This interview appeared in the Journal: CLINICAL PSYCHOLOGY TRAINING RESEARCH & DEVELOPMENT, Vol. 2, No. 1, 2003, ISSN 1479-2524, and is reproduced here in full.
Psychotherapist, Working Online
Interviewer: Ulla Damgaard-Sørensen
3rd Year Trainee Clinical Psychologist
South Thames (Salomons) Clinical Psychology Training Programme
Ulla: Tell me about your service and its history.
Walter: Psychotherapy Online began as a Bulleting Board System (BBS) in about 1992. At that time I had been in private practice as a psychotherapist for five or six years and I was conducting Psychodrama groups. With a slow modem I was also exploring the emergence of the online world. I was a member of CompuServe, one of the early online discussion forums. It struck me right at the start how the medium invited a psychological stance from people. Writing email had the therapeutic qualities of writing a journal. People were not only re-inventing the letter, but also the art of journal writing. These journals were public; they were in a group with all the associated group dynamics. With the BBS and later on the Internet I explored private groups and virtual communities. I conducted reading groups and dream groups. This was intense work. I also began to take on private clients online. Today that is the main work I do online, though it is a small part of my overall practice, which is mainly face-to-face.
People find me on the Internet. Through Google or by word of mouth they find my website and they engage with me there, enough to risk writing an email to commence therapy. I work only in email. I like the asynchronous mode where my clients and I can work in our own time. I like the luxury of reflection on what I read and write.
Ulla: This sounds fascinating, Walter. Could you tell me a little more about working with groups online. I note your comment that this particular medium give rise to similar group processes as found in the face-to face (f2f) encounter. Would this include the concepts of the anti-group? I imagine it is easier to escape conflicts in cyberspace, and if so does this mean that destructive feelings can still be worked with as they can in the traditional group format?
Walter: Groups online are technically quite easy to achieve using an email mailing list. In many ways they are like face-to-face group but there is once central difference...time is different. It is not like having an hour together, it is more like having a group spread out all through your days, and nights.
The groups I have led and been a part of have been in the nature of peers experimenting with the form, and they have been very successful. The hardest thing for me was 16 people all getting very involved in dream sharing and group dynamics generated hundreds of emails per week. It was one of the most intense group experiences of my life! This was fine for a one off, but not something I would like to do professionally. I have written about these group experiences here:
Ulla: How did you develop your idea of therapy online, and was there a specific need for this type of work?
Walter: The need is there. Most of the clients I 'see' online would not go to face-to-face therapy. The reasons vary, some are in an isolated area and working online becomes a necessity. For most it is a preference, they like the Net and they like to write. Occasionally there are more ethically demanding reasons such as not wanting to disclose something locally.
The idea strengthened as I saw how effective it was. In my own practice I became more 'analytical' in the sense of working with the therapeutic relationship and transference. I was initially surprised at how quickly people went deeply into their lives and dreams. The medium is not unlike Freud's couch in that one can't see the therapist while you talk.
Yet that is not quite true. The therapy does not take place on the screen but in the psyche. As I write to a client I have the person in my mind's eye. I can look into their eyes, virtually, using language to evoke the experience. I think that comes across through the immediacy of the text. I imagine the clients also 'see' me. The room for projection is large, yet the means of resolving those transferences is also there.
Ulla: I was hoping you might tell me a little more about the transference and in particular your interpretations in your work. How do you work with avoidance?
Walter: I think of transference as a projection of a particular type, one that awakens deep energy, energy for life. It would be hard for someone with a strong transference to kill themselves, as long as the transference is accepted and there is not a problem with the counter-transference. Thus I see the enhanced potential online to "fall into transference" as a life saving force.
The way I work is to see how the projections are aspects of themselves seeking to be found. The written word can act as a mirror. Mirroring, reflection is a traditional experience in counselling. the counsellor has to do that in some active way. That is true online as well but I find myself cutting and pasting the clients own words back. and even when I don't do that - the email reply often has their words coming back to them. Writing in itself creates a mirror.
