Interviews with Smart People: Paul Fugelsang, Psychotherapist

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Psychotherapy seems like surprising profession to embrace technology, mostly because our perceptions of it tend to be pretty antiquated.  (Couches and Freud jokes, anybody?)  Despite that, a growing number of therapists are using Skype and video chat to conduct distance counseling, opening up whole new therapeutic opportunities for anyone with a computer and a high-speed Internet connection.  But what’s it like to conduct counseling online?  Is it weird?  Is it effective?  We decided to interview psychotherapist Paul Fugelsang, who graciously gave us some insight into how technology is influencing his practice and profession.  We also asked him to weigh in on the debate about how social networking is impacting our relationships and well-being.

When did you start offering distance sessions through Skype?

I started offering sessions on Skype and on the phone around two years ago. My wife and I were spending the winter in a very small community while on a sabbatical in way Northern Michigan. I had a burgeoning private practice in New York at the time, and I was licensed to practice in Michigan, so it made sense to look into using Skype to maintain that practice from afar. I was pleasantly surprised from the very start how easy it was to set up the practice in this way, and my clients all seemed to agree that while it wasn’t as good as meeting in person, it was clearly an acceptable alternative.

What’s it like to do a session online?

Most of my clients comment that at first it feels strange or awkward to communicate through the computer, and of course, at first it is. This will probably sound a little obvious, but doing therapy online does not offer the same precise experience that a face-to-face encounter affords. I mean, you’re communicating with one another through a glowing screen and practicing the craft in ways that were unthinkable a short time ago. Every client I’ve seen online seems to agree, however, that the initial awkwardness fades away quickly as the therapeutic relationship takes center stage. I practice a mindfulness-based type of therapy so throughout a session I ask my clients to be curious about their experience in the moment and share that curiosity with me. Working together through our computers provides a different element of phenomena to explore, which in turn provides its own richness.

Has offering this type of counseling service changed your practice at all?

It has. When I moved my practice from New York City last fall, adding the distance component allowed me to continue with some of my clients open to working via phone or Skype. It’s also allowed me to work with anyone, anywhere; the affordability and reliability of Skype has given me reach I would not have had. I’m particularly grateful when the technology enables me to work with someone who for whatever reason is removed from the kind of help I offer. I still meet the majority of my clients in-person through my private practice in St. Augustine, Florida. However, because my in-person practice keeps me fairly busy, I can be more selective about who I work with online, and as a result, it usually ends up being very challenging, interesting work.

It seems like the downsides of online/distance sessions (namely, lack of personal contact) might be fairly obvious, but what are the positives?

Well, there’s actually quite a bit of personal contact through the online session – every bit as much as an in-person session, I would venture. This is to say that the integrity of the client-therapist relationship is not compromised whatsoever, in my opinion, through distance counseling. At times it can be hard to know exactly what someone is doing with their body, depending on how far or close they are sitting to the camera, but when I want to know what a client is doing with their hands in any given moment, I can simply ask. All of the other essentials – eye contact, tone, the level of empathy present in any moment, how present I am as a clinician, are maintained in equal measure during a distance session.

Other positive aspects about online therapy are more obvious: time is at a premium for many of us, and once a commute is removed from the equation, engaging in therapy becomes more attractive, maybe even more attractive when you think about doing it from your home or even your office. Also, finding a therapist who is the right fit can be a real hassle. For example, I draw from Buddhist philosophies of mindfulness and awareness as well as Western psychoanalytic tenets in my practice. You may be able to find a therapist with a cognitive behavioral approach but perhaps not someone with a less traditional background in your community. If you’re comfortable with communicating online, this type of therapy greatly expands your alternatives.

What do you think are the opportunities and challenges for this type of approach? Do you think we’ll see more therapists offering counseling services online?

The opportunities are vast: there are many people out there who are cut off from their communities for various reasons – and because the overhead is minimal for distance therapy, clinicians have the opportunity to lower their prices, which, when combined with the ease of connecting, makes therapy a much more accessible option for many people who might otherwise be struggling with their situation all alone.

