Online Counseling

Online Counseling

Verified by World Mental Healthcare Association

Online counseling, also known as online therapy, is a remote form of professional mental health counseling and therapy service that is typically conducted over the internet or the telephone. It is primarily targeted for individuals who are physically unable to visit a therapist due to different issues, like distance.

What Is Online Counseling?

It is a form of professional counseling and therapy service offered through the internet that is regarded as an alternative to conventional in-person counseling or therapy. It is also known as web counseling, cyber therapy, e-therapy, teletherapy or e-counseling. Such services are typically provided over the telephone, video conference, instant messaging or chats and emails. Along with traditional counseling and psychotherapy, qualified mental health practitioners such as counselors and therapists employ additional computer-assisted technology to assist their clients. Today, more and more people are opting for online counseling as it is easier to access and reach professionals for help and support.

One 2016 study 1 defines e-counseling 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.” It involves various benefits such as anonymity, affordability, convenience, accessibility, relocation and facilitation of face-to-face psychotherapy, which makes it “the treatment of choice” for most people. Further studies 2 have shown that one-on-one online instant messaging or chat counseling and therapy with a professional can be effective in most cases.

Read More About Therapy Here

Understanding Online Counseling

Web counseling, characterized as the conveyance of counseling services via the Internet, offers alternative cost-effective treatment opportunities and increases clients access to psychological services for their mental wellbeing. It allows mental health professionals and clients to connect via the Internet who are not in the same physical area. According to a recent 2021 study 3, it is “any type of professional therapeutic interaction that makes use of the Internet to connect qualified mental health professionals and their clients.” It also makes heavy use of computer-mediated communication innovations.

Mental health disorders create large socio-economic expenditures and lead to poor quality of life for patients, their caregivers, and their families and friends. Barriers to receiving treatment for mental health involve long wait times, high cost of infrastructure (including therapy sessions and care facilities), geographic locations and mobility challenges, and stigma associated with mental health diagnosis. Online counseling offers alternative cost-effective treatment opportunities and increases clients access to psychological services 4 for their mental wellbeing. Such counseling and intervention is determined by factors, namely, the counselor, the client, the situation, aim of the application, and the intervention that affect the process.

In the post-COVID-19 era – with the rise in mental health symptoms due to lockdown and social distancing, online therapy and counseling is regarded as the best solution 5. It should be noted that web counseling providing mental healthcare services are very different from online pastoral or spiritual counseling and career counseling, despite all of these using the Internet and technological devices for dispersal of services.

Facets Of Online Counseling

Facets Of Online Counseling
Online Counseling

Cyber therapy or e-counseling was initiated with the term “distance counseling”. Despite the lapse in time, a homogenous unifying taxonomy does not exist for web counseling, despite attempts by researchers. In fact, the psychological community has labeled, defined, as well as categorized the plethora of psychological services provided online and these services have been multifariously referred to as:

  1. Telepsychology
  2. Telemental health
  3. e-mental health
  4. Computer-based therapy
  5. Online therapy
  6. Cyber therapy
  7. Internet therapy
  8. Internet counseling
  9. Internet psychotherapy
  10. e-therapy
  11. Chat support
  12. Web-based interventions

Modalities Of Online Counseling

Modalities Of Online Counseling
Online Counseling

Cybercounseling recognizes an assortment of modalities that form subsets of online psychological interventions that have been comprehensively divided in a 2009 study:

  • Online counseling and therapy
  • Web-based interventions
  • Internet-operated therapeutic software
  • Personal publications, online support groups, and online assessments

The modalities, further distinguished by asynchronous and synchronous features, include:

1. Video-conferencing

Video-conferencing, much like face-to-face counseling, involves therapy sessions, via the Internet, using a webcam. A common modality featuring synchronous communication, it allows a two-way conversation with full audio and video.

2. Email Counseling

Email-counseling is a common modality featuring asynchronous communication and involves therapy via email and electronic bulletin boards.

3. Message Services

Message services 6, a common modality featuring synchronous and asynchronous communication, uses SMS, voice-only messages, telephonic conversations, and real-time text exchanges or chats to facilitate therapy.

