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By Adele Gibson, Dr Robyn Miller MAPS and Dr Ross King MAPS School of Psychology, Deakin University, Geelong

There is no need to be professionally isolated anymore, regardless of where you live or work. With the press of a button, psychologists located in rural and remote areas
can communicate easily with colleagues and peers. Now added to familiar one-dimensional contacts such as email and phone, are newer forms of interactive video broadcasting through government networks and personal computers.

Recruiting health professionals into rural and remote areas is difficult, unless local family and friend support networks are present. Working full-time with challenging case loads means the time and expense involved in travelling for professional development can be seen as a luxury. Consequently, professional isolation and attrition rates are often high. However, through videoconferencing, health professionals accessing short-term coursework and professional development programs report a sense of reduced isolation and increased competency (D’Souza, 2000). Further, the evidence shows successful knowledge acquisition (Rees & Gillam, 2001).

Videoconferenced communication presents a number of unique challenges. Participants are in separate locations, available non-verbal cues such as touch and smell are reduced, and the sense of presence is altered. Self-reports often mention feeling surreal or distant. Technical issues include difficulty in interpreting non-verbal cues due to visual problems, and speech clashes due to audio problems. However, when videoconferencing provides contact that would otherwise be time consuming and expensive, self-reports also highlight ease of access, a sense of safety in divulging emotional content, and a ready willingness to adapt to this form of communication (Gammon, Sorlie, Berguik & Sorenson Hoifodt, 1998; Miller & Gibson, 2004).

In Victoria, four-year trained provisional psychologists who work in rural and remote areas can achieve full registration after meeting stringent competency requirements and two years supervised work experience. This supervision involves weekly contact with an experienced registered psychologist. Yet access to a supervisor is often limited in rural and remote areas, therefore videoconferencing assumes a vital connection. However, does videoconferenced supervision match up to the gold standard of face-to-face sessions, given its lack of physical presence and more formal, less dynamic style of communication?

Study of vidoeconferenced supervision

We have recently explored the experience and effectiveness of videoconferenced supervision for 13 provisional psychologists in a rural mental health agency located in southwest Victoria and three supervisors from Deakin University (Gibson & Miller, 2005). We examined alternating blocks of videoconferenced and face-to-face supervision sessions in a two-year longitudinal study. We collected behavioural measures of session dialogue, and self-report measures of task orientation and the working alliance. Our results help to inform best practice for videoconferenced supervision in terms of communication style, teaching, working alliance, and session content.

Communication style

In videoconferencing, speech slows down and people use fewer verbal encouragers, like “hmm” and “yes”. When speech clashes occur, people find them an awkward obstacle that often stops the spontaneous flow of ideas. A common strategy for avoiding this problem is to speak in longer blocks of dialogue. Other strategies are to adopt more disciplined turn-taking in speech, and to listen more carefully without interrupting.

Likewise, in videoconferencing non-verbal cues to emotional responses are often harder to interpret. Facial expressions, eye contact, nodding and gestures become less reliable indicators of what the other feels. Some people learn to ask explicitly how the other person is feeling or reacting. This strategy to clarify non-verbal ambiguity avoids confusions, such as misreading the other’s crying as laughter.

Enhanced teaching role

Teaching is one role that supervisors take on when they instruct and guide a trainee. We found that videoconferencing led to more detailed instruction and explanations from supervisors, while trainees asked more questions. As well, the longer speech blocks in videoconferencing enabled issues to be treated in greater depth. This feature was especially true at the early stages of supervision. Supervisors were aware of this aspect, reporting that early videoconferenced sessions felt more task-oriented. From a developmental perspective, more novice trainees clearly stand to benefit from the on-task and teaching processes encouraged by videoconferenced communication.

Working alliance

Effective supervision rests upon a strong working alliance between participants. This alliance involves trust, empathy and shared goals. We found that supervisors used a more formal, and less engaged communication style in the early stages of supervision and correspondingly reported a weaker working alliance for these sessions. This is most likely due to a technical aspect of videoconferencing, namely the audio time lags. These lags produce awkward speech clashes and people respond with longer blocks of speech. Presumably these long speeches result in a sense of distancing, magnified by the ambiguous non-verbal cues.

To address the weaker working alliance in early videoconferenced sessions, we strongly recommend supervisors and trainees meet in person before launching into videoconferencing. Meeting in person provides the opportunity to become familiar in a comfortable setting conducive to small talk. As well, people have the chance to learn each other’s mannerisms, expressions, and communication style.

Session content

Our study focused on the effect of videoconferencing on coverage of the content of supervision sessions in three essential areas: intervention theory, strategies, and delivery style. Analysis of session transcripts found that coverage of these three areas in videoconferencing was comparable to that of face-to-face supervision.

Conclusion

Overall, videoconferencing has been shown to deliver comparable session content to face-to-face supervision, yet the medium does feel different to being present in person. This difference enhances teaching and staying on task, but requires effort to build an effective working relationship. Videoconferencing does provide easy access to ongoing support and development for psychologists located in rural and remote areas. Therefore it is useful to establish that some forethought can enable videoconferencing supervision to essentially function in the same way as face-to-face supervision.

Enquiries about this article can be directed to the first author at amgib@deakin.edu.au.

 

Recommendations for effective videoconferenced supervision 

Put a conscious emphasis on building the relationship

  • Conduct an initial ‘in person’ meeting to establish the relationship
  • Visit videoconferencing rooms together, or scan the rooms with the camera, to establish a familiar environment for interactions
  • Start each session with some social interaction
  • Explicitly clarify any ambiguity in non-verbal responses and emotions during sessions

Adopt a specific communication style

  • Adopt a slower, more formal speech style to address audio lags and speech clashes
  • Speak in longer blocks of dialogue
  • Jot down spontaneous comments and queries during longer speech blocks to avoid interrupting the flow
  • Engage in disciplined turn-taking and listen without interrupting
  • Fax or email written material (such as test scores) to the supervisor prior to a session 

References

D’Souza, R. (2000). A pilot study of an educational service for rural mental health practitioners in South Australia using telemedicine. Journal of Telemedicine and Telecare, 6 (Suppl. 1), 187-189.

Gammon, D., Sorlie, T., Bergvik, S., & Sorensen Hoifodt, T. (1998). Psychotherapy supervision conducted via videoconferencing: A qualitative study of users’ experiences. Nordic Journal of Psychiatry, 52, 411-421.

Gibson, A. M., & Miller, R. J. (2005). Tasks and connections: The future for videoconferenced supervision. In M. Katsikitis (Ed.), Proceedings of the 40th APS Annual Conference (pp. 103-107). Melbourne: The Australian Psychological Society Ltd.

Miller, R. J., & Gibson, A. M. (2004). Supervision by videoconference with rural probationary psychologists. CAL-laborate, June, 22-28.

Rees, C. S., & Gillam, D. (2001). Training in cognitive-behavioural therapy for mental health professionals: A pilot study of videoconferencing. Journal of Telemedicine and Telecare, 7, 300-303.