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- Unpaywall
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- 0955-6036
- DOI
- 10.1192/pb.17.2.104
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Abstract
Psychiatric Bulletin (\99Ì), 17, 104-105 Innovations Assessment for psychotherapy by interactive television suitable for transmission through telephone links P. M. MCLAREN,Research Psychiatrist, Academic Department of Psychiatry, Guy's Hospital; C. J. BALL,Research Psychiatrist, Academic Department of Psychiatry, Guy's Hospital; and J. P. WATSON, Professor of Psychiatry, Guy's Hospital, London SEI 9RT Despite the increased availability of psychotherapy grey levels at 25 frames per second or 64 grey levels within the NHS, inequalities remain (Holmes & at 12.5 frames per second can be selected from an Lindley, 1989). Traditionally, psychotherapy ser options menu. The miniature camera sits on top of vices have been provided from teaching centres in the computer screen facing the user and the picture cities and patients have had to travel for treatment. being sent to the person at the other end is shown on This may account in part for the middle-class predo a second smaller monitor. A user seated four feet minance in psychotherapy patients and Holmes directly in front of the camera will fill the picture with ( 1991) has identified the need for psychotherapists to head and shoulders. The digitised image produced by reach out and cater for the disadvantaged in large the system can be transmitted down 2 Megabit/ housing estates and rural areas. While services are second telephone links. In this prototype system the changing to meet such needs (Pedder, 1989) there are sound was generated by a technics amplifier and loudspeaker system running in parallel to the video- powerful economic restrictions on service expansion. The potential for communications technology such link connection. The system connected two side as interactive television to aid the delivery of general rooms in adjacent psychiatric wards. psychiatric services has been reviewed by McLaren Two trained psychodynamic psychotherapists, et al (1992) and similar arguments apply to the who were also psychiatrists, were asked to assess delivery of psychotherapy. ward patients, whom the responsible consultants This study was performed as part of a project to thought might benefit from psychotherapy, by inter use a new communications technology, computer viewing them on the LCVC. The patients were based interactive television, to aid the delivery of selected on the basis that they were not straight psychiatric services including psychotherapy. The forward candidates for psychotherapy. The psycho aim was to get a detailed description of professional therapists were informed that afterwards they would user responses to using the system for assessing be questioned on their responses. The patients had patients for psychotherapy as a preliminary to a both used the LCVC to talk to psychiatrists on clinical trial. several previous occasions and consented to be interviewed. The interactions were audiotaped. The study Observations Psychotherapy assessment on the LCVC Psychotherapist A saw a man of 27 years who had The communications equipment used was a proto been admitted following an overdose of medication and whose repeated self-destructive behaviour had type system known as the low cost videoconferencing system (LCVC). It is based on an Acorn Archimedes attracted negative reactions from nursing staff. The 310 M (or 440) computer fitted with a Watford psychotherapist reported developing a negative Archimedes Real-Time digitiser connected to a reaction to the patient during the interview. Initially miniature monochrome video-camera. The LCVC he began to feel frustrated by having difficulty software can be run in 1 Mbyte of memory and con hearing him. This was due to a combination of the figured to load and run from disk when the power is patient mumbling and the technical limitations of the system. He reported that having to repeatedly ask switched on. A mouse based interface presents the the patient to speak up felt intrusive so he did not do video picture of the remote user in a quarter screen it. He added that the patient's quiet voice and "the window (160 by 128) pixels on a monitor. Either 16 104 Assessment for psychotherapy by interactive television 105 machine" created the effect of distance in the inter the perceived interpersonal distance, the lack of action. This was such that the psychotherapist felt visual information for an individual who normally the urge to "climb into the machine to get closer to relies on it, or factors as yet unidentified. The un the patient". When asked to interpret his feelings of certainty of A as to the origins of their feelings of frustration Psychotherapist A said he was uncertain frustration is of interest. It could be attributed to whether this was a countertransference reaction to the machine but the fact that other staff had similar the patient or to "the machine". He also reported feelings towards the patient seeing him face-to-face feeling inhibited in asking certain questions particu suggests it may have been a genuine response to the larly on sexual topics and avoided these during the patient. Therapist B also reported problems with the interview. Psychotherapist A reported that he some interview, and unequivocally attributed these to times felt uncomfortable talking on the telephone. the machine, yet some of these difficulties may have Psychotherapist B interviewed on the LCVC a 45- also arisen in a face-to-face interview. It will be year-old woman who had a paranoid illness with a important for therapists to be aware of their own circumscribed delusional system resistant to antipsy- responses to the technology and to determine if, with chotic medication. He later described the interview as repeated use, they can learn to dissect their responses a "nice chat". He said he felt the LCVC undermined to the patient from responses to the technology. his ability to get "under the surface of the problem". This pilot study of an interactive video system for He reported that he could no longer appreciate subtle a psychotherapeutic task illustrates the potential non-verbal clues that he was "on the right track" complexity of therapist responses. It points to some key concerns of psychotherapists' which will need to with a line of questioning, such as dilatation of the pupils or a narrowing of the eyes. The use of his own be addressed before the use of such equipment can be body posture and positioning to influence the tone extended. of the session was limited and he felt deprived of a valuable tool from his therapeutic armoury. He summed up the whole experience as "like trying to Acknowledgements propose marriage to someone in Australia on the This Research was funded by the Telemed project phone that you don't even know". (RACE-1086). Technical support was provided by BNR-Europe. Comments While only two patient-therapist dyads were studied References the observations raise several important issues. The HOLMES, J. (1991) Psychotherapy 2000: some predictions therapists had difficulty obtaining information from for the coming decade. British Journal of Psychiatry, 159, 149-155. patients, interpreting their own responses and com —& LINDLEY, R. (1989) The Values of Psychotherapy. municating nonverbally to the patients. In the use of Oxford: Oxford University Press. communications technology for business activity, MCLAREN, P. M., WATSON, J. P., SUMMERFIELD, A. B. & perceived interpersonal distance has been reported as LIPSEDGE, M. (1992) Interactive television in psychiatry. an important variable in the interaction (Short et al, Psychiatric Bulletin, 16, 288-291. 1976). Therapist A described vividly such an effect PEDDER, J. R. (1989) Courses in psychotherapy: evolution when he reported wanting to "climb into the and current trends. British Journal of Psychotherapy, 6, machine" to get closer to the patient. This therapist's 203-221. negative response to LCVC may have generalised SHORT,J. A., WILLIAMS, E. & CHRISTIE, B. (1976) The from feelings of discomfort experienced talking on Social Psychology of Telecommunications. London: Wiley International. the telephone. Such responses may be mediated by
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Psychiatric Bulletin – Unpaywall
Published: Feb 1, 1993