Episode 1 – Dr. Judith Zur

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Clay: Hello and welcome to the Online Counselling Podcast. I’m Clay Cockrell and this is our inaugural, numero uno, #1 podcast and I’m very excited to get this project started. It’s something that I’ve been wanting to do for a very long time really to create a resource for other people who are doing counseling through some kind of technology, and not just counseling but life coaching. There are other people approaching telemedicine, but I’ve talked to a lot of therapists who want to expand to a global audience and to work virtually, and they don’t know how. I thought, let’s go and talk to the people that are doing it and learn from them. My hope is to create a resource of people doing this and we can all learn together.

About me, I am Clay Cockrell and I am a therapist, a licensed clinical social worker. I’m originally from Kentucky, moved up to New York City too many years ago to count, and I have a practice here in Manhattan. I have two practices. Individually, I’m walking with clients outdoors, walk and talk. I meet with clients in Central Park and we walk during the session, but about five years ago or more, I began doing couples counseling online. I’ve been doing that for five years and been able to travel and still work, and there’s just a lot of advantages, I think, to taking your practice online or perhaps adding a portion of your practice online. You’re able to reach more people and hopefully more people are able to find you.

As we go forward with this, which I hope would be an ongoing series of interviews and talks with therapists that are doing this, one thing to remember is my favorite quote, “perfection is boring” and you’re not going to see something perfect. It’s just casual conversations. I am here in Manhattan and I’ve got very thin windows so you’re going to hear the little whistle across the street of the doorman hailing taxis, sirens, and yeah. It’s going to be messy but hopefully, the information is still there.

The first person and this is the intro to the first podcast and the first interview that I’m putting online is with Dr. Judith Zur. I just found her by Googling and trying to find therapists who have a different approach and who may be willing to talk to us. She is fascinating. She’s got a dual citizenship with the United States and the United Kingdom. Several times a year, she’s based in Mexico. In fact when we recorded this, she was in Mexico and actually, it was a rainy day so the internet connection was in and out, but that gave us a chance to kind of talk about how technology is great sometimes, but there are downsides to it.

She’s just an incredibly interesting therapist who is working with individuals and couples online. We talked about her different platforms that she likes. We talked about, she an intensive history working with torture victims from war-torn areas and being able to connect with them online, so I couldn’t have asked for a better person to sit and talk with me and it’s the first one. Be patient and please come back more often to hear the other interviews that I’m doing.

If you would like to participate and think you have some value to add to our listeners, please send me an email. I’m hopefully going to be putting these up on a directory that I’m creating at onlinecounselling.com. Hopefully, we’re creating a directory there of likeminded professionals so that people who are looking for counseling can find it. Enough of me. Let’s welcome Judith Zur to the show.

Hello and welcome to the Online Counselling Podcast. I’m Clay Cockrell here in New York and I am very excited that we have today joining us a guest, Dr. Judith Zur. She is currently in Oaxaca, but she has several locations and an incredible story. Dr. Zur, welcome to the show.

Judith: Thank you. Thank you for inviting me.

Clay: Absolutely. I guess let’s start with tell us a little bit about your history and your licensure and education background.

Judith: Okay. Well, basically my education has taken place in London and England, and that initially consisted of a Masters in Clinical Psychology. I then began to work as a clinical psychologist within the National Health Service in London, and then actually, I trained as a family therapist and a marital therapist as well at the Institute of Family Therapy. My MPhil was at the Institute of Psychiatry in London, which is a really interesting place to touch to the mostly hospital which is psychiatric hospital. I trained then at the Institute of Family Therapy and was working already as a clinical psychologist.

I found that at that time, because we’re talking a couple of decades ago, family therapy was quite culturally blind and I kept feeling terrible about all the mistakes I was making because I wasn’t aware of the culture of the Asian, Indian families I was working with mainly. I decided to go into social anthropology and ended up doing a doctorate and was very interested in peace issues; therefore, got interested in issues of war and I was interested in the psychological impact of political violence.

When I lived in Latin America, learned Spanish, ended a study looking at how villages reconstruct themselves on a sociopsychological sort of basis. After surviving the Civil War, went out of London then actually felt terrible about getting a doctorate about this and leaving sort of people saying, “I’m sort of going to get my doctorate. Sorry about the war” kind of thing and decided in the greater scheme of things I would like to reciprocate and so started working at the Medical Foundation for the care of victims of torture in London.

I worked with asylum seekers and refugees from all over the world with interpreters, and then kept going back to Guatemala as part of an organization of human rights to raise awareness about Guatemala. I met another Mexican psychologist who I married and then after living in London for a while and having working this continually also in the national health service, I moved in part, part of the time, to Mexico, which is why I began working here as a therapist. We also went on Sabbatical and we worked in California.