As to interpretations. I never think of my interventions as that, but I suppose they are at times. It is about seeing meaning and patterns. I might well say something like:"You want to leave him, you know he is unsuitable and you don't trust him but you are compelled to stay by forces you can hardly name. You feel responsible. You feel scared."
This might sum up several emails and put it bluntly, but it uses only words the client has used and it is still more of a mirror than an interpretation.Or were you thinking of diagnosis?
Ulla: No, Walter, I believe you have made it quite clear that the use of labels may actually not serve a particularly useful purpose.Walter, could you tell me more about what type of therapy do you offer?
Walter: Psychotherapy Online is much the same as the work I do face-to-face. Psychotherapy of a psychodynamic kind is my preference. As we are focussing on the online side I will tell you about some of the things that are different online.
Occasionally I can see that someone might want (and need) more of a "Dear Abby" response, I can do that online more easily than in a 50 min hour. My fee is the same online as off.
Time is different online. I charge by the hour, however I do not have hour-long sessions. I require payment in advance; this assists (as it does f2f) in creating a therapeutic container. Yet the container is different, the structure of a 50 (or 60) minute hour is not there. The frequency and duration of the therapy is discussed and the structure that emerges around time varies greatly. Some people feel as if an hour is a long time to wait for a response, others think a day is fast. Establishing just how many hours roughly per month are available for a person can take some doing. A two-hour credit does not mean I can do one in-depth two-hour response. I need to develop an understanding about that with the client. There is a conversational flow to the correspondence.
Ulla: Fascinating. Now I suppose you gather lots of information about your client as you contract with them. Do you set specific goals with your clients?
Walter: Goals are fashionable but I don't initiate goal setting as such. I do note the underlying desire and motivations - often present in the first email, and quote it back when they seem to forget why they came. Something like:
"I want to feel alive again!" Or: "I need to overcome this fear."
Ulla: Can you say more about how the actual therapy works online?
Walter: I usually reply to an email by interspersing my responses right into quoted text of the client. (I use the '>' convention to quote their words). The difference here is that the client sees his or her own words come back. There is something to get used to here, as it reduces the need of the therapist to provide mirroring at that level. The mirroring is more in the form of summaries and headlines. The Subject line of the email is useful for that. I will often change it consciously so that the client finishes up with a string of potent lines such as: "You made it!" or a quote from their email such as "Need for gentle self-care".
I set writing tasks. I encourage script writing. For example, "Be your mother in 1967, just before you were born. Write in the first person as your mother. Begin: "I am 19 and I am pregnant and I feel." This sort of focus on writing is not really suited to most of my f2f clients.
I ask all clients to write up and send their dreams.
Ulla: Excellent. Now in your view what are the advantages and disadvantages of offering therapy in psyberspace?
A) to the client
B) to the therapist
Walter: I like the way you have picked up on my term 'psyberspace' there. I began using that in about 1991, it is very suitable to where we go for this work. The advantage to the client is that therapy is immediate. They can access their therapist any time - which is wonderfully affirmative of the imagination, because they access me in that imaginal realm. That they develop that inner immersion of self-talk is therapeutic. Writing like talking is to have a witness, but writing on ones own facilitates that self-witnessing. Talking to oneself is more likely to be seen as madness!
Ulla: Have you worked with very complex clients? I suppose I wonder how it might be difficult both ethically and morally to work with someone who poses risk to self or others?
Walter: I think of all clients as complex! Of course this is challenging work and I am challenged by it, however the essential tool, my own self is the same online and f2f. If there is a client who I find difficult that is more about me than them, and I use supervision to work on my own stuff.
Ethics and morality of people at risk? I have a sense that much self-harm and suicide is abated by psychotherapy. I know that people often turn to psychotherapy as a last attempt not to do harm to self or others. the point is they don't want to, and that motivation is there to tap into. Online is powerful as people can write immediately, so often the help has happened even before I receive the email!
