Tele-Coach: How An Eating Therapist Learned To Love Skype

“How’d you do with your eating since last we met?” I recently asked members of my group on food issues.

“I’m really struggling,” said Heidi, a 27-year-old entrepreneur from Boston. “When I get overly full, that self-critical voice takes over. All I can think is ‘Screw it! I’ll start fresh tomorrow.’ I don’t know how not to let my eating spiral into overeating.”

Lydia, a 45 year-old minister from Akron, jumped in: “Instead of believing that self-critical voice, I’ve been telling myself: ‘That’s not what I believe.'"

“Did you hear that?” I asked Heidi. “Next time you start thinking 'Screw it,' you might try 'That’s not what I believe' or another of Lydia’s inspired responses."

Heidi and Lydia (not their real names) are talking face to face, but not in person. Thanks to recent telecommunications advances, the 650 miles between the two are no barrier to participating in my eight-week group on using self-compassion for eating issues. Nor is a six-hour time difference. Last week, one participant Skyped in from her Lisbon hotel room.

Yes, I've jumped on the telemedicine bandwagon. I’m just discovering what hospitals, home health agencies and other major health organizations have been touting as the most cost-effective alternative to traditional face-to-face medicine since castor oil.

Clients with food and body image issues generally feel a lot less self-conscious attending a group remotely than up close and personal.

I knew about the telemedicine or "telehealth" trend, using technology to remotely deliver health-care services and information. But I’d never seriously considered joining the high-tech trendsetters. For decades, I’ve been happily providing individual and group therapy the old-fashioned way, and there are major legal questions about virtual psychotherapy, particularly across state lines.

According to Marlene M. Maheu, Ph.D., Executive Director of the Telemental Health Institute, “It’s the wild west. Clinicians are making up their own rules and disregarding those they agreed to follow when they got their licenses, and the consumers are at risk. They really don’t know who’s the right person to go to.”

Then, three things converged:

• Sixty-five members of The Center for Mindful Eating from around the world enthusiastically participated in my teleconference on The Self-Compassion Diet.
• My clients started complaining about sitting in traffic during the interminable reconstruction of Route 2 in Concord, Mass.
• One client couldn’t say enough about her Skype sessions with Los Angeles nutritionist and mindful eating author, Evelyn Tribole.

So I asked myself: “Why not Skype with clients?" Well, because telemedicine has real downsides. Besides the fuzzy legal regulations, I had at least three other concerns:

• Cost: Skype is free, and most of my clients already have what it takes — Internet access and a computer with a webcam — to telecommunicate, but a good number have insurance plans that don’t reimburse on-line therapy. Containing the rising cost of health care may be telemedicine’s big selling point (it’s been touted as a better way to manage chronic diseases and shorten or eliminate hospital stays) but for my clients who rely on insurance reimbursements, an office visit is still their best, most affordable bet.

• Privacy: Skype therapy puts client protected health information at greater risk. There may be a growing number of HIPAA-compliant telecommunication services available, but there’s still no surefire way to ensure client confidentiality on-line.

• Technical difficulties: Static, screen freezes and call disconnects aren’t so bad when Skyping with friends and family, but the possibility of being disconnected from a suicidal client, that’s a serious problem. The very idea of handling a life-or-death crisis 3,000 miles away is one more reason I’m not providing Skype therapy.

That said, the upsides of this new medium are substantial. I’m most impressed by the following three:

• Greater access: Telemedicine gives healthcare consumers greater choice about who they consult where, when and how often. Better access, too. Whether you live in a remote village or a medical epicenter like Boston, there’s no need to travel any distance or whittle away the hours in the waiting room. At least, not when the doctor or your chosen health care professional is virtually in.

• Improved quality: A growing number of studies have shown the quality of on-line care is just as good as in-person. In fact, researchers have found that mental health and ICU patients generally have better outcomes and greater patient satisfaction on-line.

• Decreased self-consciousness: Clients with food and body image issues generally feel a lot less self-conscious attending a group remotely than up close and personal. One of my obese clients, who had no time for traditional group therapy, jumped at the chance to join my virtual group.

I could go on and on about the benefits of running Skype groups for eating issues, but suffice it to say, I’m in. So are my clients, especially Heidi, who’s reaping the benefits of going easier on herself.

“I’m allowing myself to eat without self-criticism,” she reported at the next session. “What a difference! I have more energy, I feel lighter. The whole week wasn’t rosy. I binged once, but it didn’t turn into days and days of binging. That’s a first for me.”

As for me, I'd say this on-line group has done better than any group I’ve run. Would they have done as well if we’d met in person? I don’t know. Which is why I’m starting an in-person and an on-line group simultaneously. Will the on-line group have better outcomes and greater patient satisfaction? I aim to find out.

Jean Fain, LICSW, MSW, is a Harvard Medical School-affiliated psychotherapist and the author of “The Self-Compassion Diet.”