4. Internet-operated Therapeutic Software

Internet-operated therapeutic software is a modality of asynchronous communication. It uses robotic simulation, rule-based expert systems, sensor technologies, and multimedia in:

  • Evidence-based web counseling and intervening programmes
  • Interactive self-help programmes
  • Programmes with relaxing audiovisuals
  • Intervening programs designed for people with specific health conditions

These programmes could be accessed online and/or via applications in mobile devices by clients seeking therapy. Some Internet-operated therapeutic software also creates virtual environments accessed through games and 3D programmes, to treat mental disorders.

5. Personal Publication And Psycho-education Websites

Various social media platforms, blogs, and websites about mental health provide therapy services, online assessments, opportunities for emotive writing and reading, and educational literature about mental health 7 –thus qualifying for online therapy. These interactive platforms also feature online support groups that facilitate therapy. Moreover, scholarly studies 8 have found that clients seeking therapy sometimes look to peer-reviewed scholarly papers for psycho-education.

Advantages Of Online Counseling

Advantages Of Online Counseling
Online Counseling

Online therapy and counseling has several advantages 9, some of which are mentioned below:

1. Accessibility

Mental health disorders create large socio-economic expenditures and lead to poor quality of life for patients, their caregivers, and their families and friends. Barriers to receiving treatment for mental health involve long wait times, high cost of infrastructure (including therapy sessions and care facilities), geographic locations and mobility challenges, and stigma associated with mental health diagnosis.

Online counseling offers alternative treatment opportunities and increases clients access to psychological services for their mental wellbeing. The inherent ubiquity of Internet access, the low cost and cost-effectiveness of online technologies, and the unattributable geographical factor in web counseling make counseling services obtainable at any time. The service provider can operate from a distance and the client can access the services at his own comfort and convenience.

2. Effectiveness Of Computer-based And Online Counseling

Computer-based and e-counseling use technologies and internet-based cognitive-behavioral approaches that are found to create positive outcomes in therapy when compared to traditional counseling. These are especially effective in emergency situations, like therapy sessions involving patients suffering from panic attacks and social anxiety. Research 10 indicates that “multimodal digital psychotherapy is a potentially effective treatment” for various adult mental health issues, like depression.

3. Language Proficiency

Online counseling is provided and availed across long distances, using application plans, technologies, and the Internet. It enables individuals living in foreign countries and experiencing obstacles to obtaining therapy due to language proficiency to access therapy.

4. Betterment Of Clients’ Cognitive Facilities

Online psychological counseling also improves clients’ responding skills and decision-making skills through speech and writing, enabling them to reflect on their thoughts and actions and better their cognitive faculties.

5. Privacy

Online therapy is flexible and 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 thought to create a more open approach to therapy. In fact, studies show that providers and clients enjoy instant rapport, genuineness, and empathy in online therapeutic relationships. A 2017-study shows that, in online counseling, there is “a negative correlation between both approaches and the clients’ attitudes towards confidentiality of personal information and a positive correlation between the approaches’ openness for new experiences and self-expression”; in psychiatry, this is termed as the Disinhibition Effect.

Disadvantages Of Online Counseling

Here are some of the most common drawbacks of online therapy and counseling –

1. Accessibility

In web counseling, the availability of effective therapy depends on the availability of equipment (cameras, microphones, etc.), equipment quality, cyber security, data encryption, bandwidth requirements, software updates, transmission speed, and electronic record keeping. For instance, internet access of households within low-income quartile contributes to less inclination toward e-counseling. On the other hand, if people from this income group chose to avail cyber counseling with computers having access to free public internet in public places, they would be violating privacy norms inherent in online therapy and counseling.

The overdependence on technology in digital counseling makes it exclusive to certain age groups like children 11 and the elderly populations12 with physical and mental impairments (cognitive, visual, and auditory impairments) and several comorbidities. Studies 13 show that for these groups, traditional counseling yields more effective results than web counseling.