But I have listened to people plan nasty stuff, both online and off-line. I have an almost 100% sense of creating a sealed unit for the container. I have never yet gone outside of it to try and prevent some action or other. The point is that having the sealed container IS the best prevention, certainly the best one I can offer. Notice I said almost 100%.
Ulla: Indeed ... Now tell me what do you like about working online, Walter?
For me as a therapist I like the diversity. I can do some of my work in the city in my office, and some at home while I am up late at night, it allows me to indulge my natural patterns. I enjoy working right in the living room and being able to stop working to enter into real life conversations.
I also like to work with people from all over the globe. There is something exciting about being in New Zealand and having clients in New York as well as Germany and Japan.
Ulla: What is your personal experience of the development of the therapeutic relationship? Does it differ from traditional f2f, and if so, how?
Good question. It can be fast and volatile. But then not all are. The difference in the development of relationship between clients is huge. I think that difference between people is more important than the medium generated difference, by far.
Let me sum up the development process of the relationship as: Getting into it, being in it, and getting out of it. That process is much the same regardless of medium.
Yet there is something a little edgy about the online world. I have had clients suddenly stop. Online it is almost easier to send a short note just asking how they are doing. I have had the nasty experience when that email bounces - comes back as there being no such address! There is a sense of a bigger black hole, especially as I make a point of not going outside the email correspondence.
Ulla: Hmm, that sounds potentially difficult. Do you discuss issues like this with your clients when you contract?
Walter: Yes and no. The contract in psychotherapy is an art in itself. In my early years we learnt how to make contracts. and then found the need to bring in all sorts of consequences when there was a breach. Now I think of the contract as implicit and only explicit when it emerges in the dynamics of the therapy.
Of course there is an explicit statement of terms on the website which covers a lot. http://www.psybernet.co.nz/terms.html
Ulla: How do you get supervision, and in general how do you remain in contact with you peers. e.g. do you think therapy online suits some but not other therapists?
Walter: I am well connected with peers in my usual professional body and also have some contact with other online therapists. My supervision for this work is with my usual f2f supervisor.
Are some more suited than others? Definitely. Cyberspace needs to be as comfortable as ones own office. Some people just do not go beyond the computer into another realm. It is not just a technical thing. I am not that interested in technology, but I am drawn to that sense of being in an imaginal realm where our words and dreams merge.
Ulla: The notion of the written word as opposed to the spoken is interesting, what are your thoughts on this?
Walter: With all words we are into a symbolic realm. I am not sure if the auditory symbolism or the visual symbolism is more potent for all. My sense is that online I have both. Email, as many people have remarked is oral, not literally of course but in the feel of it.
As I answer these questions (in this email interview) I hear them and see them. If we were f2f I would only hear them. Maybe that is me, but I imagine it is common. In my f2f work for example I often reach for the pen and paper, especially to write down dreams. To do a dream justice I need to see every word. Words carry their meaning in the sound but often their history is buried in the etymology, which is more visible in the spelling. Seeing the words and hearing them is easier in written form.
There is more to it. It is not just that we are using the written word online. The digital text we use is mutable (i.e. we can edit it) and it is searchable. There is the powerful phenomenon that the client has a record that is searchable of the whole therapy.
People will send me a snippet from something they saw online, or received in an email. In this way in a few seconds they are sharing whole episodes of life, not by recounting them but bringing them into the work. By comparison if a client hands me a printed email in a f2f session it is almost a distraction, I'd prefer to have them tell me about it - because to move into reading mode I become disengaged in the here and now with the client.
Often I recall something the client has said and I search for it in the record, cut and paste it back into the here and now conversation. It is similar to what we might do face to face, but this exact recall is only available online.
Thanks for your interest.
Ulla: Thank you so much, Walter for sharing your experiences with me. I hope our readers will find it as interesting and thought-provoking as I have.
If you would like to know more about Walter Logeman and his work in PSYBERSPACE please check out his site at http://www.psybernet.co.nz