I sort of kept all these places as places of working, which was one of the reasons why I started working online was so that the clients I began to see who wanted to continue to see me, this became a way of being able to practice and continue having my clients working with them. Actually, that sort of like perhaps led me into what would have been another of your questions, but that’s how I then began to work as an online therapist partly because of necessity because of my own movement.

Clay: The online work, how long have you been working online?

Judith: I’ve been working online for eight years.

Clay: Eight years.

Judith: Yeah.

Clay: You’re one of the founders, I would think. It was quite, quite new at that point. Many things about your story is fascinating to me. I do want to talk a bit about your work with survivors of torture, but the other thing that I wanted to touch on because I think that this is pertinent to many of the listeners is the cultural issue. When you now have a practice that has access to everyone that speaks your language on the planet, the cultural barriers and misunderstandings are there. Tell me a little bit about your work and overcoming some of those cultural issues. We may have dropped out there for a minute. Are you there?

Judith: Yes. Could you just repeat the question because I didn’t hear all of it.

Clay: Absolutely and to let everyone know, it’s raining in Mexico today. This is one of the problems sometimes with online work is the technology sometimes fails you, but that’s part of it. My question was in working with cultures, how do you incorporate that into the therapy process and what are some of the challenges?

Judith: Well, that’s interesting on different levels because I’d say gender issues and culture issues are very much intertwined, but I would say in practice, in general, my practice is one that’s informed by curiosity and the position of what’s called not knowing. I would say that with people from all cultures, even what I assume is my own, I like to understand behaviors according to the meanings that people give it themselves and the way that people act also according to their own family history and why their cultural context.

I would say because my general position of trying to be curious, that incorporates the issues to do with culture, finding out where these meanings come from. Some of it can be because of, let’s say here in Mexico, there is certain gender dynamic which is assumed. I can then inquire whether certain behaviors between a couple come from that wider cultural context or whether there was something in their own particular family that also fed into that. I would say that the cultural issues also come into the way that people perceive me, like for example, when people come to see me from this culture, I will sometimes say to them, “Well, I come from a culture that has such and such of general belief about the position of women and the position of men and how they interact.”

I let them know this from the very beginning because I try to be neutral, while I try to be nonjudgmental with everything that people bring me, I invariably and ultimately do have my own ideology, which comes into my belief system of what’s right and what’s wrong. While I try to suspend that, I have to be honest in saying that I don’t know how totally I can do that. It’s to say that part of it is my perception of the other, but it’s also their perception of me in difference and actually I would say, “When people from a different culture come to me, it’s because they do want perhaps a different perspective and they are open and actually wishing for another point of view,” which I think is very courageous.

Clay: Absolutely and I apologize. I’m in New York and sometimes, we have the sounds of the city that are going to be coming in. I think that being transparent and putting it out on the table and saying, “This is a thing. The cultural issues here are going to be a challenge, maybe an impediment,” but if we’re aware of it and that’s the first step as therapist, I think, is this is something I need to be aware of. I cannot assume that some of my givens are going to be the same as my client’s givens. You also do couples work and working with marriages and relationship. Have you worked with couples of different culture, like the husband is one culture and the wife is a different culture?

Judith: Yes. In fact, I sort of like present myself as saying that that’s one of my specialties having sort of like lived it myself, but also having worked. Actually, London is very multicultural and it’s something I enjoy working with with couples who come from different culture backgrounds. Of course, I enjoy working with them when they come from the supposedly the same cultural background too, but yes, that is some of my work. In fact, I even worked with some couples where because of work necessities, one of the partners may be living in one country and the other may be living in another, which presents special challenges.

Clay: It’s one of the advantages, I think, of having the online practice is that you can do this three-way calls for people who are separated by distance and doing couples work myself in that way, I always find it fascinating how they are overcoming some of the challenges in their marriage.

Judith: Yes.

Clay: It’s just endlessly fascinating to me.

Judith: Yes. That’s one of the beauties of online therapy is because it actually allows that where otherwise, it would be impossible.

Clay: Looking at practicing online, that’s one of the advantages. What are some of the advantages for you personally as a therapist that this has brought for you?

Judith: Well, there are several levels. One is, as I said in the beginning, I do move around a bit myself and that makes it possible for me to see my clients on an ongoing basis. In a way, it’s my own convenience. It also makes me accessible to people who, let’s say, are in rural areas or remote areas, or are physically disabled or have some kind of impairment so for some reason or another, people can’t go out of their house. In that sense, it has made it possible for me to work with that client population which I like.

