Laura Migale: online therapy to commit to change for the better
Online therapy helps, among other things, to ensure that treatments are not interrupted.
At a time when the coronavirus seems to influence everything that happens in society internationally, professionals specializing in the field of psychotherapy have been forced to adapt their methods to the demands of the moment. Even though many businesses have closed, people need psychological assistance more than ever.
Fortunately, the existence of online therapy has meant that this transition to the "distance" format has not been too abrupt, as there have been many psychologists offering this type of service for years. An example of this is Laura Migale, whom we interviewed in the following lines..
Interview with Laura Migale: the importance of online therapy in the face of the coronavirus
Laura Migale is a psychologist specialized in psychoanalytic orientation, and works both online and in person in her office located in Barcelona. On this occasion, she talks to us about her experience offering professional support at a distance in the context of the confinement due to the state of alarm in the face of the pandemic.
From your point of view as a professional, what does online therapy bring to the world of psychological intervention with patients?
First of all, I am grateful for the opportunity to express my point of view, which is framed within the psychoanalytic framework and which incorporates the online modality within clinical practice. In the current context, the measures taken to confront the pandemic have generated changes in the encounters between people, whether with affection or in professional areas, physical contact is significantly reduced and #yomequedoencasa is the law.
There are therapeutic processes that cannot be interrupted, therefore the patient and professional must agree on the method of meeting; both must be familiar with new technologies. And something fundamental must be taken into account: the patient must have an environment that allows him/her to take refuge and achieve a certain climate of trust and intimacy.
In the present circumstances, it is common to experience unpleasant feelings such as anxiety about not knowing when the quarantine will end, loneliness, stress about uninterrupted family life, worry about loss of income, fear of illness and death, difficulty in coping with confinement, unsatisfied sexual desire. These fears, which surface in everyday conversations during the COVID-19 pandemic, are also reflected in the exchange between patients and analysts as both try to adapt to the new channels of communication.
But online therapy is not only used in pandemic cases. Patients living far from urban centers, those living in or suffering from some form of seclusion, being ill or disabled, agoraphobic or highly anxious can be treated in this way. The list includes those who have migrated within or outside the country and wish to continue their therapy with the same professional.
I confess that it is not easy to recreate the office situation if one is not in the office due to the reasons of confinement or eventual schedules that exceed the face-to-face agenda; but at the same time the online modality becomes the possibility of being able to do the therapy that in other historical moments would have been impossible.
Are there still frequent cases of people who cannot do online therapy due to technical limitations, such as a bad Internet connection or a computer that is too old?
Personally I have not heard too many technical complaints due to bad connection but some patients did not accept the change and preferred, for the time being, to interrupt the treatment. They report not being comfortable with the use of technologies, they feel limited or maladapted, causing a break in the course of their analysis that they postpone until the face-to-face meeting. Other patients do not accept this variant because they cannot replace the face-to-face or the use of the couch that generates a situation of accompaniment, of joint work.
It is important to emphasize that although there is no meeting of the bodies in the same space, this does not mean that there is no presence of the psychoanalyst. This is inferred in the way of interpreting, of operating on the analyst's discourse. And fortunately, online therapy has shown that it is possible to do fruitful analytical work.
What are the psychological problems for which online therapy is most useful?
Online therapy is an alternative to the therapy that we can do in an office, and consists of having sessions through new media such as Skype, WhatsApp, phone, or other devices or applications from a place that is private and comfortable to talk. In an online therapy we can treat anxiety problems, depression, self-esteem, family and couple problems.
Although human contact is not the same as online, we can work seriously and with good results most of the psychic problems. The important thing to emphasize is that the therapeutic process is based on a solid and respectful theory of singularity, without stereotyped models of supposed "normality" and guaranteeing professional ethics.
As a psychoanalyst I propose the method of free association and work in transference so that each patient is authorized to take his or her word and has the possibility of creating a singular discourse of his or her own. To be a psychoanalyst is to be in a basically responsible position, as the one who is entrusted with the operation of a radical ethical conversion that introduces the subject (patient) into the order of desire.
Does the fact that it is an accessible way of doing therapy have an impact on the commitment that patients develop with it, in your experience? For example, in terms of not skipping sessions.
There are patients who accepted to continue at a distance and others who feel uncomfortable because they do not have a physical space without people nearby listening, others who are more reluctant but at some point they try and decide to continue; some use this as resistance, i.e. they found it difficult to move forward and any reason can be used to make a pause, and there are those who are scared about how they will sustain the economy when all this passes and prefer not to continue with the treatment.
At this time one of the most serious issues is financial. In many patients the anguish points to the uncertainty of how they are going to live and with how much money, to the instability in jobs rather than the question of the fear of dying from the coronavirus.
In any case, it is surprising how a great majority of patients continue their sessions with the topics they were dealing with before, their symptoms, their anxieties, their previous worries are the ones that continue to appear as a priority and at some point they talk about the current situation but not as a central theme in the treatment.
How does the first online psychotherapy session usually develop?
In general, the schedules and fees are agreed with the patient and he/she is invited to state his/her preference for the technological means for the development of the first session. We can discuss what is most convenient for their process, but in my experience the first sessions are by video call and then we suggest or arrive at a phone call for technical reasons of timing and listening. In my opinion the most effective way to keep the attention focused on the word.
What do you think are the barriers that online therapy has yet to break down to reach its full potential?
Beliefs that it doesn't work the same, fantasies of lack of intimacy, and above all the level of commitment. On the other hand I see a real difficulty in working with children, working through virtual interviews is almost impossible because children express themselves through play.
In the office we put the body, we play with various materials and toys. Each child chooses his/her own game to express him/herself and tell his/her story, what is happening to him/her. In these cases it is preferable to have virtual interviews with the parents in case they require it.
(Updated at Apr 15 / 2024)