I recently had the pleasure of appearing on a SXSW panel organized by Dr. John Grohol called “Online Therapy… Naked?”
Joining me were Audrey Young and Julie Hanks, along with Dr. Grohol. The topics discussed ranged from the kinds of clients we’re all seeing online to the software we use to the differences between in-person and online therapy to the details of my practice, Naked Therapy.
Besides describing their own online work, there was a vibe from my co-panelists that Naked Therapy, while cute, had come from another planet. And in a way they are right — it has come from the Internet planet with a history very different from their psychotherapeutic backgrounds.
The current definition of NT (now just over a year old) is a form of talk therapy in which the client and/or the therapist gets naked. This is a new kind of therapy bred from new ground and I am in the early stages of assessing its possibilities.
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I consider all the panelists here my colleagues, and at the very least, my tweeps. Sarah, I think what is important is not whether having the proper training AND practicing “Naked Therapy” would prohibit licensure as a mental health practitioner- or rather, place your license in jeopardy but that obtaining the fundamental education regarding counselling theories and approaches would certainly place you in a position to better weigh your outcomes and understand other’s more “traditional” concerns about your approach. Remember, therapy, counselling, psychotherapy are not regulated professions in many parts of the world so choosing to become more educated in the traditional sense may actually help your argument and lend credence to your methods, if in fact, your form of therapy proves to be a legitimate (with quantitative research and outcome studies) successful intervention.
Just my two cents from an online therapist who does not consider delivery of mental health services via technology to be new at all…
DeeAnna, I completely agree. We should all, always, in every way be educating ourselves. I am looking into furthering my education in an official sense (graduate school), and I am currently furthering my education by collecting data on outcomes, working on a book about NT, researching for articles, and reading a wide variety of texts in the field, as well as talking with some trusted associates about my practice. So thanks for the encouragement!
Full disclosure; I am NOT a professional therapist. However, I have been on the other side for about 15 years, and have studied the topic for as long.
All that said, it is abundantly clear to me that watching television, and especially the political “opinion” programming, is far more harmful in some cases than a Naked Therapist could ever be. Obviously, that too would depend on which side of the political fence one’s views lean.
What is not clear to me, because of my ignorance of who you are and your depth of knowledge, as to whether this platform is a more about marketing than it is science. It’s probably not too difficult to determine this, over time, by simply observing your words, actions, marketing and other avenues of public expression.
There are many people in the virtual and real world who happily pay real money for tarot card readings, past-life and future story telling, and who knows what else. Is it possible these people have been “harmed” by following the advice given?
I heard a PhD, in this field, state that the worst people to try to influence or get to accept something new in their profession is another PhD (paraphrased). Be careful of the bias-monster.
Next, men are hard-wired in certain areas, and the word “naked” is to a man is like “squirrel” to a dog. Men, I understand, are tough to get into any kind of therapy, unless it involves cars or motorcycles, or surprisingly… women. Imagine the number of men who may be drawn to the light, helped, and move on to the next step.
I say be supportive of this new concept, unless there are blatant offenses that professional or society norms would not accept. Dare I finish by whispering “it could be good for business”.
Gary, thanks for your thoughts. I appreciate your openness. Certainly, it would be easy to look at what I do as highly integrated to some kind of marketing scheme, but I have two things to say about that. First, I personally know therapists with online practices who are heavily involved in marketing their practices in some way, and I definitely spend time trying to grow my practice, just as anyone else does. Second, however, is the fact that my client base has been consistent and growing over the first year of my practice, as have my comments on therapy and NT in general, all in an attempt to try to document, explain, and learn about what I’m seeing in my sessions. Like any therapist I have a set of regulars, as well as a large number of less regulars. Point being, I have a practice with paying clients, not just a marketing scheme, and these clients wouldn’t be paying if there weren’t something more than just marketing to what I’m doing. That said, if I’m allowed to be a bit cheeky, your very good question makes me ask, to what extent was the immense amount of time Freud put into codifying his system just an advanced and very rich marketing scheme? After all, one has to get the word out if one hopes to exchange words with those who need help! Finally, yes, I do think one of the values of NT is it gets some men into therapy, though also, as I’ve said elsewhere, about half of my clients have seen other traditional therapists (but not been satisfied).
Sarah, you should be teaching marketing courses at Wharton School of Business, or maybe to Goldman Sachs.
TPG, thanks. If you have any contacts there, pass them on
Sarah, there were a bunch of questions I wanted to ask at your panel but didn’t have an opportunity to ask because I had to run out a bit early. I’m hoping you might answer them here.