I’ve always liked making therapy accessible whether it’s sort of also in terms of economically but I like the idea of being able to offer therapy to people who might not otherwise be able to. The accessibility, I think, is one and also the convenience both for me because, when in fact, I do have consultation rooms where people see me face to face as well, but the fact is that it’s also convenient being able to see people. Actually, I used to do home visits when I lived in London for one reason or another and now actually, that sort of the inconvenience of having to travel and take time and so on has been sort of overcome.

I would say mostly, those for me are what make it better for me. I think there might be something different for the clients themselves, but I’d say for me, that’s what I like about doing online therapy and also of course meeting a vast range of people all over the place is very interesting as a therapist.

Clay: It really does expose to a worldwide population. I’ve got clients in Saudi Arabia, in Japan, and North Dakota. It’s invigorating, I think, as a professional to be exposed to different types of people.

Judith: Yeah. I was going to say, I also see it somewhat as a two-way process that I also do learn things from my clients and also working with people from different cultures, it’s sort of puts a lens on your own culture and makes you reflect and question things that you might not do otherwise also about yourself. I like to try to remain open and questioning and I think when you come up against that with somebody from a different culture, it just compounds that necessity and I really enjoy that.

Clay: We’ve talked about some of the benefits of online counseling. What are some of the challenges? I mean, one we talked about today is some of the cutting out and the weather sometimes affects our broadband. What are some of the challenges that you’ve seen in your practice?

Judith: Yeah. I mean, I will talk about the challenges, but I’d like to also talk maybe afterwards about, as I talked about the advantages from my point of view, I don’t know whether you’d also like to hear about what I perceive as advantages from the client’s point of view. Would you like me to talk?

Clay: Yeah. Let’s talk about some of the advantages that you’re seeing in therapy.

Judith: Okay. Like for me, the whole convenience I think also pertains to clients who also might be traveling for example. I do have several clients who, for work purposes, are always on the move and that means that they can also schedule appointments with me wherever they are. That’s convenient and also people who are remote, as I say, also have – and also, some of the people who maybe are uncomfortable with sitting in a room face to face with a therapist, that can be quite intimidating. Especially if people have social phobias, agrophobia or difficulties with social anxiety, I think for some, I mean, there are also other problems where sitting face to face with somebody can present a major challenge.

I think doing therapy online actually with a camera or indeed even without a camera if people prefer not to be seen to have the anonymity actually presents something that was never available before. Other people will even go as far as preferring to chat, not even to use their voice or even do emails. There are different levels of being able to be accommodated in terms of what you need as a person and also to deal with your own anxieties or your own wishes, which I think is a great thing.

The other side is it takes out some of the stigma, which probably doesn’t exist as much. Also, I think probably not in New York or London or Sidney or places like that or in California where having a therapist is not unusual. I think in some areas of the world, there’s quite a lot of stigma attached and I think the idea of being able to be in control, seeing your therapist through your computer, not being seen in a waiting room, for example, or traveling to and from, that also helps people who have issues with feeling stigmatized because they are going to see a therapist. This is something much more private and also more anonymous.

Also as I was saying, the whole thing of not being seen, some of the prejudice that we have around race, gender, age, size, or physical appearance, if you’re not seen, okay, those may be things that people decide to work with per se in therapy, but if they don’t want to work with that or they want to work with other issues at least initially, that also give them the opportunity of not having to be confronted with things that they might feel very uncomfortable with. Those, I think, are some of the other advantages I see from the client’s point of view.

Clay: Yeah. I think that that’s really important to look at because I think too many times in our industry, we look at the difficulties of online counseling and the warnings and the challenges, but we don’t look at those positive things that we’re meeting the client right where they are.

Judith: Right.

Clay: But just in your experience, either with technology or whatever, have you seen some challenges that are present?

Judith: Oh sure. I mean, there are many challenges. I think we’re dealing with one of them right now. I would say one of the biggest challenges are if you’re in a place where, let’s say, the sound or the picture, the speed of the internet is slow that that can affect the sessions and in cases where the call gets dropped or the session gets dropped and in fact, I try to let my clients know beforehand that this could be an issue now and then especially if they are traveling to different places or they are somewhere very remote. I let them know that if the call gets dropped, that’s not nothing intentional on my part and in fact, I’m really sorry about that, but it’s one of the things that one has to decide whether one wants to work with that or not.

Beyond that, there is also, part of therapy is looking at people in the eye and you also work with the incongruity of it between verbal and nonverbal communication, whether it’s a gaze, whether it’s a turn of voice, whether it’s many other things. You do lose a bit of verbal cues, but I find that that isn’t too inhibiting from my point of view or I do check in with clients how they find it especially in the beginning especially if it’s something new, and actually, it surprised me that people haven’t actually complained about that more, but the fact is you do lose some of that because of course, being in the same room, you pick up on a lot of nonverbal communication even more so.

