Online therapy is a growing area of the mental health field and early research shows that it can be just as effective as therapy for many populations. Online therapy, also known as e-therapy, e-counseling, tele-therapy or cyber-counseling, can occur through e-mail, video conferencing, online chat, or Internet phone.
Skype, and encrypted digital software through third-party sites, have made online private practice accessible for a broader swath of patients, including those who have difficulty with office treatment. Some examples of these types of clients are parents with kids with disabilities, those with physical or psychological limitations (e.g., agoraphobia, nerve pain, etc.), people who work more than 40 hours a week, and the list goes on. Convenience also is a factor; remote capability addresses some pragmatic barriers, such as transportation difficulties, lower overhead and fees for services, and one may no longer need to cancel appointments due to minor or even some major inconveniences, like broken legs, being out of town, etc.
There are some issues with online treatment; eye contact, erratic Internet connections, exploitation, privacy, and reimbursement are all issues that must be addressed by the therapist and client prior to beginning online treatment.
Therapists should have an informed consent for online treatment that address confidentiality, privacy, and Internet policy related to technology use. Since the client and therapist typically look at each other’s faces on a computer screen, gazes can be off-kilter. “So patients can think you’re not looking them in the eye,” said Lynn Bufka, a staff psychologist with the American Psychological Association. “You need to acknowledge that upfront to the patient…” In addition, “You have to prepare vulnerable people for the possibility that just when they are saying something that’s difficult, the screen can go blank,” said DeeAnna Merz Nagel, a psychotherapist licensed in New Jersey and New York. “So I always say, ‘I will never disconnect from you online on purpose.’ You make arrangements ahead of time to call each other if that happens.” For a copy of my consent form, click here: LJN_phone:online consent
Clients should verify therapist credentials in the first session by asking to see the license or have a facsimile emailed. Clients may also want to inquire as to the privacy precautions they can take on their end that might further protect information being shared across the web during session. Some examples are always making sure to fully exit all other programs, carefully ending session by signing out and closing whatever application was used for treatment, and using a private location for the session.
In spite of these obstacles, online therapy is proving to be efficacious. A study published by the journal Psychiatric Services, patients receiving mental health treatment through video conferencing reported “high levels of satisfaction” (Frueh, C., et. al., 2000.) One article in Newsweek (2006) reported that recovering addicts might benefit from online therapy, especially for those who feel uncomfortable attending traditional face-to-face support groups. Researchers from the University of Bristol compared the effectiveness of 10 online sessions with a therapist to treatment by a general practitioner. 42% of the participants treated through online therapy recovered from depression versus 26% with in-person care. What seems to matter most is the match between the client and the modality “The success of therapy depends a lot upon how willing and engaged the client is,” said Tina Tessina, who has a doctorate in psychology and has been practicing in southern California for 25 years. “So if that person responds better to online than to in-person, or is more willing to disclose in the online therapy, because if feels more anonymous, it can definitely be beneficial.”
I currently offer online therapy services in the form of Skype videotherapy and teletherapy over the phone. If you are interested in my services, please contact me! Note: In keeping with my licensing requirements, I only work with clients currently within the Texas borders.
Lavelda Naylor, MA, LMFTA
San Antonio, TX 78229
References for Post
Frueh BC, Deitsch SE, Santos AB, et al. (2000) Procedural and methodological issues in telepsychiatry research and program development. Psychiatric Services, 51:1522-1527.
Ehrenfeld, Temma. (2006) Virtual Therapy. Newsweek