1. Are all of your clients male? Even in your post here, you talk about male clients. Do you see female clients? Couples? If so, is this work qualitatively different than what happens with your male clients?
2. What is the average course of treatment? How many sessions do people typically require? How many one-time sessions are common?
3. What are the most frequent treatment issues that people are bringing to you?
4. How common is it for you to collaborate with other professionals in your practice, and do you experience them as…collaborative or are do they consider your treatment at odds with the goals in their work w/your shared clients?
Thanks in advance. It was an interesting session.
To add to the questions above: What accountability is in place, since you are not practicing therapy (of whatever description) using your legal name? If there’s no shame here, and you are providing a legit service, like other therapists you should give your legal name to clients.
I don’t have much to say to that Tom. I don’t know what basis you have to claim this is not my legal name, or what that has to do with accountability, or why you haven’t posted using your full legal name and email address here.
Thanks for your great questions, Dr. Kolmes.
1: Yes, they are currently all male. I am more than open to seeing female clients but they don’t seem to have the same attraction to doing NT, at least with me. I am open to seeing couples as well. It seems that work would be different because the focus of the arousal would be different. I’m proud to be bringing and seeing so many men in therapy. There was a NYTimes article on this last year that I responded to here: http://nakedtherapy.org/2011/05/24/a-hard-man-is-good-to-find/
2: I’m still working on collecting data for those questions. My estimate would be that a third come in for one-session, a third are done after 4 sessions, and a third I see weekly or monthly.
3: Relationship issues, sexual issues, confidence issues, motivational issues, addiction issues, affective issues…
4: I am very open to collaborating and have met with a few professionals to discuss research projects. Professionals have also referred clients to me and consulted with me on common clients.
Thanks for your responses, Sarah.
My practice seems to have more men than typically come to therapy (about 40%). But many of them identify as bisexual, gay, kink or poly identified.
Oh, I forgot one more question: do all of your clients undress? Or is it only you? I had assumed you were both naked, but now I realize that maybe it’s just you?
I think Julie’s question is a good one, but I also had to stop and think, “How do any of us know that what we are doing is therapeutic?” Aside from a client’s assertion that their treatment goals have been met, I think most therapists are usually guessing at their effectiveness, unless they are regularly using some sort of assessments during treatment, and I think many do not.
And interestingly, the data seems to point towards the effectiveness of therapy being based less upon theory or technique and more on the client’s belief that the therapist likes him or her.
It’s not that I don’t have my own skepticism about Naked Therapy–because I do. But I think your data will be very interesting as you try to make a case for this as an effective treatment modality.
Have you considered getting professional certification in the field of sexology or anything like sex surrogacy? I would imagine this sort of credentialing might be just as useful to your work as a counseling degree.
Keep us posted.
Dr. Kolmes:
Definitely not all of my clients undress, but some do. They are free to if they wish, and some avail themselves of that option.
I have considered a variety of educational options, and sexology is one of them, but it might surprise you that I don’t really consider myself a sexologist, because “sex” is a small portion of what I talk about with my clients. I guess I consider myself what I am – a naked therapist – so I’m leaning toward counseling or psychology for Masters, but of course there’s a hitch. I would not be allowed to get a license, so my educational prospects contain a paradox. Most people can expect to be licensed and begin practicing their favorite style of therapy after spending $50,000 on grad school. I, however, do not sense that I could be licensed (for instance, as an LPC) doing what I do, which is therapy, not sexology, and certainly not sex surrogacy, so I’m still investigating what would be the wisest route.
While I appreciate innovation in terms of therapy approaches, I do find it difficult to take this seriously, Sarah. A google search of your name and naked therapy practice suggests that you’ve also been a “naked coder”, “naked consultant”, & a “naked tutor”. If that is accurate, then “naked therapy” is just the latest business brand and the theme is not therapy, but providing services of many kinds naked. I think Gary brings up a good question…is this about marketing or science?
I agree with DeeAnna in that if you are trying to venture into a new form of therapy is that you actually get some kind of formal education and training in doing traditional psychotherapy first, before trying something “new”. I asked you in the panel and ask you again to consider “How do you know that what you are doing is actually therapeutic?”
I wonder if Sarah might not give the same answer that people benefiting from 12-step programs give about the utility of their programs. That is, they show the utility by voting with their feet. They keep coming back.
