When I discuss the idea of providing online counseling, I usually get different responses depending on my audience.
Psychotherapists are often skeptical about the idea and whether it will stay true to the nature of what we do. I have found potential clients to be much more receptive to it, depending on their location, availability, and the nature of their problem. In this post, I focus more on the client’s perception and how it may benefit them.
Telepsychology, telemental health, online therapy, and virtual therapy are all different names for what is essentially the same practice: seeing a therapist who is not physically present in the room with you. Telepsychology, as I refer to it, can be done synchronously—at the same time—using a video platform or a phone call, or asynchronously, via email and text message. In my home state, licensed psychologists are only allowed to provide synchronous therapy and video therapy is usually encouraged.
There are definitely benefits to receiving therapy through media. It is extremely helpful for those in rural communities, for starters, who have no access to providers or extremely long waits, or those with transportation issues. It can also significantly cut back on any stigma individuals feel by being seen in a therapy office or community counseling service and can be wonderful to those short on time. These things make telepsychology ideal in many ways, but it is not for everyone.
When I give presentations about psychotherapy I often mention that the client must have a good fit with the therapist and the therapy approach; this is also true with telepsychology. If you do not feel comfortable with the therapist or doing therapy online, it is probably not for you. In fact, recent research discovered that client comfort level was the best predictor of developing a positive relationship with a therapist in online therapy (Reese, et. al., 2016). However, anyone who has used video conferencing or FaceTime in the past may want to consider this method of engaging in therapy.
Telepsychology is not appropriate for every concern. Many guidelines caution against using it if the client is seriously mentally ill—for example, if they are at risk of hurting themselves or someone else (APA, 2014). In my personal experience, telepsychology works best for individuals over the age of 16 and those not using substances or experiencing eating disorders. These individuals often need a more intensive approach to therapy and someone to look out for their safety and well-being, which can be challenging to do while using telepsychology. Those caveats aside, I have had a range of clients in my virtual practice, from individuals in their late teens to those in their late 70s, and most appear very comfortable with the process. They must be prepared for occasional glitches, but overall it has been met with success.
In addition to some of the practical issues, there has been much concern about whether this type of therapy can be effective. This question has been addressed for more than 10 years, since the advent of this type of therapy. A review of recent research with a variety of populations contends that telepsychology is usually effective (Hynes et al., 2009; Reese, Slone, Soares, & Sprang, 2015; Tuerk, Yoder, Ruggiero, Gros, & Acierno, 2010). This appears to be particularly true when the practitioners use a CBT approach and the presenting problem is depression or anxiety (Glynn, Randolph, Garrick, & Lui, 2010; Hailey, Roine, & Ohinmaa, 2008).
More recent research has even compared the quality of the therapeutic alliance and empathy across platforms (video conferencing, phone, and face-to-face) and found that there was no significant difference (Reese, 2016). Clients continue to feel connected with their therapist even when in online settings—but this appears to be particularly true if their therapist is comfortable working online (Frueh et al. 2007).
In conclusion, online therapy or telepsychology seems to be appropriate and beneficial for many individuals. Many insurers will also cover synchronous services just as they do face-to-face visits. If you find a licensed counselor willing to provide telepsychology or online therapy and it meets your needs, it may be worth a try.
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Frueh, C., Monnier, J., Grubaugh, A. L., Elhai, J. D., Yim, E., & Knapp, R. (2007). Counselor adherence and competence with manualized cognitive-behavioral therapy for PTSD delivered via videoconferencing technology. Behavior Modification, 31, 856866.
Glynn, S. M., Randolph, E. T., Garrick, T., & Lui, A. (2010). A proof of concept trial of an online psychoeducational program for relatives of both veterans and civilians living with schizophrenia. Psychiatric Rehabilitation Journal, 33, 278-287.
Hailey, D., Roine, R., & Ohinmaa, A. (2008). The effectiveness of telemental health applications: A review. Canadian Journal of Psychiatry, 53(11), 769-778.
Hynes, D. M., Weddle, T., Smith, N., Whittier, E., Atkins, D., & Francis, J. (2009). Use of health information technology to advance evidence-based care: Lessons from the VAQUERI program. Journal of General Internal Medicine, 25, 544-549.
Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. (2013). Guidelines for the practice of telepsychology. The American Psychologist, 68(9), 791-800. doi:10.1037/a0035001
Reese, R. J., Mecham, M. R., Vasilj, I., Lengerich, A. J., Brown, H. M., Simpson, N. B., & Newsome, B. D. (2016). The effects of telepsychology format on empathic accuracy and the therapeutic alliance: An analogue counselling session. Counselling and Psychotherapy Research, 16(4), 256-265. doi:10.1002/capr.12092
Reese, R. J., Slone, N. C., Soares, N., & Sprang, R. (2015). Using telepsychology to provide a group parenting program: A preliminary evaluation of effectiveness. Psychological Services, 12(3), 274282.
Regueiro, V., McMartin, J., Schaefer, C., & Woody, J. M. (2016). Efficacy, efficiency, and ethics in the provision of telepsychology services: Emerging applications for international workers. Journal of Psychology and Theology, 44(4), 290-302. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2085011059%3Faccountid%3D27965
Tuerk, P. W., Yoder, M., Ruggiero, K. J., Gros, D. F., & Acierno, R. (2010). A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology. Journal of Traumatic Stress, 23, 116-123.