Three examples are discussed where he author has become involved in the delivery of psychiatric treatment via telepsychiatry (video conferencing). The first is in a county rural mental health clinic in California. The second is in conjunction with the Chinese American Psychoanalytic Alliance (CAPA) where mental health professionals in China who are in a training program provided by American teachers via SKYPE ( video conferencing) desire to have their own personal one to one psychotherapy by this technique. The third is psychotherapy in the United States for private patients who for a variety of reasons find it more convenient and feasible to have their therapy via telepsychiatry.
The Internet has changed referral patterns for psychotherapy. Whereas in the past many therapists tried to keep information about themselves hidden, now days with the Internet it would be very difficult to do this. Rather than rely on referrals by other doctors, patients locate doctors as well as information about them via the Internet. The relationship to transference issues is also discussed.
A movie review written by the author of the recent film “The Rabbit Hole” is presented. The story deals with the responses of two parents to the death of their five year old son. The film shows realistic grieving of each parent. The issue of “complicated grieving” is explained and discussed. It is suggested that this movie should be used as a teaching tool for professional students interested in understanding the grieving process.
A nanny tells her psychiatrist that she has slapped the 18 month old child under her care. A course of action for the therapist could include filing a report of child abuse, a Tarasoff warning to the family and an involuntary hospitalization of the patient if indicated. The possibilities of what could happen if the therapist did the above or some other action were discussed.
The author describes his experience of wishing a patient in psychotherapy a happy 65th birthday and telling the patient that his fee is now reduced since he is now on Medicare. Opting out of Medicare is discussed as well as the implications of new healthcare changes which may discourage psychiatrists from doing psychotherapy.