Telephonic and Videoconferencing
You see, wire telegraph is a kind of a very, very long cat. You pull his tail in New York and his head is meowing in Los Angeles. Do you understand this? And radio operates exactly the same way: You send signals here, they receive them there. The only difference is that there is no cat.
—Albert Einstein (Hamilton, 2003)
Einstein's paradox of the missing cat may refer to deep concepts of modern physics,1 and it indirectly speaks to the realities of delivering mental health care by telephone (and other audio means) or videoconferencing. In distance treatment, the medium is shaping what can be done, attracting attention to itself, influencing patient and therapist both subtly and overtly, and always threatening to shift from being a means to being an end. The “cat” demands attention not only for its helpful and occasionally troublesome role in health care but also for its effect on what may be considered the postmodern online version of transference and countertransference (Schachter, 2002).
Einstein's cat is all over the place. Psychotechnologies are providing services in prisons, clinics, schools, and homes. The challenges, however, are to disseminate these strategies more broadly in order to improve care throughout the mental health delivery system and also to make their use normal operating procedure and part of the standard of care. In 10 years, we will be asking, “Where did that cat go?”
For practical purposes now, the real question about distance therapy is whether to rely on the telephone as the primary vehicle or to use videoconferencing technologies. The terms telephone and audio will be used interchangeably in our discussions. Telephones, which are used for many activities related to health care, nearly always play a supportive rather than a primary role. Interactive videoconferencing is the preferred technology for direct care of patients by licensed health care practitioners in all aspects of health care, including mental health. To meet standards of care that have evolved for traditional in-person diagnosis and treatment, videoconferencing is the “next best thing to being there” although simply using the telephone or email can be tempting to the unequipped practitioner. Technology increased ease of use and manageability in videoconferencing units has attracted more users (Moore, 2001). Videoconferencing____________________