Thoughts regarding using remote video and phone contact during the Covid restrictions

The last year has brought about many changes in how we interact with family, friends colleagues, and patients. Much of my practice consists of the preparation of expert reports for the Family and Criminal Courts. What follows are my personal observations as to the use of remote technology.

Regarding professional meetings carried out by zoom or other platforms, it is even more essential that there is an effective chair. Too often the meetings become unfocused, and business is not concluded. It is much harder when using remote platforms to interrupt or indicate that someone needs to stop talking. As well as being frustrating this also can cause me, certainly, to switch off somewhat and become distracted by looking at my iPad or iPhone. In addition to facilitating the business of the meeting, the function of the chair is to carry out the housekeeping that so is essential with the multi member video, for example ensuring that people are muted so that we don’t hear them eating and conversely reminding somebody when they are muted and trying to speak.

I have enjoyed the chat function if there is a particular message for a particular person, although have been tempted to use it, literally, to chat if the meeting is not working! I have had experience of both well and badly chaired meetings. I am of the view also that professional meetings should be shorter than normal as it feels more intense and harder to sustain concentration and attention.

The quality of the transmission is also of significance. For example, my experience of the court video platform (CVP) has not been very positive as often there are multiple technical problems and difficulty in acoustics and view. This makes giving evidence in court remotely an even more complicated experience than it already is. How much more this must be true for the client. Poor quality can make the meetings almost unendurable.

I have assessed many people for the preparation of medico legal court reports, during the lockdown period. My experience is that they seemed to have more difficulty in managing Zoom invitations and similar. Therefore, I have found it most useful to either use WhatsApp or FaceTime video. The advantage of WhatsApp is that it is encrypted, and many people have it. The disadvantage of FaceTime is that it is only available to people with iPhones/iPads

The disadvantage of both of these is that it appears difficult to conceal one’s number and one of my issues, regarding the remote assessment of patients, is that, on the whole, the patients have had access to my personal telephone number. Perhaps one should get another phone.

When assessing somebody it is vital to ascertain at the beginning that they are in a private and protected space so as to maintain boundaries and to stop, if other people enter the room or the person decides to make lunch during the meeting – both of which have happened to me. Assessing a mother who has no one to look after her baby has been a challenge, both because of requiring attention if not asleep but also the nature of the conversation – even if the child is young it can have an inhibiting effect. Interviews over 2 hours are difficult to maintain with regard to concentration, etc.

My experience has been that, when I assess people with personality difficulties, they manage the video recording quite well. They are often younger, used to using phones, etc and therefore seem to respond to the assessment. Of course, one misses the subtlety of the transference and countertransference which I have found to be a difficulty over the period of time. When there was a lifting of the lockdown for a period, and I returned to face-to-face assessments that made quite a difference. However, it is also true that I have been able to carry out assessments from further afield which has meant that it is possible to keep to a shorter timetable.

The group of patients that I think are difficult to work with remotely are those who are either paranoid and/or suffer from a psychotic illness. My experience has been that the anxiety created by the camera and trying to relate with somebody not in the room has been problematic. Such patients often find it difficult to manage the medium and also to remain focused and concentrated.

I carry out some individual work and supervision via telephone which has proved satisfactory mainly because I already knew them. I think it would be harder to for me to start afresh with someone I had not seen before.

I hope that after restrictions ease we will be able to continue to use what we have learnt through remote contact and blend with face to face contact. Much as working remotely has enabled assessment and treatment to continue it lacks an important social and interpersonal quality although its judicious use alongside could enhance our delivery of interventions.