Advantages and Disadvantages of Online Therapy
Online therapy encourages clients to communicate openly and freely with a therapist from their own private space or virtually anywhere there is access to a computer and the internet. Online counseling utilizes modern technology allowing the client to receive counseling via video, email or chat.
Online Therapy Treatments
Online therapy is simply defined as therapy over the computer. The client accesses the therapist through video conferencing with programs like:
- Google Video
Additionally, the therapist and client may interact through written correspondence such as:
- Text Messaging
- Instant Messaging
Often there is a combination of the services stated above.
How Does Online Counseling Work?
Online professional counseling can take on many forms. Online counseling allows you to receive counseling via video, Skype, phone, email or instant messaging. The online clinician should outline the services offered and the fees.
Therapeutic ethics and standards are practiced with online therapy just as it would be with traditional face to face therapy. Prospective clients are encouraged to make sure the online therapist they are inquiring for support has the correct education and credentials.
An email correspondence therapy session is a convenient and helpful way for the clients to feel supported with issues that need a quick response and issues that are not multifaceted. The client sends an email whenever they feel like it and read the reply from their therapist whenever they need to. Clients will always have the therapist's reply and can read it over and over again if they are needing reassurance or hope.
Most often email therapy looks like the following:
- The client pays the fee established by the therapist.
- The client sends an email detailing their issues, problems or questions.
- The therapist will spend time reading and contemplating a helpful response.
- The therapist usually responds within 24 hours.
- The email correspondence could be a one time exchange or continue depending on how the therapist outlines email treatment.
The cons to email counseling is the written word can be misunderstood, the email could be read by someone else who has access to the client's computer, and the turn around time for the email response is not immediate.
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Online Instant Messaging or Chat Therapy
Real time instant messaging happens on your computer in a chat window with your online therapist. The client and therapist utilize an instant chat program like; MS Messenger, Skype, Facebook, AIM, Yahoo Messenger or other online chat programs and engage in a therapeutic dialogue using text or typing.
Most often online instant messaging or chat therapy looks like the following:
- The client pays the fee established by the therapist.
- The client and therapist set a time and day for the instant messaging session.
- The client begins with telling their story, a question, or the reason why they are seeking counseling support.
- The therapist immediately response.
- The correspondence continues for a set period of time such as one hour of instant messaging time.
The cons with instant messaging include, the written word can sometimes be misunderstood, and the client and therapist could be typing at the same time without each other knowing.
Online Therapy is Convenient
Video counseling is similar to face to face counseling. The client and therapist utilize a video program like; Google Video, Skype, FaceTime or other online video programs and engage in a therapeutic dialogue using the computer's camera, microphone and speakers.
Most often video therapy looks like the following:
- The client pays the fee established by the therapist.
- The client and therapist set a day and time for the session.
- The client and therapist agree on the video conferencing program, i.e. Skype, Google Video or FaceTime.
- The client and therapist will give contact information on how to be reached through the video conference program chosen.
- The therapist will reach the client at the appointed time through the agreed program.
- The session will begin and usually last an hour.
Cons of video counseling include the therapists is limited in seeing facial expressions, vocal signals or body language. Technical problems such as internet connection can disrupt sessions.
The Actual Office Space is Therapeutic
The actual office space is an important part of the therapeutic process that online therapy cannot offer.
- It offers a "holding environment"
- It creates a neutral space
- It keeps the client from being interrupted from visitors, emails, phone calls, etc.
- It allows the client to psychologically and metaphorically allow their emotional angst and stress to be held in a room away from their home and work
- It is a predictable space
The Therapeutic Space is Important
The Therapists Office
One of the disadvantages of online therapy is not going to a traditional therapist's office. Although, this can be an advantage because it allows for convenience and those who are homebound access to therapy it also can impede the therapeutic process.
The therapeutic process is affected by many dynamics including:
- Frequency of sessions
- Length of session
- Therapeutic ethics and boundaries
- Honesty and transparency from the client
- Empathy and unconditional positive regardfrom the therapist
- Setting the therapy takes place
All of the above dynamics remain intact with online therapy except for the therapeutic space of an office setting. The therapeutic space is the literal physical environment where the therapist and client meet. The environment they meet inevitably influences the relationship between the client and therapist. Donald Winnicott, a psychoanalyst and pediatrician developed the concept of a therapeutic “holding environment.” The therapist recreates a “holding environment,” similar to a mother holding an infant. The “holding environment” concept is abstract as well as concrete. The therapists “holds,” the client's stories, growth and encourages the client’s positive changes. A good online therapist can offer an abstract “holding environment,” where the therapist conveys to the client he/she is safe to explore areas within him/herself that are threatening or causing distress.
