A Review of ‘Online Therapy’
Norton recently sent me a review copy of Online Therapy, yet another book about doing psychotherapy online. This one was written by Kathleene Derrig-Palumbo and Foojan Zeine. The book is a practical guide to the in’s and out’s of doing online therapy, plain and simple. The authors have access to “Dr. Phil” and Albert Ellis, so I suspect — given how truly tiny the online therapy market is, less than 1% of all therapists — this is a work of love… or something else.
I had only vaguely heard of these authors in my online travels, and when I began reading the Introduction, I remembered where. One of the authors is the owner of an online psychotherapy clinic. Once you learn that, you can find the entire book is tinged with hints and highlights that steer the reader, if they’re a therapist looking to enter into the online therapy world, toward an online clinic like hers.
The first five chapters are fairly useful, but they sometimes overreach. For instance, Chapter 1 is entitled, “The Most Effective Therapeutic Approaches for Online Therapy.” The fact is, there is only a trickle of research into online therapy and none of it has comprehensively addressed this question in any meaningful manner. So basically the authors go through every major therapeutic approach and show how it can be adapted to online use. Interesting, but not really helpful answering the question posed by the chapter’s title.
Chapter 2 is a giant Frequently Asked Questions chapter called simply “Common Questions about Online Therapy.” It seems out of place here in the middle of the book, breaking up whatever flow the authors had established in Chapter 1.
Chapter 3 is entitled “Clinical Guidelines and Approaches” and most of it won’t be new to anyone who’s ever done face-to-face therapy. Running through topics such as informed consent, the first session, transference, and the basics of a goal-oriented, brief psychotherapy model, you’ll see how to adopt current practices to the online world.
Chapter 4 delves into the “effectiveness” of different modes of therapy. Illustrated by and large by other professional’s opinion and single case studies, the reader isn’t really going to find much of use here (and some of it is already repetitive with previous chapters). Basically any modality can be effective online if wielded by an experienced therapist in that modality. And besides, individual therapists shouldn’t really be concerned about so-called effectiveness as long as they are seeing positive outcomes.
Chapter 5 is entitled, “Is it time to go online?” and gets at the heart of this book — trying to convince therapists who aren’t already doing online psychotherapy that they should. This and the following chapter begins to show the purpose of this book — as a marketing tool rather than as an educational tool. Remember, one of the authors owns and runs a large online clinic, so she wants more professional customers to sign up with her clinic. Even if an online clinic isn’t right for every professional. In Chapter 6, “Going Digital,” the only “primary” disadvantage the authors could come up with why a therapist wouldn’t choose a clinic like their own is that the therapist wouldn’t have control over the look and feel of the website. And they have to share the site with other therapists. Nothing about other legitimate concerns and reasons to do online therapy independently:
- Confidentiality and security concerns. For instance, is everyone in the online clinic’s organization beholden to a code of ethics, right down to the lowly Web developer, database or system administrator?
- Brand marketing. Your name is your brand. Going with an online clinic gives up one of your greatest marketing assets. You’re also beholden to whatever the clinic’s marketing strategy is, whether you like it or not.
- Data integrity and business practices. When you are responsible for your own online therapy business practice, you know everything that’s going on. What data is collected, where it’s stored and backed-up, and how you do business with other partners. With an online clinic, none of that is known outside of some general feel-good statements. You must trust and rely on others that your data will be there in the case of a disk failure, and that they’re doing business in a trustworthy manner. (I wouldn’t mention this, except that this field already has a history of businesses who’ve set up online clinics, and then went out of business without telling anyone!)
The rest of Chapter 6 does what any good marketer does when they’re trying to sell you something — go through all of the features and benefits of a random online clinic (oh, look, it’s actually the author’s own online clinic!), highlighting all of the “features” you will receive when you join. Of course, using their own site as a template for what is the “best” will always make others look deficient. That’s because what the authors believe is important or useful is a positive, and anything they lack or have deemed unimportant, they leave out or show as a negative.
The final quarter of the book is just a bunch of Appendicies. One is all about purchasing a computer and going online for the first time. That, to me anyway, seems like a very inappropriate thing to place in a book devoted to online psychotherapy. If a therapist has no experience or background in going online or using a computer, one shouldn’t be encourage their first foray into the online world should be trying to conduct a psychotherapeutic relationship online! That’s like a book about learning to drive a Formula 1 race car with a chapter about tips on buying your first car and getting a driver’s license! You have to learn to walk before you can run and you definitely shouldn’t be brand new to the Internet before you consider doing online therapy. That’s Appendix A.
Appendix B starts with one of those marketing charts based upon the author’s “research” into online therapy clinic sites. Not suprisingly, the author’s own site has a checkbox next to every feature, while no other site comes close! Such a table is constructed to show exactly what the authors want you to think is important to online therapy. But is every feature they listed really a part of doing online therapy? For instance, what does CEU training have to do with offering therapy online? Or an investment opportunity (and what does that even mean, the authors don’t say)?? Nobody is going to get rich offering online therapy, and it’s silly to suggest one might through an “investment opportunity.”
Appendix C is simply a reprinting of every semi-relevant ethical guidelines or code the authors could fine from the various professional associations.
Barring these glaring errors, the rest of the book offers some interesting commentary and descriptions of taking different theoretical approaches and applying them online.
If you can get past the obvious marketing purpose of this book — the authors’ desire to get more therapists doing online therapy and therefore increase the number of professionals who use their own site — it has some chapters that may be helpful to the beginning online therapist. I found it disappointing that Norton agreed to publish a book of this nature, and that Albert Ellis wrote the Foreward. A book that really helps a therapist to objectively decide important components of getting into this emerging field would’ve been far more useful.
Full disclosure: Some of you may find it odd I’m giving a negative review to a book that is trying to encourage online clinic use, since I help run one of the other large online clinics that does online therapy. The fact is, I don’t think our model is right for every therapist, and I believe an objective book would acknowledge it more plainly and objectively than this book did. It only made a cursory and shallow attempt to show that there may be reasons not to join an online clinic, and I find such subtle bias unfortunate. Yes, the author is up-front about their background in the Introduction. But that doesn’t mean the entire book has to be colored by their current position, does it?
Grohol, J. (2005). A Review of ‘Online Therapy’. Psych Central. Retrieved on May 6, 2015, from http://psychcentral.com/blog/archives/2005/10/01/a-review-of-online-therapy/