The other thing that I think could be an issue, which I would really recommend people is, like, who it is that you’re meeting as a therapist? You really have to know that they are responsible professionals, that they have the qualifications and the credentials that are needed to be able to be in the very privileged position of working with someone else’s life, someone else’s issues. They are putting those issues into your hands and so while I like to think that everybody who is out there is qualified to do so, I always say, “Well, make sure that that’s the case.”

The other issue is to do with making sure that protecting of confidentiality and that is something that as a client, issues of that can come up. There are different technologies – Skype, there’s also one called VSee, which is more particular for professionals, so to make sure that the information that you’re giving is confidential and I think to make sure that therapists work by their code of ethics, to make sure that that is being implemented. I think it comes sort of like going into more another area, but I think that those are issues rather than maybe problems.

Coming back to problems per se, I would say it’s the limitation of the technology. Sometimes, certain clients, if they are older, they may not be used to technology and it might make them feel deskilled. I actually find like the adolescents and younger people, they sometimes really like it because they are much more adept than certainly I am and many other people of my generation. I think that’s not a problem for them but it can be for some other groups who have to install, let’s say, Skype or another, they have to download different [inaudible 27:54]. They may not be that conversant, so that is an obstacle.

Clay: Yeah. That is an obstacle. I’ve seen it. You bring up an interesting point regarding Skype, VSee, and the different technologies. Here in the US, we have a law that is in regard to patient confidentiality and patient information. It’s the HIPAA Law, which says that Skype really is not, at this point, compliant and this is 2015 when we’re recording. What platform do you use with your work and what do you prefer?

Judith: Well, it depends. I negotiate that in the beginning with clients and I do use some platform through particular therapy websites where you log on on that actually therapy website. I do use Skype if people want to use that. I mean, this is where I’m seeing people face to face or just with voice. I have used FaceTime and Google Hangout as well. I have used VSee, which is specifically in terms of absolutely being confidential. Everything I do is confidential and I use my consultation rooms especially for that, but some people if they are more concerned about that and they want to use VSee, for example, I will use that and I will offer that to every person. I suppose I do like VSee, but I will be open if other people don’t want to have to start downloading it and so on. I will take the lead from my clients.

Clay: They got their listings to see what they are comfortable with knowing that there are a lot of options out there to meet each profession’s ethical standards and keep the therapists and the clients safe.

Judith: Yes.

Clay: We’re coming up on the half hour and I want to be cognizant of your time. I appreciate you sharing your time with us, but there are still so many things I wish that I want to talk with you, your work with survivors of torture and what it’s like to do therapy in different languages, but just one thing that I always try to ask people that we interview because the audience that we’re speaking to are therapists that maybe are doing online counseling or are thinking about incorporating that into their practice, as a business person, as someone who has been doing this, as a private practitioner for quite some time, is there some recommendation out there that you might be able to give or a tip that might be helpful for someone who is considering doing this in their practice?

Judith: Well, I would really say, I mean, I myself was quite reluctant to do it and was convinced by sort of by a client who had heard about it before I did. I would say just to try it like I also say to clients, just it give it a go and see how you feel and if it’s not for you, then don’t do it. If you feel that the benefits outweigh the drawbacks, which I say is mostly the technology then don’t do it. Other than that, I would just hope for you as I do for me that you got a good speed internet. Really, that’s what I would say and just make sure that you have your insurance and so on and so forth. You sort of present yourself as you are and you get your clients in the same way. Other than that, nothing occurs to me. I’m sorry.

Clay: No, that’s wonderful. That is great advice across the board. Try it. Get your ducks in a row. Get educated about the options that are out there, but try it. It may not be for you in your practice, but it may actually open up a whole new world. What’s the best way of someone listening and wants to learn more about you and your practice? What’s your website and what’s the best way to contact you?

Judith: Well, they can go to my website although I am redoing it, but at the moment, my website is www.onlinetherapyandlifecoach.com or through my email address, which is [email protected]. One or the other, just shoot me an email and to ask me any question that you might want to ask or even arrange to see me. Of course, I’d be more than happy to try and accommodate whoever contacts me.

Clay: We’ll put that information in the show notes again just in case it cut out when she was saying it. It is www.onlinetherapyandlifecoach.com. This has been Dr. Judith Zur and if you want to learn more about the online counseling practice and podcast, you can certainly go to onlinecounselling.com and also if you would like to follow on Facebook, send us an email. We’ll let you join our Facebook group to support therapists doing online counseling. In wrapping up, Dr. Judith Zur, you are a fascinating practitioner. Thank you so much for the gift of your time today and we certainly wish you the best.

Judith: Thank you, likewise.