Online Therapy

Online therapy is a form of remote psychological therapy that is conducted over the Internet. It primarily targets individuals who are physically unable to visit a therapist for their mental healthcare needs.

What Is Online Therapy?

Online therapy is a type of professional counseling and therapy service which is conveyed over the Internet via telephone, video conferencing, instant messaging or chats, and emails. It is regarded as an alternative to conventional face-to-face/in-person therapy.

It forms one of the components of the larger group of electronic psychological services called online counseling and goes by several names, including web counseling, cybertherapy, e-therapy, teletherapy, etc.

One 2016 study [mfn] Giotakos, O., & Papadomarkaki, E. (2016). Psychiatrike = Psychiatriki, 27(2), 127–135. https://doi.org/10.22365/jpsych.2016.272.127 [/mfn] defines online therapy as “the process in which both parties, namely the therapist and the client, are involved in an oral or written conciliation through means of an internet connection, videoconferencing, live chat or email exchange.”

In a typical online therapy session, the therapist and the client meet in a ‘virtual’ chat or video room at a scheduled time. Via one of the modalities, they correspond about the patient’s mental health issues and attempt to look for solutions. The duration of psychotherapy sessions depends on the client’s mental health needs.

At the beginning or end of such sessions, issues like payment, medical record-keeping, prescribing of medications, scheduling future appointments, etc. are taken care of. In some cases, the identity of the clients are kept anonymous in accordance with the clients’ wishes.

The benefits of online therapy lie in its anonymity, affordability, convenience, accessibility, —which makes it ‘the treatment of choice’ for most people. Today, more and more people are opting for online counseling as it is easier to access and reach mental healthcare professionals for help and support.

Read More About Therapy Here

Differences Between Online Therapy And In-person Therapy

Traditional in-person therapy comprises a form of therapy in which sessions take place in a physical setting. Herein, face-to-face, in a therapist’s office, the therapist and the client discuss mental health issues and ways to resolve them. In sharp contrast, online therapy is a therapy service that is conveyed over the Internet, using several modalities like email, SMS, video chatting, etc.

Experts argue that this difference in modalities influences the trajectory and treatment outcomes in both kinds of therapy. Of particular concern is the fact that online therapy overlooks body language, the ‘human touch’, and the therapist’s control over the therapeutic environment.

In a typical face-to-face (F2F) therapy session, the therapist sits down with a client in a supportive environment and—through dialogue and gestures—the client communicates his/her thoughts, beliefs, fears, and other mental processes.

It is considered that the basis of such a sensitive correspondence comprises physical proximity, trust, and in-person interaction. Online therapy apparently strips therapy sessions of these non-verbal communication cues (posture, eye-contact, mimics, etc.), thereby creating issues of transference and countertransference [mfn] Situmorang, D. D. B. (2020). Online/Cyber Counseling Services in the COVID-19 Outbreak: Are They Really New? Journal of Pastoral Care & Counseling, 74(3), 166–174. https://doi.org/10.1177/1542305020948170 [/mfn] in a therapeutic relationship [mfn] Békés, V., Aafjes-van Doorn, K., Luo, X., Prout, T. A., & Hoffman, L. (2021). Psychotherapists’ Challenges With Online Therapy During COVID-19: Concerns About Connectedness Predict Therapists’ Negative View of Online Therapy and Its Perceived Efficacy Over Time. Frontiers in psychology, 12, 705699. https://doi.org/10.3389/fpsyg.2021.705699 [/mfn].

This, according to some scholars, creates misunderstanding between the therapist and the client [mfn] Dowling M, Rickwood D. Online counseling and therapy for mental health problems: a systematic review of individual synchronous interventions using chat. 2013. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138124/ [/mfn], often causing the latter to feel isolated and alienated. Studies [mfn] Situmorang, D. D. B. (2020). Online/Cyber Counseling Services in the COVID-19 Outbreak: Are They Really New? Journal of Pastoral Care & Counseling, 74(3), 166–174. https://doi.org/10.1177/1542305020948170 [/mfn] also show that online counseling is ineffective in severe psychiatric cases involving abusive, suicidal, and homicidal behavior; emergency intercession; or restorative control.