2. Approach Toward Online Counseling

Systematic reviews and meta-analyses of e-counseling sessions of supportive therapy and structured therapy, computerized CBT interventions, and individual synchronous intervention conducted within the context of online therapy reveal that cultural concerns influence online counselling. These concerns include the client’s race, gender, age, language, sexual orientation, socioeconomic status, religious practices, immigration history, cultural background, etc.

Because of this, experts recommend examination of cultural concerns–on part of both the provider and the client–to assess the effectiveness of the impending cyber counseling. Such assessments encourage 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 Cognitive Behavioral Therapy (CBT) Here

3. Traditional Counseling Vs Online Counseling

Online therapy and counseling, though easily accessible, strips therapy sessions of non-verbal communication cues (posture, eye-contact, mimics, etc.), thereby creating issues of transference and countertransference 14 in a therapeutic relationship 15. This creates misunderstanding between the therapist and the client, often causing the latter to feel isolated and alienated. Studies also show that online counseling is ineffective in severe cases involving abusive, suicidal, and homicidal behaviour; emergency intercession; or restorative control.

However, a 2017 study shows that, in web counseling, there is “a negative correlation between both approaches and the clients’ attitudes towards confidentiality of personal information and a positive correlation between the approaches’ openness for new experiences and self-expression”; in psychiatry, this is termed as the Disinhibition Effect. While e-counseling’s ability to do away with the stigmatization involving traditional counseling is irrefutable, its promptness and effectiveness have been subject of much debate. This sometimes contributes to clients’ hesitation to avail it.

4. Ethical Concerns Surrounding Online Counseling

Confirming clientele identity and acquiring informed consent in cyber counseling are difficult 16, especially in therapy that uses asynchronous modalities lacking visual features like email, text, chat, etc.

Web counseling sometimes takes place across transcontinental distances, with the provider and the client may be subject to two different sets of national laws governing the conveyance of mental healthcare services. This difference in jurisdictions of laws and regulations might affect licensing, liability insurance, billing, and electronic record-keeping in e-counseling, thereby negatively impacting therapeutic relationships between providers and their clients.

6. Privacy Concerns Surrounding Data In Online Counseling

Online contexts make it difficult to maintain patient records, files of sessions, transcripts, and data confidentiality. Databases in devices with access to the Internet are often vulnerable to technology-related security vulnerabilities, such as hacking, viruses, etc.

7. Lack Of Data

Studies 17 on online therapy have attempted to examine client satisfaction and comfort, effects on therapeutic relationship, and effectiveness of digital counseling in diversified ethnic and age groups and contexts (children, youth, adult, geriatric) for a number of mental disorders. However, such studies have yielded inconsistent data. This, coupled with lack of research, has hindered the development of online counseling and prevented both caregivers and clients from utilizing it to its full potential.

For instance, a 2013 review 18 on the effectiveness of telemental health revealed the elderly population, especially in rural healthcare units, was an active availer of telepsychiatry and online therapy yielded positive outcomes in mental disorders such as dementia and Alzheimer’s disease. However, the case of this group was understated in neuropsychiatric studies. The knowledge of such case studies appears to be wasted than being effectively involved in the betterment of web counseling for the elderly population.

Suggestions For Clients Availing Online Counseling

  • Educate yourself on your mental health condition and assess your (personal and cultural) approach to therapy.
  • Update yourself with your own and the service provider’s geographical restrictions, time-planning, jurisdictional licensure, and territorial standards and occurrences.
  • Acquaint yourself with the information of your own and the service provider’s particulars governing the utilization of electronic communication, such as Internet access, adequate private computer access, etc.
  • Communicate effectively with the service provider, so as to benefit well from the e-counseling sessions.
  • Cooperate with the service providers in issues relating to accessibility of medical records and payment for service.

Suggestions For Service Providers In Online Counseling

  • Avail professional training for computerized therapies. This training should include, amongst other skills, technical competencies, risk management, learning of legal jurisdiction governing e-counseling, and designing counseling programs, intervention programs, application plans, and waitlists for control groups.
  • Initiate a prior-to-counseling and during-counseling evaluation process to assess each client’s treatment history, geographic location and culture, personality and capabilities, technical competence, and treatment goals to ensure proper client satisfaction from online therapy.
  • Update yourself with your own and the client’s geographical restrictions, time-planning, jurisdictional licensure, and territorial standards and occurrences.
  • Acquaint yourself with the information of your own and the client’s particulars governing the utilization of electronic communication, such as Internet access, adequate private computer access, etc.
  • Cooperate with the clientele in issues relating to accessibility of medical records and payment for service.