Thanks, Julie. Feel free to reference my answer to Gary above in regards to marketing vs. science (though the question was really marketing vs. therapy, and I’m not convinced therapy is a science, and would side with Lacan in thinking it more of an art). I can understand that you’d have a hard time taking it seriously. Lots of new things seem ridiculous in the light of established and self-legitimizing practices. Wasn’t it somewhere said that the ridiculous is the surest sign of progress? For example, many people still don’t take Freudianism seriously, yet many other people claim it has helped them.
In terms of your google research on me, when I started offering services online I posted a few different things to see which of my strengths might actually be of use to people. I was, admittedly, looking to engage people via the web. But I found out fast that people weren’t interested in naked coding or naked tutoring, and never actually had a single client take me up on those offers. If there are screencaps from then, you’ll find that the message of NT was very similar then to what it is now. So, unlike the other ventures that had no theoretical bases, NT was founded on my ideas, strengths, and experiences in life and on the web as well as my history with and ambition for psychology. Many people have tried a variety of careers before hitting on the one they succeed at, and that doesn’t lessen their eventual success.
You seem to be suggesting that I should have gotten formal education and training and done some traditional psychotherapy before trying Naked Therapy. Honestly, I have a hard time taking THAT seriously. Really? So I should have sensed a need out there among men for my methods, sensed that such an idea might work, sensed that bringing nakedness into the therapeutic context really might be an interesting experiment and be helpful to some people, and then set that aside for…what…5, 6, 7 years…and then tried it, when, upon doing so I would be immediately stripped of the license I had spent so long acquiring? Hmmm…I think I’d get the marketing job at Goldman Sachs before you.
I am not opposed in any way to education. People want to paint me as someone who thinks that formal training is useless. That is definitely not the case. I am already in the process of talking to graduate schools, I am continuing my education on my own, and I am conducting research on my methods. What I take issue with is the fact that what I am doing is completely invalid and “only marketing” because I haven’t gotten any formal training. That just seems like academic snobbery to me, especially in light of the hundreds of clients I have had and helped.
And to your last question, let me ask you, Julie – How do YOU know that what YOU are doing is actually therapeutic? Because a book or a professor told you it is? No, I’d imagine that you know it because your clients respond positively to it. And if that is the primary criteria by which therapy’s value can be judged, then what I am doing is therapeutic.
Nicely written, Sarah.
Your last point is exceptionally well-taken. Not only does the psychotherapeutic profession have a long and storied history of analysts and others working effectively without formal degree training, but finally, I think you’re right. That is, the only way to tell of what we’re doing is working is what our clients report to us they’re feeling.
I would pose this interesting question, though.
Despite the near ubiquitous presence (except in the most success therapists with huge practices, or those working on salaries) of what the therapist Stephen Diamond so eloquently calls “unconscious fiscal convenience,” which is the unconscious wish of therapists for their clients not to leave therapy because of the revenue streams they provide, I believe that the goal of every therapist should be — must be! — to have their clients move out of psychotherapy as quickly as possible. This is no different from any other fee-for-service business in the “real” world. We are all conscious of the high economic cost of the therapy for the client.
Maybe I need to cross-stitch this on a pillow for the couch. “Successful Therapy Means Successful Termination”
Is that your over-arching goal in NT? That is, to do your best to make it so your clients are NOT weekly/monthly online visitors with you?
I wonder if your panelist sceptic(s) would meet with you via Skype? It might be more productive than dueling blog entries.
Thanks, Cynthia, for the comment. I would like to think that yes, my goal is to help my clients feel better, which would mean their leaving therapy. I do my best to push them in that direction. But, of course, therapy is different, for instance, than someone paying for a lawyer. There’s really no joy in seeing a lawyer, but there can be in seeing a therapist, so there is a blurring in therapy between “going because you feel broken” and “going because you enjoy it.” I mean, why not see a therapist with some frequency for your whole life? If everyone did that, mightn’t life be a more pleasant journey?
Sarah,
For clarification, education and licensure are two different things. It is possible to be trained in psychotherapy in an educational setting without choosing to pursue licensure. In any field, art or science, it is important to study the masters and the classic works in the field so you know what you are departing from. Training in how to do traditional psychotherapy and distance therapy would lend credibility to your “new” idea.
From your comment above it sounds like you put a few other business ventures involving attracting men on the web and your willingness to strip while providing computer programming, tutoring, consulting, but only naked therapy was the one that consumers showed some interest in. That is telling.