Systematic reviews and meta-analyses of online therapy, or e-therapy further reveal that, in comparison to F2F therapy, cultural concerns influence how people approach and avail digital therapy. These concerns include the client’s –

• Race
• Gender
• Age
• Language
• Geographical location
• Sexual orientation
• Socioeconomic status
• Religious practices
• Immigration history
• Cultural background

Because of this, experts recommend examination of cultural concerns–on part of both the therapist and the client–to assess the effectiveness of the impending treatment.

Such assessments encourage mental health providers and clients to reflect on their cultural identities, limited competency, individual prejudices, treatment goals, and reading and expression of symptoms and dysfunction in mental illness before therapy sessions.

Read More About Gender Here

Is Online Therapy Effective?

Experts are mostly divided in their opinions about the advantages and disadvantages of online therapy. While the unconventionality of online therapy and its legal and ethical premonitions may appear discouraging, research [mfn] Alavi, N., Yang, M., Stephenson, C., Nikjoo, N., Malakouti, N., Layzell, G., Jagayat, J., Shirazi, A., Groll, D., Omrani, M., O’Riordan, A., Khalid-Khan, S., Freire, R., Brietzke, E., Gomes, F. A., Milev, R., & Soares, C. N. (2020). Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic: Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program. JMIR research protocols, 9(12), e24913. https://doi.org/10.2196/24913 [/mfn] indicates that web-based, multimodal psychotherapy [mfn] Marcelle, E. T., Nolting, L., Hinshaw, S. P., & Aguilera, A. (2019). Effectiveness of a Multimodal Digital Psychotherapy Platform for Adult Depression: A Naturalistic Feasibility Study. JMIR mHealth and uHealth, 7(1), e10948. https://doi.org/10.2196/10948 [/mfn] is the future of mental healthcare.

Online therapy transpasses the constraints of traditional face-to-face therapy and is credited with better treatment outcomes in:

• Mental health emergencies
• Situations involving violent behavior, self-harm, or suicidal ideation
• Individuals who are nervous or anxious about discussing their problems in person
• Countries with a heavy stigma on mental healthcare treatment
• Countries with poor psychiatric infrastructure
• Pandemics and other situations wherein lockdowns are imposed

Read More About Self-Harm Here

Emerging studies [mfn] Situmorang, D. D. B. (2020). Online/Cyber Counseling Services in the COVID-19 Outbreak: Are They Really New? Journal of Pastoral Care & Counseling, 74(3), 166–174. https://doi.org/10.1177/1542305020948170 [/mfn] also reveal that online therapy, when compared to face-to-face therapy, is more successful in:

• Enabling greater clientele access to psychological resources (like free online therapy, etc.)
• Fostering a more approachable therapeutic behavior
• Greater clientele honesty, vulnerability, and anonymity
• Bringing about lesser [mfn] Lippke, S., Gao, L., Keller, F. M., Becker, P., & Dahmen, A. (2021). Adherence With Online Therapy vs Face-to-Face Therapy and With Online Therapy vs Care as Usual: Secondary Analysis of Two Randomized Controlled Trials. Journal of medical Internet research, 23(11), e31274. https://doi.org/10.2196/31274 [/mfn] treatment dropout rates
• Bettering the client’s social and cognitive skills

Types Of Online Therapy Services

Online therapy and medication services are conveyed over the Internet via a variety of modalities, including:

1. Email

Email counseling is a common modality in online therapy. It features asynchronous communication and conveys therapy services through email and electronic bulletin boards.

