Online Therapy Blog

Hiccups in Online Therapy
Blog about Online Counselling and Therapy

Challenges in Online Therapy.

Even though Online Therapy may be a good solution, it has it’s own hiccups… it’s own challenges that it presents to both the Online Psychologist and the online client. And it will only be to the extent that these issues are resolved that the effectiveness of Online Therapy will be enhanced.

Some of these challenges are….

1. Online Therapy is part of a new world

The internet (and the whole cuber world it is part of) operates in the same way as any culture. You cannot just accept it and everything is fine. It is not like a switch you can turn on or off. It is, rather, like a culture you need to experience and grow into.

For younger people (who grew up in this) culture it is easy to operate in it. For older people it is not the same. Online Therapy (as one expression of the cuber culture) presupposes that both the client and the therapist have certain basic online skills and feel at ease in the culture. Which is not true of older people. One of the challenges for Online Therapists is therefore to help people who are not at ease in the cuber culture to grow accustomed to it and to master the skills necessary to utilize it effectively.

2. In Online Therapy sessions it is more difficult to pick up on non-verbal communication.

According to therapists this may be the largest and most important challenge presented by online counselling. And for a simple reason: when a therapist listens, he/she not only listens to the person’s words, but to the person’s whole body. The body language of the client speaks as much (if not even more) than his/her words. When these non-verbal cues become muddled it might present an obstacle to the effectiveness of Online Therapy. It might prevent both the therapist and the client to feel a real connection.

But there is more to it…

  • Even if though this might be true, the existing body of literature on telephone therapy could logically be applied to online therapy.
  • Research literature has shown telephone therapy to be a cost-effective, clinically-useful, ethical intervention modality in psychotherapy.
  • Information processing research has supported the hypothesis that the lack of visual cues intensifies the psychologist’s need to listen and ability to listen.
  • The lack of non-verbal cues is nothing new in counselling. Psychoanalysis, where the analyst sits out of view of the patient, and Catholic confessions are illustrative examples. We also trust some of the most serious mental health problems to phone interventions (e.g., helping those who are extremely suicidal, a common practice on telephone helplines set up in communities).

With both voice and video formats of Online Therapy it should not present a serious a problem. Both are real-time and immediate modes of communications – with enough non-verbal cues to do the work effectively.

The main challenge thus seems to change your attitude, to not compare these different modes of therapy and to utilize the possibilities of Online Therapy as much as possible.

3. Online Therapy is more anonymous than face-to-face therapy

One of online therapy’s greatest advantages is also one of its greatest disadvantages for the therapist. Clinicians who take their role seriously also must seriously assess individuals for suicide, if appropriate, and take necessary action to ensure their client stays alive. If that client is largely anonymous through online communication, and reports suicidal ideation and behaviour during an online session, the therapist may have little recourse for interventions.

The therapist therefore has to find a way to screen for suicide at the onset. He/she also has to develop an open relationship with the client – one where questions about these kinds of issues can be raised at any time.

4. Uncertainty about the Credentials of your Online Therapist

There are only two ways to ensure that an Online Therapist has the education, experience and credentials he or she says he or she has. One is to call up the clinician’s university to verify education credentials, call the licensing board to verify licensure, and/or call past employers of the therapist. This is a time-consuming task most people won’t bother to take.

As in all online deals, the therapist will have to find a way to give any client the assurance that he/she is qualified and registered to do psychotherapy. At the same time the client has to show a certain amount of trust in order to start working with a therapist. Fortunately Online Therapy make sit easy to step away from a therapist if a client suspects the he/she is being scammed.

5. Problems with a grievance against an Online Therapist

The grievance process for addressing complaints against online therapists is really murky. Nobody really knows where or with whom to lodge a complaint. Additionally, there has never been any court case against an Online Therapist. So it is uncharted waters as far as complaints against Online Therapists is concerned.

However, therapists are offering an online service. By doing that they are choosing to provide their service within the current cuber culture. As such they are indirectly giving permission to write about and evaluate their services – which just might (at this stage) be the only way to handle your grievances.

On the therapist’s side, good online therapists will clearly define their policies for grievances, as well as, who to contact if a client believes the therapist has acted unethically or wrongfully.

Online services in mental health are here to stay.
In fact, all trends indicate that these services will continue to grow and proliferate
with the enormous growth of the Web in general,
and the steady increase in numbers of people who are getting online.
Both clinicians and clients therefore have a role to play in the process of finding ways to overcome these challenges or obstacles. In order to ensure the disadvantages outlined above do not hurt clients more than the advantages help them.


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