Online therapy techniques have a short history, but they build upon the learning developed by computerized interventions and other self help programs, including bibliotherapy.
In “Hands-on help” Marks, Cavanagh and Gega argue that computer-delivered Cognitive Behavioral Therapy (CBT) may be a viable alternative in treating anxiety and depression.
Also, in “Handbook of self-help therapies”, Watkins and Clum collect evidence about the benefits of bibliotherapy, including enhanced consumer’s self-efficacy (an individual’s belief in his or her capacity to obtain beneficial behavioral changes), cost-effectiveness and reduced stigma.
For the purpose of this article, we define “online therapy” as any form of psychotherapy that uses the power and convenience of a digital medium to facilitate simultaneous or asynchronous communication between an individual and a licensed psychologist or mental health counselor, including self help computerized programs with frequent check ins with a counselor. Examples of services offering this time of care include eTherapi.com, 7cupsoftea and Moodgym.
Advantages of Internet-Based Therapy
Several academic studies have discussed the growing advantages of internet-based therapy, including:
1. Improved access to evidence-based treatments for patients
2. Cost-effectiveness, compared to face-to-face treatment
3. Improved learning and retention, since patients can return to the program at their convenience to access treatment information
4. Easier access to care – With the assistance of software features, therapists can monitor patient progress and outcomes and proactively support patients. This means that patients in an Internet intervention may receive support from a therapist faster than would have been the case if they were only attending weekly visits.
5. Better fit with cases of low treatment readiness – There have been several cases of patients failing in person treatments and subsequently improving following computerized CBT interventions, which may reflect issues around treatment readiness.
Role of a Therapist in Internet-based Therapy
Available evidence suggests that treatments guided by a therapist have better outcomes, whether in person or online, face to face or via messages.
Advantages of treatments guided by a therapist are
1. A therapist can make a diagnosis, to help determine the suitability of a treatment for a patient
2. The intervention can be tailored and advice individualized following consultation with experienced clinicians
3. There are clear indications that support increases adherence and prevents dropout
4. Therapists can actively assist patients to access other services that may be required, including social, health and crisis services
Further, studies have shown that the particular approach used in psychotherapy is not as big a factor in our healing as the therapeutic alliance we form with our therapist. In other words, it is the relationship that heals.
At the same time, there is no clear relationship between the amount of support offered by the therapist and outcome, and treatments in which substantial support is given do not appear to differ from treatments with minimal support.
These considerations lead to argue that it seems possible to form deep and meaningful relationships even with low frequency interactions over a teletherapy tool like eTherapi; and that these relationships can be healing.
With the number of studies on online interventions rapidly increasing, there is now considerable support for the use of the Internet for delivering evidence-based psychotherapy for common mental disorders.
When to choose online therapy?
• A person may be too embarrassed, or too uncomfortable to make an appointment with a therapist.
• A person may live in a remote area, far from any therapists office.
• Scheduling, money, physical challenge, conflicting relationships, or misconceptions keep people from seeking help.
• When the client displays low readiness to treatment
• When higher frequency of meetings is recommended
• For clients who may have difficulty reaching appointments during normal business hours.
• When the client is located in areas traditionally under-served by traditional counselors. Rural residents and expats along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities.
• When the client prefers having some time to compose their thoughts before communicating them. This is particularly true with messaging based therapy: some people achieve higher level of insight when on their own, but in general evidence shows that writing about traumatic events contributes to improved mental health, as it gives people time to pause and reflect.
• Initial finding show that online counseling would benefit people functioning at a moderately high level. People in severe situations might benefit more from in person counseling.