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A journey through online therapy – how do we respond to advances in technology?

We all know that a comfortable, welcoming and private room can make a big difference to a client’s experience of therapy. But what happens when a client is unable or unwilling to talk face to face?

Over the last 20 years or so we have seen therapists making use of emerging technologies to offer their services in different ways. Therapeutic services via telephone or letter have been around for much longer.

In 2004, an article published in the Journal of Clinical Psychology[1] explored the benefits and disadvantages of offering therapy by email. Advantages such as convenience, increased access and potential disinhibition were explored. But there were concerns around misreading, missing non-verbal cues, the time delay and difficulties around crisis intervention. For therapists and clients who were used to talking face-to-face or over the phone, email seemed to be much less effective.

Since then, advancing technology and increased access to faster Internet has allowed therapists to video chat with clients. This seems to be the preferred method of online therapy. Until virtual reality becomes accessible for all, video calls are the closest we can get to the face-to-face experience.

We spoke to three therapists about how they like to work.

Julia Bueno is a psychotherapist and counsellor who offers therapy through video chat. She takes a pragmatic view, telling me that for some people it can be the only way they are able to access support. Amy Hutson also offers video call services. She says that meeting online can sometimes be a first step towards face-to-face support. Samantha Marks will only offer occasional video calls if she has already built a relationship with the client face-to-face.

But we wonder if things are circling around again. Smartphones are used to access the Internet more than they are used to make phone calls[2]. Many people, particularly digital natives and millennials, communicate mainly via the written word. Long phone calls have been replaced with Whatsapp chats. When you use the phone so little, talking can cause more anxiety than sending or receiving a message or email. For some, a video therapy carries the risk of being overheard by family or friends.

As people become more used to written support accessed through forums and social media, they are asking for therapy through webchat too. Some youth services, for example The Mix, are responding. They are currently no longer taking additional referrals because of the volume of demand. We are also seeing an increase in apps such as Talkspace that allow people to combine writing at a time that suits them with video calls to provide more in-depth support.

Webchat does seem more effective than email as a way of offering therapy. It allows young people to speak in real time and build a relationship with a counsellor in a safe place. We can check misunderstandings and even provide crisis support. But, like email, it relies on participants’ writing skills. There is no body language to help. We need more research to help us understand if and how we can make a webchat genuinely therapeutic.

Where does this leave therapists? Video calls allow us to use the basic principles of our training, albeit in a slightly different way. Offering therapy through online chat or a text service seems to require different, or at least adjusted, skills. Is it possible to use the written word thoughtfully and precisely to create the online equivalent of that comfortable and welcoming space? We may have to learn.

Of course, we mustn’t forget where technology is taking us next. Research has already shown virtual reality therapy to be effective in treating phobias. It won’t be long before we can offer therapy to clients this way. But will sitting opposite a client in a virtual room be more like face-to-face therapy or will it be something different again? Will there come a time when actually sitting in a room together will feel as old fashioned as writing letters? The speed of change seems to bring more questions than answers – and perhaps all we can do is keep an open mind.

[1]Rochlen, A. B., Zack, J. S. and Speyer, C. (2004), Online therapy: Review of relevant definitions, debates, and current empirical support. J. Clin. Psychol., 60: 269-283. doi:10.1002/jclp.10263

[2]Offcom Communications Market Report – Aug 2018 https://www.ofcom.org.uk/research-and-data/multi-sector-research/cmr/cmr-2018/interactive

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