Resolution, Not Conflict

The guide to problem-solving.

What's Up With Online Therapy and Marriage Counseling?

If there is online dating, how about online help for unhappiness as well?

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The internet is here to stay, and mostly that seems to be a very good thing. 

This past weekend, for instance, I realized that our home would need serious refreshing before our kids and grandkids arrive next month for their annual whole-family visit. How could I shop most efficiently for new wastebaskets, duvet covers, floor and table lamps, pillows to match our sofa, and sports equipment? On the web, of course. The internet enabled me within minutes to view a full range of options for each item. I even was able to carry my portable computer to each room to check that its current decor and the colors and patterns of my purchases.

So if furnishings can be found online, how about love? Does online dating work?

Yes again. Online match-making has its hazards, not the least of which is dangerous folks who lie about who they are and even worse could prove threatening if you meet in person. 

At the same time, there's no disputing that many now-happy folks have found the love of their life via web-based matchmaking services.

If furniture and love now can be found online, what about psychotherapy?  

Apparently so. 

Each year an ever-higher percentage of the clients who choose my clinical practice find my colleagues and me from my website. Whereas most people used to get the name of a therapist from their physician, now they turn to Dr. Google.

If finding a therapist works online, what about online therapy?

For a number of years now I have received requests for treatment from readers who live outside of the state of Colorado where I abide. When they ask if I would be able to work with them as a therapist via Skype however, my answer has had to be "No." It's illegal.

The issue is not whether therapy over the phone would be effective. Most therapy techniques produce essentially the same strong impacts over the internet as they do in person. Rather, the issue is laws that prohibit treatment across state lines.  

My psychology license enables me to practice within the state of Colorado. Other states have similar laws, the impact of which is to bar therapists from working in any state other than the one in which they live and have obtained a professional license.

On the one hand, I sustain a full schedule of clients with local residents only. At the same time, I feel terrible about saying No when people who requesting treatment they is not available in their locale. Lack of insurance is just one factor that blocks people from getting the mental health treatment that they need. Legal consequences for any therapist who violates the no-practice-outside-of-state-lines rulings also play a significant role.  

Even within Colorado, individuals cannot obtain legally obtain treatment over Skype or even by telephone unless they have had a prior in-person treatment relationship with the therapist. For individuals and couples who live in rural areas with few if any therapists, these rules can seriously crimp ability to get help.

Enter the recent upsurge in interest in revising laws that block online therapy.

As Bob Dylan once so aptly put it, "The times, they are a-changin." The evidence that most encourages me is a change proposed in New York that would enable physicians to use telehealth options more broadly.

 The new rules that the Federation of State Medical Boards is proposing would make medical treatment via telephone and skype more feasible, and hopefully also eventually mental health treatment. That is, the proposal would be a model act that encourages licensure portability.

Are therapies via Skype and telephone happening now even with the current restrictions in online therapy help?

Delightfully, one of the leaders in offering online and telephone therapy services has been the VA. Many veterans live in rural areas where mental health services are scarce, yet, alas, many vets return from war zones with serious psychological impairments. To their credit, the Veterans Administration has launched forth to become a leader in telemental Health. 

According to testimony given by Robert Petzel, MD, the former undersecretary of health for the US Department of Veterans Affairs, the VA has provided telehealth mental health services to nearly  half-million veterans via 150 medical centers and 750 community-based outpatient clinics. Hooray for the VA!

Are online therapy services a good idea?

Interestingly, NPR radio ran a story this week about the merits of therapy via telephone or the internet. Their report discusses the pros and cons of the spread of Skype therapy for folks who want counseling help without having to leave their home or office. Their overall assessment was definitely pro.

Still, consumers do need to beware. Online services often are offered by minimally trained and unlicensed therapists, as these counselors do not need to abide by the rules of licensed mental health professionals such as psychiatrists, psychologists, social workers and marriage and family therapists.

Still, online therapy of almost any sort can prove helpful to the many people who are reluctant to take time off from work to travel to a therapist's office. Therapy during an extended coffee break, a lunch hour, immediately after work or even in the evenings all become more possible when treatment occurs via the internet.

What about online help for couples? Is there online marriage counseling?

CBS TV in New York recently ran an enouraging news story about online help for couples who want a better marriage yet are reluctant to spend the time and money for in-person couples counseling.

This news report stressed that marriage therapy online may be unrealistic, but marriage education online works very well.

I especially liked the CBS TV report as it included the PowerOfTwoMarriage.com communication and conflict resolution skills program that's based on my Power of Two book and workbook as an example of a way couples can use the internet to gain help for couple stresses. 

Couples therapy poses challenges for telephone or skype treatment. It is difficult for a couple to talk with each other when they have to keep their eyes on the computer screen.  

At the same time, I have found when I've worked with couples in my case load who have moved from Denver but stay within Colorado that therapy over the phone, with each partner using a separate phone, can work surprisingly well.

Because online therapy is iffy however, the CBS TV program concluded that marriage education programs online so far appear to be the better option. 

What is the difference between marriage counseling and marriage education?

PowerOfTwoMarriage.com does not offer marriage counseling or therapy. That is, it does not help couples to explore deeper issues, discover the role of childhood experiences in current difficulties, or even guide them through to resolution of specific current issues that have been breeding tensions. 

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What Power of Two and other marriage education programs do offer is skill-training. When couples learn to talk collaboratively, they can cease having arguments and can resolve their differences cooperatively.

Unlike marriage therapy, marriage ed turns out to be relatively easy to package for online access.  The convenience consequently becomes unbeatable. It's available online 24/7, with zero travel time to get there or back. The price is right also. PowerOfTwo for instance offers a wide variety of fun learning activities, email access to a real-person coach, and a full span of topics: what to do with anger, how to make win-win decisions instead one person dominating, and how-to's for more harmonious living—all for $18 a month, which is probably less than the cost per month of one evening out.

So while marriage counseling over the internet still is not an option, marriage ed can enable motivated spouses to make the leap from a marriage that's an endurance test to a truly gratifying love relationship.

How effective is online marriage coaching?

Very. A research study of the outcomes of an early prototype of poweroftwomarriage.com yielded significant improvements in couples' abilities to enjoy their relationship with fewer fights and more satisfaction. 

Studies on the impacts of other marriage ed programs such as the ones described in the CBS TV report have obtained similarly impressive results.

The bottom line on online therapy.

For online therapy via skype and telephone to become more broadly available, laws limiting therapy practice over state lines need to be modified. 

In the meantime however, online individual therapy with less highly trained counselors already is proving helpful for many people. 

And for a couple, or even just one spouse, who is frustrated by marriage tensions and bumps, programs that offer coaching in the skills for marriage success can make an immediate difference.

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online therapy, marriage counseling
Denver clinical psychologist Susan Heitler, PhD is author of The Power of Two book, workbook and online program.  To check out the web-based program with a free trial plus a free marriage assessment, click here.

Susan Heitler, Ph.D., is the author of many books, including From Conflict to Resolution and The Power of Two. She is a graduate of Harvard University and New York University.

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