Laura Migale: online therapy to commit to change for the better

At a time when the coronavirus seems to influence everything that happens in society at an international level, the Professionals specialized in the field of psychotherapy have been forced to adapt their methods to the demands of the moment. And it is that although many businesses have closed, people need psychological assistance more than ever.

Fortunately, the existence of online therapy has made this transition to the "remote" format not It has been very abrupt, since for years there are already many psychologists who offer this type of service. An example of this is Laura Migale, whom we interviewed in the following lines.

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Interview with Laura Migale: the importance of online therapy against the coronavirus

Laura Miguel She is a psychologist specialized in psychoanalytic counselling, and attends both online and in person at her office located in Barcelona. On this occasion, he tells us about his experience offering remote professional support in the context of 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 in patients?

First of all, I would like to thank you for the opportunity to express my point of view that is part of the psychoanalytic framework and that incorporates the online modality into clinical practice. In the current context, the measures taken to deal with the pandemic have generated changes in the meetings between the people, whether with affection or in professional areas, physical contact is significantly reduced and #yomequedoencasa it is law.

There are therapeutic processes that cannot be interrupted, therefore the patient and professional must agree on the meeting method; both must be familiar with new technologies. And something fundamental must be taken into account: the patient must have an environment that allows them to take refuge and achieve a certain climate of trust and intimacy.

In the current circumstances, the emergence of unpleasant feelings is common, such as anxiety about not knowing when the quarantine is over, loneliness, stress over the uninterrupted family life, worry about loss of income, fear of illness and death, difficulty coping with confinement, sexual desire dissatisfied. 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 cases of pandemic. Patients who live far from urban centers, those who live or suffer some type of confinement, due to being sick or handicapped, agoraphobic or highly anxious can be cared for in this way. The list includes those who 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 situation of the office if one is not in it for reasons of confinement or eventual hours that exceed the face-to-face agenda; but at the same time the online modality becomes the possibility of being able to do therapy that in other historical moments would have been impossible.

Today, are there frequent cases of people who cannot perform 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 about bad connection but some patients did not accept the change and preferred, for the moment, to interrupt the treatment. They refer to not being comfortable with the use of technologies, they feel limited or maladjusted causing a cut in the future of their analysis that they postpone until the face-to-face meeting. Other patients do not accept this variant because they cannot replace 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, it does not mean that the presence of the psychoanalyst does not exist. This is inferred in the way of interpreting, of operating on the analysand'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 therapy that we can do in a doctor's office, and consists of having sessions through new media of communication such as Skype, WhatsApp, telephone, or other devices or applications from a place that is private and comfortable for talk. In an online therapy we can treat problems of anxiety, depression, self-esteem, family and couple problems.

Although human contact is not the same as online, we can work seriously and with good results on most psychic problems. The important thing to note is that the therapeutic process is supported by a solid and respectful theory of singularity, without stereotyped models of supposed "normality" and guaranteeing an ethic professional.

As a psychoanalyst I propose the method of free association and transference work so that Each patient is authorized to take her word for it and has the possibility of creating their own speech and singular. To be a psychoanalyst is to be in a basically responsible position, insofar as he is the one to whom one entrusts the operation of a radical ethical conversion that which introduces the subject (patient) into the order of the desire.

Does the fact that it is an accessible way of doing therapy have an impact on the commitment that patients develop with it, according to your experience? For example, in regards to not skipping sessions.

There are patients who agreed to continue at a distance and others who feel uncomfortable because they do not have a space physical without people nearby listening, others who are more reluctant but at some point try and decide continue; Some use this as resistance, that is to say that it was difficult for them to move forward and any reason can be used to make a decision. pause, and there are those who are scared about how they will sustain the economy when all this happens and prefer not to continue with the treatment.

Right now one of the most serious issues is economics. In many patients, the anguish points to the uncertainty of how they are going to live and with how much money, to job instability rather than the fear of dying from the coronavirus.

In any case, it is surprising how a large majority of patients continue their sessions with the issues they had been dealing with before, their symptoms, their anxieties, their previous concerns are those that continue to appear as a priority and at some point speak of the current situation but not as a central issue 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 is invited to state his preference for the technological medium for the development of the first session. We can discuss what is most convenient for your process, but in my experience the first sessions are for video calls to then suggest or arrive for technical reasons of timing and listening to the call telephone. In my opinion the most effective way to keep attention focused on the word.

What do you think are the barriers that online therapy has yet to break to reach its full potential?

The beliefs that you don'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 her game to express themselves and tell her story through it, what is happening to her. In these cases it is preferable to have virtual interviews with the parents in case they require it.