The concrete therapeutic environment has valuable components that cannot be easily replicated with online therapy. The room itself plays an important role, as it becomes the physical “holding environment.” The room is predictable; it is a neutral space for the client away from home, friends, and work. This neutral space not attached to the client’s everyday life becomes a valuable holding space.
At the end of the therapeutic session, the client can then leave the office room, metaphorically and psychologically leaving behind the distress and angst in the room. Online therapy does not enable the client to go to a neutral space away from home, work and environments that may induce the stress for seeking therapy.
The office space also allows the client and therapist to be uninterrupted. The space is bounded away from visitors, emails, and most often phone calls because the phone is usually turned off during sessions.
Pros and Cons of Online Therapy
Accessible for people in remote areas.
Not advisable for people with serious psychiatric illnesses.
Accessible for people who are disabled or housebound.
Most insurance policies do not cover online therapy.
Therapist is limited in referring client to additional local support because they are not from the same geographical region.
Therapists can treat clients from anywhere in the world.
Therapists is limited in seeing facial expressions, vocal signals or body language.
Clients can see a therapist who specializes in rare disorders or issues that is not available locally.
Ensuring confidentiality is more problematic on the Internet than traditional therapy.
Time friendly. If a client has a non-traditionial schedule, the times of seeing an online therapist is often a broader range than seeing a traditional face to face therapist.
There is no mutual room, or therapeutic office away from the client's home, work, or car.
The Internet can facilitate peer support groups to rare populations.
Technical problems such as internet connection can disrupt sessions.
It is handicap accessible. Clients who have visual or auditory problems that make seeing a traditional therapist difficult can access video chat or instant messaging.
Clients can access people who protray themselves as counselors but are unlicensed, unregulated, and who may not have the training and education that is essential to ethical practice.
No long commute, waiting in traffic or a waiting room.
Lacking a physical presence some clients may experience a reduction of intimacy, trust and commitment as they would in an office setting.
Clients who might not otherwise visit a therapist, may take comfort in the anonymity that online and telephone therapy provides.
Unlike traditional psychotherapy, online counseling cannot provide formal diagnosis and treatment.
Less expensive than office counseling.
Clients with poor typing skills may find online counseling frustrating.
When Is Online Therapy not Recommended?
- If the client is considering suicide or has suicidal thoughts.
- If the client is in physical danger or in danger of being physically or sexually assaulted.
- If the client has a serisous substance abuse addiction.
- If the client is in immediate or urgent crisis.
- If the client is having thoughts of hurting someone else.
- If the client is experiencing serve psychosis.
- If the client is unwilling, uncomfortable or unable to express feelings in written form or on video.
- If the client has no access to a computer or internet connection.
- If the client is under 18 years of age.
Tips to Begin Online Therapy
Here are some ideas and suggestions before you begin online therapy.
- Research the therapist make sure they are a legitimate therapist. Most therapists need a master's degree and a license to practice.
- Know how much are the fees and what exactly you are getting when you pay.
- Know how your online therapist accepts payment such as credit card, PayPal, check etc.
- Make sure you have the correct equipment needed to interface with the online therapist of your choice such as a computer, telephone, iPhone, Skype, etc.
- Make sure when you have your online session you are not easily interrupted.
- Make sure you have a place where you will not be overheard and what you say can remain confidential between you and the online therapist.
The Benefits and Limitations of Online Therapy
The online counseling field is quickly growing. The benefits of online counseling are many. The most obvious advantages relate to convenience and accessibility. Online counseling offers opportuneness to remote users, serving clients with limited mobility, time restrictions, or anyone seeking help who is reluctant to see a counselor in person. Contact with an online therapist can transcend geographical boundaries and time zones.
Online counseling also has numerous limitations. Not all clients are ideal for therapeutic services that take place entirely online. Ease of access may be inconsequential if a client’s needs are compromised misunderstandings due to technical limitations.
When online counseling is at its best, and the positive conditions are in place and adhered too, clients can experience the many benefits of therapy.
Carly Sullens 2013. All Rights Reserved.
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