With regard to the concerns you raise, why are you uncomfortable? Is this due to the client’s treatment needs and your concern about them effectively being met through ‘Skype therapy’? Is it because of your discomfort with the technology or even the thought of providing treatment in this way (with any client)? Or, is it for some other reason? Clarifying this for yourself seems important to do.

If the client was going to be away for a short time this situation might be addressed differently, but two years is a significant period of time. Why is your client uncomfortable seeking treatment from a new psychotherapist? There may be some important clinical issues there to address. Also, I don’t see any abandonment issues here. Abandonment occurs when you fail to meet a client’s treatment needs. That doesn’t necessarily mean that you have to personally provide the treatment. If you have a legitimate reason for not continuing to provide the client with treatment you obligations are to 1) discuss this with the client in advance, 2) share a plan for how you suggest the client can have these ongoing treatment needs addressed, 3) make appropriate referrals, 4) offer to assist the client with the referral process, 5) with the client’s permission share relevant treatment information and treatment records to help facilitate the transition to the new clinician. Doing these things ensures that no abandonment is taking place. While the client may not be happy with your decision (again, a potential clinical issue to address) you are under no obligation to provide treatment you are not comfortable providing. You are, however, obligated to make a good faith, reasonable effort to ensure that the client’s ongoing treatment needs are met as I have described above. But, that’s different than you having to provide the ongoing treatment regardless of the situation or circumstances.

I hope this is of help. If you have other questions or would like to discuss it further just let me know. Best wishes – Jeff

“A lot of that depends on the client’s treatment issues and needs. For some clients this may actually appropriately meet their clinical needs.”

What happens in this situation: I’ve seen a patient for almost two years, once a week. That patient is relocating far away for work and family purposes for about two years, and then will return to the area, she says. She is relocating too far to come to my office. This patient has had a productive therapeutic relationship with me and has basically begged me to continue with her either by phone or by Skype, even though I am not comfortable working that way, in my gut. The patient says that may be true, that I might be uncomfortable, but there’s no way of telling whether the phone/Skype thing will work in her interests in actuality — or my interest, for that matter! — unless we try it for a few sessions and then evaluate. She seems to think that while phone/Skype will understandably not be as productive as coming to my office, it could well be more than productive enough, and in her opinion would be far more productive than finding a new therapist and then switching back to me when she moves back to the area in a couple of years. In her opinion, phone/Skype will meet her clinical needs, and my failure to work with her this way would create a clinical problem for her. In my opinion, I don’t know if it would meet her clinical needs, but it would not meet my needs. She says that if after a few sessions of phone/Skype I professed ongoing difficulty, she would demur and terminate, at least until she returns to the area.

I find it hard to argue with her logic, which makes me very uncomfortable, because my emotional feeling is still not to pursue phone/Skype with her. Is my unwillingness to work this way tantamount to abandoning her? I kind of think not, since I’m not the one moving away, and she is. Yet my discomfort persists.

I look forward to your thoughts.