And the challenges are interesting. The way we communicate online is constantly in-flux, and at times, not very desirable. I’ve been in the middle of working through emotional material with people, and lost a connection. It’s rare, but it has happened, and obviously it’s a drag. I do trust in the technology, though, and the hiccups have been so few and far between that it hasn’t deterred my enthusiasm for the work.

As we become more comfortable with the technology, we should see more therapists offering online services. However, at this point in time there’s no national licensing board for mental health professionals, and guidelines vary from state to state. Whenever a person is seeking out a therapist, unless they have a strong endorsement from someone with whom he or she has a high level of trust, it’s important to do some research into what options are available. The Internet has made that component much easier to navigate (at this point the Yellow Pages have never seemed more antiquated). As a new generation of clinicians – people who are much more computer savvy – come into their own in the field, it’s very likely that online providers will continue to expand.

Can you imagine any other type of distance therapies or uses of technology that we haven’t seen yet?

Well, to be totally honest, I’m not sure I want to imagine too many others. I know some people conduct entire sessions by chatting online, or by sending email messages back and forth, which is something that I’m not very interested in doing. A strong, personal connection is essential for therapy to be effective. I haven’t seen any long-range study on therapeutic efficacy for ‘chatting’ versus actually speaking with a clinician; it would be interesting to know this. I feel that taking the audio and the visual component out of the equation is far too impersonal for me. I have no clue how holographic technology is shaping up these days, but I imagine that at some point we’ll be able to (literally) project ourselves into different rooms with one another. I’m not sure how distracting that would be, but then again, doing therapy Jetsons-style seemed preposterous just a short time ago.

It seems like every few days I read an article saying that social networking is either the best or worst thing that’s ever happened to us – that it’s either positively or negatively changing our lives and relationships. What do you think about social networking?

Journalists are very skilled at taking advantage of the mind’s tendency to compartmentalize information into this-or-that equations. Unconsciously, we often believe that if one thing is true, then the other thing must be false, so if I read research that says that Facebook tends to make people feel sad about their lives because they’re constantly comparing their experience of sitting at home with their friend’s posted snapshots of travels in Thailand, then I may be quick to conclude that social networking is bad news and is negatively affecting my life or even society at large. But the truth is, while I may feel some envy for my friend at the beach (and if that’s the case, it is a wonderful thing to be aware of), I also enjoy corresponding and keeping up with my friends and acquaintances in ways that are not totally intimate.

So yes, social networking is probably shaping our experience with others in negative or unhealthy ways. Simultaneously, it’s enriching our lives. Ultimately, it’s a tool that can amplify what we’re experiencing if we choose to use it. I would add here that it’s always helpful to be curious about whatever it is we’re experiencing in the present moment: how do I feel when I’m social networking? What is my body feeling, what is my mind doing? Do these thoughts and feelings change depending on how long I’m on a certain site? How do I feel when I’m on this site versus that other one? Am I using technology to enhance my life, or am I using it to avoid being present with myself or others in some way? Maybe somewhere in between? Those answers are most likely always going to shift depending on whatever is going on in the moment, and actually, the answers aren’t nearly as important as the questions themselves.

How do you see digital culture changing us?

I have no clue. I’m acutely aware that I spend much less time alone now than I ever have before as a result of the connectivity that digital culture provides. I think there’s something integral that emerges from being alone and quiet, and I have to work harder now to access that space. It takes much more discipline and effort than it did ten years ago and I do wonder if some personal creativity or emotional intelligence has been compromised in the process. It’s all happening very quickly, and it does seem more important than ever to take a few steps back and a few deep breaths every now and then.

Paul Fugelsang is a Licensed Mental Health Counselor who offers in-person therapy in St. Augustine, Florida, as well as online therapy through the telephone and Skype.  Paul has been an active practitioner in the mental health community since 1996. He has worked extensively with children and families in Latin America, mental health clinics in Colorado, and at an esteemed juvenile justice organization in New York City designed to reduce temporary and long-term incarceration of adolescents. A long-time meditation practitioner, Paul received his Masters degree in Contemplative Psychotherapy from Naropa University, in Boulder, Colorado. In addition to his clinical experience, Paul has served as an interpreter at the United Nations. More information about Paul and his private practice can be found at: www.paulfugelsang.com

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