商周專欄:心難過?線上諮商時代來臨

⚕️ 這些年,心理健康成為大眾關注的領域,無論網路上的社群資源,或是專業心理師提供的諮商服務,都已是稀鬆平常的事。

:woman_health_worker: 值得高興的是,從今年開始,不用出門也可以諮商了。去年 12 月,衛福部公布《心理師執行通訊心理諮商作業原則》,醫療機構、心理治療所、心理諮商所提出計畫、經各地主管機關核准後,就可以實施。換句話說,只要機構經過許可,無論個案身在何處,都能進行諮商。

:art: 這一切源自於 2017 年時,國發會主動在民間的 vTaiwan 平台上,提出「醫師、心理師透過網路平台提供服務」法規調適案,透過平台徵求包括心理師、律師和諮商民眾等各方意見,從中盤點法規、調整方向。

:card_file_box: 在 vTaiwan 社群討論的基礎上,2018 年 5 月,衛福部公告《通訊診療辦法》,首先放寬遠距醫療的照護對象與模式。與此同時,心理師的法規研議,則透過經濟部的《創新法規沙盒平台》持續進行。

:man_health_worker: 例如,《心理師法》規定「心理師執業需以一處為限」,但並未限定個案所在的地點。對此,包括諮商心理師和臨床心理師公會,以及相關的網路平台、社群,也根據自身專業提供注意事項,讓遠距諮商在合乎法規之餘,也能安全、確實、有效,保護參與者的權益。

:fr: 在我的個人經驗裡,遠距作為會面的輔助,確實有相當好的成效。從 2012 年開始,直到 2017 年初,我透過半近端、半遠端的方式和法國精神分析師同步工作,每半年實體會面一次,其餘時間每週四天透過網路視訊對話,每次 45 分鐘。

:seat: 古典精神分析的做法,是一個人躺在長椅上,想到什麼就講什麼,另一個人專心聆聽。這個方式雖然與心理諮商不同,但仍有相似之處。對我來說,能持續與專業聆聽者分享,這樣認真被傾聽的過程,就是非常療癒的事。其中最關鍵的是,要如何透過遠端連線,來達到「共同在場」的感受。

:gift_heart: 透過 vTaiwan 平台和沙盒機制,所有利害關係人一起「從放話到對話」,為這個時代完成非常重要的一件事:每個人無論身在何方,都能找到可以傾訴的專業諮商師,讓自己的心理健康,受到認真的對待。

⚕️ In the past few years, mental health has become an area of interest to the Taiwanese society. Both online community resources and consultation services of professional psychologists have become commonplace.

:woman_health_worker: A piece of great news is that starting from this year, it will be possible to consult a therapist without leaving home. In December last year, the Ministry of Health and Welfare published the Practice Principles of Psychological Counseling Provided by Psychologists. Medical institutions, psychotherapy clinics and counseling offices will be able to provide online services when the plans they submit to local authorities have been approved. In other words, as long as an agency is licensed, consultation can be conducted wherever the patient is.

:art: The policy originated in 2017, when the National Development Council first proposed a “Provision of services by doctors and psychologists via online platforms” regulatory amendment on the public vTaiwan platform. It used the platform to solicit comments from different parties, including psychologists, lawyers, and the general public in order to take stock of the regulation and revise its direction.

:card_file_box: Based on discussions of the vTaiwan community, the Ministry of Health and Welfare announced the Communication Diagnosis and Treatment Measures in May 2018. It started with broadening the scope of care targets and means of long-distance medical treatment. At the same time, discussions about the laws and regulations concerning psychologists’ provision of remote consultation continued to take place on the Innovation Regulations Sandbox Platform of the Ministry of Economic Affairs.

:man_health_worker: For example, the Psychologists Act stipulates that “a psychologist’s practice must be limited to one place”. However, there is no limit placed on the location of a patient. Regarding this, the Association of Consultant Psychologists and Clinical Psychologists, as well as relevant online platforms and communities, have actively participated in the discussions. They also noted important issues based on their own expertise to ensure that the legalization of remote consultation can happen concurrently with the safe, reliable and effective protection of participants’ rights and interests.

:fr: From my personal experience, using remote consultation as a supplement to face-to-face meetings is indeed quite effective. Starting from 2012 to the beginning of 2017, I worked with a French psychoanalyst in a semi-proximate, semi-remote manner. Every six months, we would have a physical meeting. The rest of the time, we conversed via online video conference four days a week, 45 minutes each time.

:seat: The classical method of psychoanalysis involves one person lying on a couch and saying whatever is on their mind, while another person listens attentively. Although this method is different from psychological counseling, they have their similarities. From my perspective, the process of continuously sharing one’s thoughts with a professional listener and being listened to attentively is tremendously healing. Most importantly, this feeling of co-presence can be achieved via a remote connection.

:gift_heart: In my opinion, the government’s role in this policy is to listen carefully to the voices of all parties. It has used the vTaiwan platform and sandbox mechanism to help all stakeholders move from brainstorming to dialogue and proceed towards a collaborative creation. It has achieved a very important task for our generation — enabling every person, no matter where they are, to find a professional consultant to confide in and have their mental health taken seriously.