You ask how I know what I’M doing is therapeutic? I know because I have outcomes data to support the effectiveness of my clinical work. For example, I have pre and post test for all of my sessions last year that show my effectiveness is NOT simply based on anecdotal evidence, or the fact that my clients like me and keep coming back. I also have research data on the effectiveness of the therapists that I’ve trained and who work for me in my clinic.
You seem to suggest that just because your are being bold and bucking the traditional therapy system you are onto something effective or helpful. Some new and provocative therapeutic notions prove to through research to be helpful and some end up being harmful. I’m looking forward to your research that shows where NT lands on the continuum.
In my clinical practice I have worked with some escorts, strippers, and former prostitutes who have shared with me that their clients are not only interested in sexual pleasure but surprisingly, they are also interested in talking and exploring emotions. Other than the fact that there is no physical contact in NT how do the services you provide differ from the services they provide?
Fascinating.
Julie, you do pre-and-post objective assessment for each and every psychotherapy session, that results in a longitudinal data set for each patient? And that assessment is objective, and not based on patient self-reports?
How does that work, as a practical matter? I can sort of understand how it would function if patient self-reports were involved, such as giving every client being treated for depression one of the depression assessment scales before and after every session, but even those are based on self-reports.
On a different but related topic, Julie, your thoughts about the value of groundedness in therapeutic history and technique, even if one plans to veer from it, are exceptionally well-taken. I agree with you.
I do wonder, though, if worry about substandard (by my or your standards) training in an era where the strength of the therapeutic alliance seems to take precedence and power over everything else is founded more on biases, hopes, and wishes than in fact.
Me, I wouldn’t see anyone without Masters level education. But can a B.A. or B.S. level person do effective counseling and therapy (and I’m talking here in a regular office setting, with his or her clothes and my own clothes on!)? I wouldn’t want to be the one to find out, but I would venture that in some cases the answer would be yes.
Caveat emptor, no? It’s one of the reasons I think that all therapists should put the C.V. up online at their websites, and would caution people about seeing a therapist who doesn’t.
Julie and other therapists here, I would say that Sarah poses a fair question. Even when you’re doing accepted-paradigm-therapy, how DO you know when what you’re doing is actually therapeutic, (unless you’re administering a bunch of assessments along the way, as Dr. Kolmes mentions in her comment?)
Doesn’t it rest entirely on the twin columns of the self-reports of the patient, and what you can assess from the client in the chair across from you?
I once heard a very well-respected peer say that while the profession is certainly loath to shine a bright light on the metaphor, there are actually certain similarities between certain aspects of psychotherapy and certain aspects of prostitution.
The more I think about the Naked Therapist paradigm, the more those comments resonate.
I’m sure you’re aware that your well-respected peer was beaten to the punch by the well-respected (at least by some) Karl Marx, who (at least implicitly) made it clear that in a capitalist society there are few professions that are not analogous to the oldest.
A Pyschcentral search for “Prostitution therapy” yielded a post quoting from a book by Deborah A. Lott.
“Therapy is like seeing a prostitute. Even though it feels awkward and embarrassing you have to hurry up and take your clothes off so you can get what you came for. After you’ve relaxed some and are feeling extremely vulnerable, you have to be quick about putting your clothes back on, so someone else can use the room.”
<<<<>>>>
I did not post this in an effort to compare my therapist to a prostitute. She certainly is no such thing.
——————————————————————————-
If I understand some of the earlier blogs correctly. They try to cast Sarah as a prostitute, a stripper, an escort, a harmful incompetent and who knows what else.
In stark contrast to those judgemental views http://sarahwhitetherapy.com/welcome contains the following endorsement:
“I would like to speak out in support of Naked Therapy as a new and exciting form of talk therapy. Sarah White and I have a client in common and while I worked with him for over five years with various cocktails of prescriptions and therapy methods, he has made significant improvements with her over the course of a few sessions and the improvements have continued over the past couple months. His energy has increased, he is overcoming bad habits, and he is excited about life again. Naked Therapy can be a helpful addition to conventional treatments. I encourage people to open their minds to this new method, and urge anyone interested in talking openly and honestly about themselves via the power of arousal to give Naked Therapy a try.” – Alan S. Liu, MD Child, Adolescent, and Adult Psychiatry,
I doubt there are many open minds blogging here.
Dear Moderators,
Please edit my prior post to include ” Later on within a sea of protest he posted… ” within the <<<>>> brackets. The phrase was in my “pasted” comment but now are missing.
Thank you