Why Online Psychotherapy? Because There is a Need
Online professional discussions about psychotherapy often come around to the same topic — online therapy (or “e-therapy”). Is it good? Can you really do psychotherapy online?? If so, what are the disadvantages to such a modality? Are there any advantages?
Something like therapy or counseling is already being conducted online. (What you call these online services is really a minor matter of semantics to me, so I’ll use online therapy, e-therapy, online psychotherapy, online services, online counseling interchangeably throughout this article.) See Metanoia’s list of Internet Mental Health Services for over 50 such providers. And this index is by no means exhaustive; there may be as many as 100 or more providers of online mental health services today. Some of these providers have been doing this type of counseling for over a year. Where did all of these providers come from? Why are they offering services online?
I would argue these providers are online because there is a demand for their services. After all, setting up a Web site and setting aside the time to administer this type of service is not something most people can do in a few minutes. This kind of effort takes a fair amount of commitment and understanding of the online world. So most of these providers are not “fly-by-night” operations. On the contrary, most providers are simply therapists who already practice in the real world. They saw the need to offer similar services online and being somewhat familiar with the online world, developed an online service.
Most professionals I know argue against these types of services for basically one reason — the idea that psychotherapy and everything it encompasses simply cannot be done in the same manner as it is done in the real world. Let’s examine some of the advantages and disadvantages to e-therapy:
Advantages of Online Therapy
Increased Perception of Anonymity
This is one of the strongest and most influential factors contributing to the popularity of online counseling services. Whether people really are more anonymous online or not is really a moot point.
What is important is that people believe they are more anonymous and therefore respond and behave differently online. One of these differences is the ability to discuss more important, personal issues in a therapeutic relationship online much more quickly than they could in real life. For instance, in my thrice-weekly mental health chats online, I get quite a few private messages throughout each chat. I have seen a fair amount of these discuss issues of extreme importance to the individual (childhood abuse, feelings of guilt about a loved one’s death, sexual abuse, chronic pain and ways of dealing with it, suicidal ideation, suicidal behaviors, self-mutilating behaviors, etc.) with me in these chats, having never had any previous interaction with the individual. In addition, some of these individuals go on to tell me that they felt more comfortable talking in an online chat room or environment, and hadn’t even told their current therapist or clinician about this issue of importance to them!
This is a very powerful effect in my opinion, and one which is often not given enough weight. After all, what good is three years of psychotherapy if the client never felt like they could discuss their childhood sexual abuse? (This is a true example.) Because of this factor, it is my supposition that the therapeutic relationship is equally as strong and effective in online therapy as it is in real-life therapy. This presupposes that both the client and the therapist have certain basic online skills and meet the other usual qualifications for best-outcome psychotherapy (e.g., highly verbal, motivated for change, etc.).
Ease of Contact
It is easier, in some cases much more easily, to contact your online mental health provider through e-mail and get a quick response than if you call a therapist or psychiatrist in real-life to ask a general question. This varies, but ideally, an online therapist could respond to an e-mail or chat request immediately if he or she did that full-time. While I don’t know of anyone who does online therapy full-time, the potential is there.