Some insights about mixing ccVC and cCBT
By Nils Kolstrup, medical advisor at the Norwegian Centre for E-health Research.
Traditionally psychological treatment is “patient meet therapist in therapist’s office”. Is that always the best model for treatment?
Video technology is now widely used in private settings. Business meetings are conducted using this technology. We also use this technology in teaching old-fashioned lectures. A relatively new field for video use is in training of surgeons in operation techniques. The doctor operating wears a head camera and an expert surgeon, perhaps located in another continent, advices the operating doctor in real time during the operation.
For many years internet based treatment programs for psychology have been used as treatment in self-help programs or with more or less contact with a therapist. As homework between therapy sessions therapists have used computer treatment programs instead of handouts or books.
Many patients have to travel to meet a therapist in an institution that may feel intimidating and may be far from the patient’s home. A combination of video consultations with internet-based programs may alleviate these inconveniences.
We now have experiences with the use of video consultations in combination with internet based treatment programs.
Patients by large readily accept this type of consultations. Many of them find it easy to relate to the video consultation. It is no different from talking to friends on Skype. Video is a clear advantage for the most vulnerable and insecure. The patients are in their “home territory”. In a difficult situation, they also have a possibility of ending the therapy by simply switching of the computer. From the patients standpoint the combination of video and internet based treatment programs is no different from face to face therapy with treatment programs.
Video consultations are more challenging for the therapists. They feel that the therapeutic alliance may be more difficult to obtain. This worry is most prominent before the therapist have tried the video consultations. However, we recommend that the patient and therapist have met face to face at least once to establish a relation and to establish if it is safe and acceptable to use video. We do not recommend this form for therapy if patients are suicidal.
The therapist should receive some training in use of video. The therapists should also be able to instruct patients in video use. Finally, the therapist should get comprehensive training in computer-based therapy.
For video consultations, a reasonable good link is required. However, the technology is simple and patients can downloaded the software from the internet. The security of the link needs consideration, but good signal encryption is standard in most of the video software. Standard computers with microphone and cameras will suffice for video use.
Patients in Norway are more than ready to use computer-based treatment combined with video consultations. However, therapists and especially reimbursement for this treatment lags behind. I wonder if this divide between patient’s expectations and administrative inertia is the same in the other countries involved in MasterMind.