2. Message

Message services [mfn] Reynolds, D. J., Jr, Stiles, W. B., Bailer, A. J., & Hughes, M. R. (2013). Impact of exchanges and client-therapist alliance in online-text psychotherapy. Cyberpsychology, behavior and social networking, 16(5), 370–377. https://doi.org/10.1089/cyber.2012.0195 [/mfn] in online therapy feature both synchronous and asynchronous communication. Therapy with the help of messaging can be conducted using:

• SMS
• Voice-only messages
• Telephonic conversations
• Real-time text exchanges
• Chats

3. Video conferencing

Video-conferencing involves therapy sessions conducted over the Internet, using a webcam. Much like face-to-face counseling, it allows a two-way conversation with full audio and video.

4. Audio

While online counseling usually involves an audio-visual mode, sometimes people may prefer to not use their cameras. In such cases, the therapist mostly listens and verbally responds to the client, without any visual feedback.

Moreover, according to a recent study [mfn] Marcelle, E. T., Nolting, L., Hinshaw, S. P., & Aguilera, A. (2019). Effectiveness of a Multimodal Digital Psychotherapy Platform for Adult Depression: A Naturalistic Feasibility Study. JMIR mHealth and uHealth, 7(1), e10948. https://doi.org/10.2196/10948 [/mfn], multimodal digital therapy platforms or blended “platforms that offer multiple modes of digital communication” hold great promise in propelling the popularity and effectiveness of online therapy.

Advantages Of Online Therapy

Online therapy provides a number of advantages [mfn] Schuster, R., Pokorny, R., Berger, T., Topooco, N., & Laireiter, A. R. (2018). The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria. Journal of medical Internet research, 20(12), e11007. https://doi.org/10.2196/11007 [/mfn], including:

1. Accessibility

Mental health issues are generally associated with comorbid physical health conditions, large socio-economic expenditures, and reduced quality of life (for both the patient, the care-givers, and their family and friends). Mental health treatment, in turn, involves long wait times, high cost of infrastructure, mobility challenges, and diagnosis stigma.

Online therapy is particularly beneficial in addressing these challenges. Studies [mfn] Kumar, V., Sattar, Y., Bseiso, A., Khan, S., & Rutkofsky, I. H. (2017). The Effectiveness of Internet-Based Cognitive Behavioral Therapy in Treatment of Psychiatric Disorders. Cureus, 9(8), e1626. https://doi.org/10.7759/cureus.1626 [/mfn] over the years show that this type of therapy is linked to:

• Increased client-accessibility to therapy sessions and care facilities
• Increased accessibility to mental health emergency services
• Low cost and cost-effectiveness of technological psychological services
• Greater utility of mental health help, thanks to the flexible timing and location of services

2. Effectiveness of computer-based and online counseling

Internet-based therapy is associated with positive intervention outcomes in emergency situations linked to:

• Depression
• Panic attacks
• Social anxiety
• Suicide ideation

Read More About Social Anxiety Disorder (SAD) Here

3. Language proficiency

Studies [mfn] Funk, B., Sadeh-Sharvit, S., Fitzsimmons-Craft, E. E., Trockel, M. T., Monterubio, G. E., Goel, N. J., Balantekin, K. N., Eichen, D. M., Flatt, R. E., Firebaugh, M. L., Jacobi, C., Graham, A. K., Hoogendoorn, M., Wilfley, D. E., & Taylor, C. B. (2020). A Framework for Applying Natural Language Processing in Digital Health Interventions. Journal of medical Internet research, 22(2), e13855. https://doi.org/10.2196/13855 [/mfn] show that online therapy has been conducted in a number of languages since its inception. This enables mental health treatment for people living in foreign countries and experiencing obstacles to obtaining therapy due to language proficiency, stigma, poor psychological services, etc.

