We do everything online. Shop, pay bills, talk to our medical doctors, and talk to mental health professionals. Online therapy has had a lot of tomatoes flung its way, but the research speaks to its effectiveness in multiple situations.
Regardless of therapeutic platform, the relationship that therapist and client build together is the most important factor in successful therapeutic outcomes. Other factors that contribute are the client’s belief that therapy will help, the clinician’s ability to build rapport, and finally, presenting problem, and method of approach.
As early as 2012 research had indicated that online therapeutic relationships aren’t any less deep or rewarding as those formed in the in-person setting (Sucala et. al., 2012). This particular concern about online therapy isn’t something I’ve had an issue with. Not every counselor is right for every client; it is essential to get that “click” between counselor and client. Sometimes I’m not the right person for the work ahead. This happens in my online practice just as rarely as it happens in person.
The research questions we need to ask are, “What are effective online therapists doing? What skills do they have?”
Not every mental health counselor belongs in the online environment. It requires a bit of tech savvy, the ability to communicate well in text and email, and to troubleshoot on the fly. That isn’t a set of skills that some therapists have or even want. Not all modalities translate well into the online environment either. Some have specific research support in the online environment like cognitive behavior therapy, and some just translate the mediums better.
Clinician flexibility is a must! Our ability to adapt is important in the in-person setting as well. Far too many times I encounter tales from clients and other clinicians alike that reveal the hazards of ill-equipped therapists in the online environment.
Thankfully, I grew up a product of the email and chat room generation. I mastered text as that technology became more common. Some of these skills have come in very handy in communicating across different tech platforms with my clients. Its not that my old “yahoo chat” skills made my clinician game strong – its that my ability to read between the lines of text on a screen, and to deliver text on a screen is a bit finer tuned than someone else’s who didn’t have that experience.
You know that person who always thinks you’re angry in text? I’m not usually that guy. I’m also not the guy who sends texts that come off as forceful. A therapist’s ability to be genuine, admit mistakes, seek feedback, and monitor therapy progress help determine outcomes too. Any ethical therapist is going to do these things in order to work with the client, regardless of medium.
Not all clients are suitable for online therapy. Crisis situations, recent suicide attempts or plans, and other considerations may mean that in-person help is the place to address particular issues. An ethical therapist will refer someone not suitable for online therapy to local resources.
Any ethically practicing therapist will utilize research proven means of intervention regardless of the platform through which they’re delivered. Research about what interventions are most helpful in the online environment are developing and its important for clinicians to stay up to date on this information.
“E-therapy” has been shown to be effective for a variety of issues (Barak et. al, 2008). Anxiety, depression, and the variations thereof have research support. In my practice I have case study support for a variety of more detailed issues. As an ethical and licensed therapist, I’m not willing or able to practice outside the realm of my expertise. If a problem doesn’t fit well in the online environment, I refer it out. Most counseling interventions used during counseling can be successfully transferred to online chat according to Barak et. al, (2008).
There are some clear benefits to online therapy:
- Access in rural areas is increased
- Access to qualified clinicians at a broader range of hours
- Enhanced privacy for clients (no car to park in a therapist’s lot)
- Fees for online services may be lower than for in-person sessions as overhead costs are reduced
- Lower fees increase accessibility to services
- No travel of any distance to a counselor’s office
- Appointments can occur outside normal business hours which enhances convenience and accessibility
The factor that rates highest in the research as the most important factor in successful therapy outcomes is that of the therapeutic relationship or alliance. This alliance occurs and is part of the healing process and work that takes place in therapy. The ability to get online and fish from a much larger pond of professionals increases the likelihood that someone will find their ideal match. That match may just make the difference.
Finding a good online therapist is the same as finding a good one in person:
Examine credentials and education
Research the clinician through their state licensing board
Find out what professional organizations the therapist belongs to and review their ethics code (For example, I’m a member of the American Counseling Association and the National Board for Certified Counselors – both have ethics codes and so does my state. I adhere to all three.)
Ask questions about expertise and experience
Speak up and change counselors when in doubt
Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., & Montgomery, G. H. (2012). The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review. Journal of Medical Internet Research, 14(4), e110. http://doi.org/10.2196/jmir.2084
Azy Barak, Liat Hen, Meyran Boniel-Nissim & Na’ama Shapira (2008) A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions, Journal of Technology in Human Services, 26:2-4, 109-160, DOI: 10.1080/15228830802094429