manure, the canine equivalent of antipasto, the smell of which must send his olfactory receptors a-dancin’ and a-twirlin’. His round black eyes, fringed with impossibly long black eyelashes, squint and tear up from the force of the air rushing past us. His smooth pink tongue peeks out from between his small, sharp puppy teeth. He is salivating, and makes frequent little lapping movements. All of a sudden, I realize. He is tasting the air.
Before you dismiss these descriptions as those of a dog-crazed fool, let me explain. I am not an animal person. I have always been people, people, people all the way. But I love my new puppy with a passion that has surprised me, and I feel that in the very short time we’ve had together, I’ve re-learned some of the things I had forgotten were important in the world. Like how wonderful it is to be greeted like you’re a long lost love each and every time you leave the house and come back through the front door. Everybody should have that experience at least once a day. Like remembering that stretching and yawning luxuriously and taking your sweet time about it is a sensual delight, and if you can be scratched under the armpit at the same time, then all the better! That running as fast as you can through long grass is nothing short of heaven, and that doing it with a pal is even better. Sniffing, licking and lapping are crucial to any dining experience and the louder you can do them the better you enjoy your food (and a post-culinary nap is a must!) Impromptu enthusiastic wrestling with people you love is a bonding experience and sleeping curled up with your head in somebody’s lap feels like the safest thing in the world, especially if they softly stroke your hair and murmur loving sentiments. That bad things happen from time to time, but you can get over them and move on with gusto, because you’re loved and accepted by the people you live with, who will reassure you of that whenever it’s needed.
When my clients talk about their desires and wants and how impossibly out of reach they feel, I sometimes tell them that if I had a magic wand I would wave it and grant them their wishes. These doggy learning lessons are things I would want each and every one of my clients to experience daily. I would happily relinquish my therapy practice if I could make this happen for them.
In addition to my dog, I am accompanied on my trip by a pile of books, but not as many as I usually bring because Kathy and her husband, Daniel, have more books than the local library and I can browse at leisure. I have brought Nancy Slonim Aronie’s book, “Writing From The Heart,” with me and my plan is to read each chapter and complete the writing exercises at the end of each. I’m now on chapter 4. Kathy, who also loves writing, is doing some of the exercises with me. One of the chapters is about seeing an old place through new eyes. Yesterday, we sat at her kitchen table with our laptops hooked up to her wireless server, and both wrote our pieces about aspects of Kathy’s home and when we had finished, we read our stories to each other and cried as we read our own, and cried as we listened to each other’s. Being with Kathy IS therapy for me: it’s the lived experience of being required to think differently about who you are in the world and how you can be more fully yourself, despite what people say, think or feel around you. Most of the days I spend with her, continuing to get to know her deeper and deeper, is a learning curve on the friendship road of life (how’s about that for a contrived cliché?) For reasons we don’t fully understand, we are not affronted by each other, we are not threatened by each other, we don’t judge or feel judged by each other and we are endlessly curious about each other. I laugh when she criticizes me. She is now able to cry in front of me and risks feeling the deep humiliation at her own tears. We encourage each other to be as big a human being as we possibly can. A visit with Kathy changes me profoundly on some small deep level, and it’s effortless, fun, hilarious and engrossing while it’s happening. It's one of the relationships I have in which I am as close to canine as I can get. If only all therapy could be like that.
Not the Trojans that Sex Therapists are usually concerned with!
I've been online since 1996, and in all that time I've never had a virus on my computer. For the first 5 years I had a Mac Performa, a beloved computer that finally gave up the ghost and was "buried" with many tears on my part. But even since "going over to the dark side" and moving to a PC, I've been remarkably lucky and virus-free for somebody who spends a lot of time online unwilling, blogging, talking with friends and family in the UK via instant messaging or planning my website, etc.
Several months ago, I invested some considerable funds in a brand, spanking new lap-top for my clinical office. There it usually sits, my pride and joy, gleaming in silvery splendor on my office desk. Imagine then my horror when, despite the most up-to-date virus software available from McAffee, my computer became infested with Trojan worms, which eventually occupied 1.5 GB on my computer hard drive! Running the anti-virus program was to no avail - the little beasties remained stalwart and resistant to infiltration, spreading their noxious threads throughout the length and breadths of my computer's functioning. Icons sprang up on the desk-top, and not particularly pleasant ones. For example, a woman's burgeoning breasts in a push-up bra with the heading "Love" beneath the icon - something that you would be surprised to see on any professional's desktop, even that of a sex therapist. More frustrating still was the fact that I couldn't delete them. In response to attempts to delete, the worm would spew forward ever more of these inappropriate icons. The computer was becoming unusable. It would close down the Word program in the middle of typing a letter to a colleague, prevent me from running virus software, and was making my office life extremely difficult. I didn't dare email anybody from the computer for fear of transmitting the virus/worm around my address book.
A family member who works in Information Technology suggested that I try PlumChoice.com who have secure online computer support. Initially, I couldn't log on to the website for Plum Choice. The newest Trojan worms have code that prevents you from accessing virus software sites or online computer assistance. It took me several tries to get to the site, mostly as a result of running McAffee to "distract" the worm, while simultaneously signing on to the website. I don't know how or why but this seemed to work. (Can you tell I'm a therapist and not a computer expert?) Anyway, I am a PlumChoice.com convert! I signed up online to receive remote computer support, which consisted of logging on with a remote technician, who proceeded to fix most of the computer via remote control. Nothing is more amazing that sitting back, with hands in your lap, watching the cursor move around your desk top as the technicians clear up the mess on your computer. Remote control via the web allows them to see and interact with the computer while you watch. So, while this is not a psychotherapeutic topic for a blog, it is at least my attempt to spread the information to anybody struggling with these awful viruses that there is help at hand!
Location: Northampton, Massachusetts, United States
While listening to people and helping them effect change in their life is my beloved profession, it is beyond the scope of this blog to provide therapy to people. I will give you my two cents if you write in and I would happily make suggestions as to where to look for a therapist in your own geographic area or online.
