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Head-shrinkers on Skype: Now that's what I call transference

"August is a wicked month," Edna O'Brien once wrote. When I met her in London a few years ago, I asked her what she meant. The Irish novelist gave a caustic laugh and said, "Because that's when all the shrinks go on holiday."

In the digital age, however, no one need be separated from their therapist ever again.

More and more people are using Skype, the Internet phone service, to keep in close, long-distance contact with their nearest and dearest - and for many people, that includes their shrink.

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Just this month, the U.S. Army launched a pilot program that allows soldiers and their families to use a phone or computer with video-conferencing capabilities to "communicate directly with licensed counsellors about stress-management issues, family difficulties and pressures, family separations and deployments … or any personal problems that might adversely impact work performance, health or well-being," according to a press release.

"I believe we have taken a very important first step in getting behavioural health care to soldiers and family members who might not have received it otherwise, because of stigma or geographical separation," said General Peter Chiarelli of the TRICARE Assistance Program.

The idea of soldiers in the field Skyping their shrinks might seem revolutionary. But for many people posted away (or separated from a therapist they are close to), video counselling is as much a part of daily life as grocery shopping or getting a haircut.

One friend of mine, a foreign correspondent, used Skype to communicate with his Toronto therapist from an overseas war zone (previously an unthinkable setting for a man to talk about his feelings).

"At first when I went away, I let my relationship with my therapist go because it seemed too complicated," he recounted, adding that he considered searching for a new therapist in his posting but didn't want to start all over again with someone new. "It wasn't until I'd been gone some time and then I repented having fallen out of contact with therapist. Whatever the issues, therapy forces you to pay attention to your life."

With Skype, my friend found that he was able to rekindle and maintain a close relationship with his Toronto therapist across continents and oceans - and the best part about it was that no one had to pay the charges, since Skype-to-Skype calls are free.

But the technology wasn't without its problems. One was scheduling, which is difficult for busy people in different time zones. The other was connection speed, which can be slower in less developed countries.

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Despite the glitches, my friend is glad that he stuck with the same therapist. "When you've been with someone a while, they get to know you pretty well. They don't fall for your routines any more. The idea of starting that all over again from scratch is very tiring."

Stephan Tobin, a registered psychologist in Portland, Ore., has used Internet video phone with about half a dozen patients in his practice over the past few years. While he concedes that it's "generally better" to see someone in person, he believes that Skype therapy is a good option for people who want to continue with the same therapist or find themselves in a remote location where traditional counselling is simply not an option.

The argument for sticking with the same shrink no matter where you live is actually bolstered by the therapeutic process itself. "A lot of people, when they come to therapy, have trouble letting themselves feel dependent. And so when they feel they can depend on a therapist, a very strong bond develops."

This bond, known as a "transference tie," is one that can be maintained, much like any other human relationship, via phone and Internet. With video, Dr. Tobin is also able to see his patients' visual cues and body language.

But he takes it one step further. A respected clinical psychologist with more than 30 years of experience, he practises a form of therapy known as EMDR (Eye Movement Desensitization and Reprocessing), which allows patients to "reprocess" traumatic or unpleasant events in their lives by moving their eyes back and forth and focusing on the memory. Dr. Tobin practises EMDR on Skype and says that, for his patients, it has been highly effective. He is also mentoring another psychotherapist in Iceland on Skype and says that, increasingly, his work is being done in front of a computer rather than beside a couch.

Meanwhile, therapist Laurie Anne King says she has kept virtually her entire client list after a recent move to Australia from Canada. She updates her hardware, Skypes often and has her clients pay online through PayPal.

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"I've worked over the phone/Internet for many years now, so in fact nothing has changed in terms of logistics or payment," she told me. "I could be on the moon and as long as I have an Internet connection it would be business as usual."

One of her clients, a Toronto wedding photographer, said that, if she couldn't see King on Skype, she would quit therapy. "I don't think I could find someone else like her," she said.

Gen. Chiarelli has great hopes for the possibilities of online therapy. "I could set up a gymnasium, when a brigade came back, that had 250 computer stations in it," he recently told the press. Those stations, he explained, could accommodate the entire chain of command, from the brigade commander to the sergeant major to the soldiers of the brigade, all of them "getting a no-kidding, real mental-health evaluation after a 12-month rotation."

Yes, it's a long way from Dr. Freud's couch. But if it makes a soldier's August less wicked, who can argue?

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About the Author

Leah McLaren is a journalist, novelist and screenwriter. She’s published two novels, The Continuity Girl (2007) and A Better Man (2015) both with HarperCollins Canada and Hachette in the USA. The first was a Canadian bestseller, though the second is actually much better. More

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