Takeaway

Online counseling has broken down barriers and limitations to provide simple and affordable mental health care services, ensuring the mental well-being of many clients. However, it still needs to be developed further–with more exhaustible research, more awareness, and more sincere implementation–so that its benefits can be harnessed fully. Especially in the post COVID-19 era, web counseling has been a decisive tool in keeping afloat the mental wellbeing of a world ravaged by a pandemic.

Online Counseling At A Glance

  1. Online counseling, also known as online therapy, involves providing counseling services and intervention over the Internet.
  2. Web counseling offers alternative cost-effective treatment opportunities and increases client-access to psychological services for their mental wellbeing.
  3. The modalities in online counseling are video-conferencing, email counseling, message services, Internet-operated therapeutic software, and personal publication and psycho-education websites.
  4. Online counseling, despite the associated ease, is plagued by issues of accessibility, cultural constraints, concerns around data collection and storage, privacy concerns, and ethical and legal issues.
  5. More exhaustible research, more awareness, and more sincere implementation should go into online counseling, so as to fully harness its benefits.
👇 References:
  1. Giotakos, O., & Papadomarkaki, E. (2016). Psychiatrike = Psychiatriki, 27(2), 127–135. https://doi.org/10.22365/jpsych.2016.272.127 []
  2. 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/ []
  3. Messina, I., & Loffler-Stastka, H. (2021). Psychotherapists’ perception of their clinical skills and in-session feelings in live therapy versus online therapy during the COVID-19 pandemic: a pilot study. Research in psychotherapy (Milano), 24(1), 514. https://doi.org/10.4081/ripppo.2021.514 []
  4. Dowling, Mitchell & Rickwood, Debra. (2013). Online Counseling and Therapy for Mental Health Problems: A Systematic Review of Individual Synchronous Interventions Using Chat. Journal of Technology in Human Services. 31. 1-21. 10.1080/15228835.2012.728508. []
  5. Situmorang D. (2020). Online/Cyber Counseling Services in the COVID-19 Outbreak: Are They Really New?. The journal of pastoral care & counseling : JPCC, 74(3), 166–174. https://doi.org/10.1177/1542305020948170 []
  6. 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 []
  7. Hilty, D. M., Marks, S. L., Urness, D., Yellowlees, P. M., & Nesbitt, T. S. (2004). Clinical and educational telepsychiatry applications: a review. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 49(1), 12–23. https://doi.org/10.1177/070674370404900103 []
  8. Woo, H., Dondanville, A., Jang, H., Na, G., & Jang, Y. (2020). A Content Analysis of the Counseling Literature on Technology Integration: American Counseling Association (ACA) Counseling Journals between 2000 and 2018. International journal for the advancement of counseling, 1–15. Advance online publication. https://doi.org/10.1007/s10447-020-09406-w []
  9. 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 []
  10. 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 []
  11. Myers, K. M., Valentine, J. M., & Melzer, S. M. (2007). Feasibility, acceptability, and sustainability of telepsychiatry for children and adolescents. Psychiatric services (Washington, D.C.), 58(11), 1493–1496. https://doi.org/10.1176/ps.2007.58.11.1493 []
  12. https://pubmed.ncbi.nlm.nih.gov/25645168/ []
  13. 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 []
  14. Situmorang D. (2020). Online/Cyber Counseling Services in the COVID-19 Outbreak: Are They Really New?. The journal of pastoral care & counseling : JPCC, 74(3), 166–174. https://doi.org/10.1177/1542305020948170 []
  15. 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 []
  16. 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 []
  17. 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 []
  18. Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: a 2013 review. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 19(6), 444–454. https://doi.org/10.1089/tmj.2013.0075 []
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