Online Therapy

Online therapy allows the client and therapist to work together without meeting. This may be via instant chat, email or Skype. It has been seen as especially suitable for clients who cannot easily access face-to-face services, perhaps because they are home-bound, work unusual hours, or live in a remote area.

One of the arguments against online therapy has been that much of the richness and depth of face-to-face therapy is stripped away in online, text-based communication. There is no body language or tone of voice, no eye contact or indeed, any other direct non-verbal communication (the exception being video conferencing). Since studies have suggested that over 90% of our everyday communication is non-verbal, which means that online therapy offers a very different experience from that of face-to-face work, both for counsellor and client.

However, online therapists argue that while working with clients online may be very different from working face-to-face, this does not make it any less effective. They also argue that online therapy can reach many clients who would never seek help in a face-to-face setting, especially those concerned about issues of confidentiality and privacy, or who feel threatened by being in such close proximity with just one other person.

Online therapy is potentially far more secure, confidential, and private than traditional face-to-face therapy. Because of the unique qualities of the online relationship, therapeutic change can take place in a relatively anonymous context. This provides a level of security and confidentiality that cannot be matched in the real world.

There is also some evidence that clients participating in online therapy feel able to get to the point more quickly and do not spend early sessions talking about issues of little relevance to the reasons that brought them into therapy. The fact that they are at a distance from the therapist and cannot be seen seems to help them focus on core issues almost immediately. Therapists have reported that while in their face-to-face work a great deal of time may be spent on non-therapy issues, such as payment, rescheduling appointments, and record-keeping on paper forms, this happens to a much lesser extent in online therapy.

Online therapy may also be particularly important for clients who are socially shy, isolated or physically challenged. The Internet allows them to reach out for connectedness or support. People who find it difficult to form interpersonal relationships in the offline world may find it much easier in the online world, allowing them to access social support that has previously been unavailable to them, whether this is through therapy or less formal online relationships. At the same time, people who are comfortable with interpersonal relationships both online and offline can integrate both types of experience into a strong web of online and offline support. This is not only in the form of therapy, of course, people can also use the Internet to seek out support from other individuals or groups, to find information, to seek companionship, and to explore both positive and negative ways of acting out in relative safety.

Several unique advantages exist in online work. Many have been described in the literature already, such as access for the homebound, geographically isolated, or stigmatised client who will not or cannot access treatment locally. One of our case presentations illustrated vividly not only the possibility but also the advantage of Internet-based therapeutic support. A pilot in the military, exploring sexual orientation and afraid of the potential impact of “coming out” and jeopardising a military career, demonstrated how seeking help online was reassuring to the client in terms of confidentiality. The absence of geographic boundaries allowed the client to select a therapist who appeared to have the expertise and understanding needed in the client’s particular situation.

There are numerous examples of other particular types of clients who benefit from having access to mental health services via the Internet. Hearing disabled people, celebrities, business travellers, people who are shy and introverted, concerned about stigma, or socially phobic, also might find unique advantages to seeking therapeutic activities, self-help materials, and a diversity of mental health professionals, all easily accessible online.

Online clinical work is not only possible, but offers a unique “elasticity of communication” that includes several factors, such as flexibility of location and of time, varying levels of synchronicity, and flexibility to employ various online channels of contact. Online therapy has shattered three of the basic premises of therapeutic interaction, which is that it must always, by definition, be based on

CSG3, International Society for Mental Health Online.

Online Therapy Providers

UK – Borders Counselling

US & International – Counselors Online

Couple Therapy – Couple Therapy Online