4. Betterment of clients’ cognitive facilities

Research [mfn] Schuster, R., Pokorny, R., Berger, T., Topooco, N., & Laireiter, A. R. (2018). The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria. Journal of medical Internet research, 20(12), e11007. https://doi.org/10.2196/11007 [/mfn] shows that online therapy improves a client’s:

• Responding skills, via speech and writing
• Decision-making
• Conflict management skills
• Social skills
• Reflection and thought processes
• Cognitive faculties

Read More About Decision-Making Here

5. Privacy

Online therapy is flexible in its timing and location and it offers greater anonymity to its users. The comfort of such anonymity, intangibility, and availability of more time to structure reactions in a secure, non-judgmental environment is said to create a more open approach to therapy.

In fact, studies [mfn] Lustgarten, S. D., Garrison, Y. L., Sinnard, M. T., & Flynn, A. W. (2020). Digital privacy in mental healthcare: current issues and recommendations for technology use. Current opinion in psychology, 36, 25–31. https://doi.org/10.1016/j.copsyc.2020.03.012 [/mfn] show that providers and clients enjoy instant rapport, genuineness, and empathy in online therapeutic relationships.

Disadvantages Of Online Therapy

Online therapy, despite its widespread prevalence [mfn] Torous, J., Jän Myrick, K., Rauseo-Ricupero, N., & Firth, J. (2020). Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow. JMIR mental health, 7(3), e18848. https://doi.org/10.2196/18848 [/mfn] and benefits, has faced criticism in recent years for its ethical and legal limitations [mfn] Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical Issues in Online Psychotherapy: A Narrative Review. Frontiers in psychiatry, 10, 993. https://doi.org/10.3389/fpsyt.2019.00993 [/mfn]. These concern:

• Its unsuitability to treat severe psychiatric illnesses
• The lack of easy availability of technological resources like the Internet, camera, webcam, etc.
• The overdependence [mfn] Navarro, P., Bambling, M., Sheffield, J., & Edirippulige, S. (2019). Exploring Young People’s Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study. JMIR mental health, 6(7), e13152. https://doi.org/10.2196/13152 [/mfn] on technology in digital therapy
• Inadequate therapist-client bonding in virtual therapy sessions
• Clientele identity and consent in online therapy
• Issues of diagnosis privacy
• Data storage and confidentiality
• Legal regulations about licensing, liability insurance, billing, etc.
• Exclusion of people with inadequate knowledge of technology

How To Find The Right Online Therapist For Yourself?

For many, online therapy comes across as a complex, technologically challenging form of therapy, and this discourages them from pursuing it. However, if you familiarize yourself with the formalities and processes in online therapy and prepare yourself beforehand, you can reap well the benefits that online therapy has to offer.

Consider the following tips to make the most of online therapy:

• Try to research and learn about your own mental health issues
• Assess your personal and cultural approach to therapy
• Decide on the type of online therapy you are comfortable with
• Look up different therapists offering online therapy, and read up on their experience, qualifications, client reviews etc.
• Check out your own and the therapist’s geographical restrictions, time-planning, jurisdictional licensure, and territorial standards and occurrences
• Acquaint yourself with the information of your own and the therapist’s particulars about the utilization of electronic communication, such as Internet access, etc.
• Communicate effectively with the therapist about your mental health problems
• Cooperate with the therapist and other service providers in processes linked to medical record-keeping and payment for service

Takeaway

Online therapy has crossed many boundaries and limitations to deliver flexible, effortless and affordable mental health care services and ensure the mental wellbeing for a wider clientele. However, it still needs to be developed further. More exhaustible research, more awareness, and more sincere implementation is needed to fully harness the benefits of online therapy.

Online Therapy At A Glance

1. Online therapy is providing counseling services and intervention over the Internet.
2. It is conveyed through email, real-time messages, or video conferencing.
3. It offers alternative cost-effective treatment opportunities and increases client-access to psychological services.
4. It is found to be more effective than traditional therapy in mental health emergencies.
5. Despite its accessibility, it is plagued by cultural constraints, privacy concerns, and ethical and legal issues.

Frequently Asked Questions (FAQs)