Working online using different modalities

In preparation for the 2014 Multi Modality conference at which Philippa Weitz is speaking about working online she asked a number of clinicians from different modalities to comment on the Joanna case study.

Below the case study you will find the links to the individual responses. Please be aware that they are “work in progress” for this conference and that each of the contributors will be continuing to work on their reflections for a book planned on the subject.

The Case Study

Joanna is a 42 year old married lady. She has presented at the GP requesting help for her depression and panic attacks. Joanna has been more or less a weekly attender at the GP practice for the last 10 years, since she moved to the area with a wide variety of symptoms, none of them life threatening. The GP has exhausted all physical tests.

What the GP doesn’t know or discover is that Joanna has been physically and sexually abused throughout her childhood by her mother who wanted only a boy. She has struggled throughout her life with night terrors and depression and has made several suicide attempts. She is not suicidal at the moment, just very distressed. She also has had some NHS based in-person psychoanalytic psychotherapy which she found interesting but it did not move her forward in any meaningful way. She has a very supportive husband and three young children whom she adores but finds difficult to look after when in her blackest moment. She has been on Paroxetine for 6 months which she has found helpful, but she is keen not to stay on it for ever.

The GP is at a loss as to what to do with her and has referred her on to a locally contracted counselling service which has spaces for working online. The online service can offer 6 sessions initially, but this can be renewed in an ongoing way where needed. She was given a choice of formats – video conferencing, email or instant messaging. She chose IM but was open to other formats. The service is flexible enough to be able to allow clients to change between formats if they wish.