A curious story in the NY Times on the increasing use of video skype in
"telepsychiatry" (perhaps a more accurate term is "teletherapy"); see:
http://www.nytimes.com/2011/09/25/fashion/therapists-are-seeing-patients-online.html?_r=1&nl=todaysheadlines&emc=tha26&pagewanted=all
  

The article is generally favorable about the practice but does point
out some problems, especially those with severe mental illness.
Quoting from the article:

|Indeed, the pitfalls of videoconferencing with the severely mentally ill 
|became apparent to Michael Terry, a psychiatric nurse practitioner, 
|when he did psychological evaluations for patients throughout Alaska’s 
|Eastern Aleutian Islands. “Once I was wearing a white jacket and the 
|wall behind me was white,” recalled Dr. Terry, an associate clinical 
|professor at the University of San Diego. “My face looked very dark 
|because of the contrast, and the patient thought he was talking to the devil.” 
|
|Another time, lighting caused a halo effect. “An adolescent thought he 
|was talking to the Holy Spirit, that he had God on the line. It fit right into 
|his delusions.” 

The article does downplay a couple of points:

(1)  This type of therapy seems best suited to people who once would
be called "neurotic" or, I believe, today's phrase "worried well".  The
type of person who might benefit from psychoanalysis.  Indeed, one
of the cases discussed was about a person who appeared to be in
traditional psychoanalysis.  Cognitive-behavioral therapy and other
structured therapies also well suited but we'll have to wait until the
effectiveness/efficacy studies are done.

(2)  Being the NY Times it probably shouldn't come as a surprise
that the focus is on people who can afford and use new technologies
such as Skype, high-speed internet connections, smartphones, etc.
It is no accident that the article starts off with a person getting a
reminder of the upcoming therapy session on her iPhone, fixes
a mojito to "prep herself" for the session, and so on.  The convenience
of reaching one's therapist and even having a "mini-session"
is probably something the upper-middle class and the investor class
will surely benefit from because it allows them to fit therapy into
their busy schedules.  But I wonder about those in poverty, the
working poor, and the lower middle class who will have more
people with mental illness and fewer resources.  I would not be
surprised that in the future, poor people would have to come in
to a facility, enter a little room, and receive therapy from someone
far, far away and little understanding of their background and
current situation.  I'm sure that insurance companies would prefer
to pay for that rather than a face-to-face session with a therapist.
It is useful to remember that in the U.S., the census reports that
median income for 2010 was $49,445, a 2.3% decrease from 2009 
and that the poverty level rose to 15.1% from 2009's 14.3%.  For 
more fun-filled facts, see the Census bureau press release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html 

-Mike Palij
New York University
[email protected]

P.S.  Consider the following for statistics classes when one is
comparing statistical significance with practical significance.
Quoting from the above report:

|Since 2007, the year before the most recent recession, real median 
|household income has declined 6.4 percent and is 7.1 percent below 
|the median household income peak that occurred prior to the 2001 
|recession in 1999. The percentages are not statistically different from 
|each another.

Would one consider a 7.1% reduction in income insignificant 
relative to a 6.4% reduction if they are not statistically significantly
different?



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