I was recently asked by someone to contribute to their thesis. She wrote to me a year after our first contact to suggest that the work that we did together then had been so successful for her that she wanted to make online therapy her subject. I was flattered and accepted right away. However, it made me reflect on some of the differences between working online and face to face. I am a keen supporter of taking therapy online and giving people who would normally not have access to it. However, there are challenges in this brave new world.
Online therapy is relatively new and not yet fully accepted by everyone. When you browse articles on this topic, you generally find that the main issues center around privacy concerns, proposed regulation and the usual chatter from psychotherapists stuck in the Freudian era. However, there are some studies, the most recent in Australia, stating that online therapy is proving more and more effective across a wide range of mental health issues including depression…READ HERE. This is exciting news for therapists who have decided to add online therapy to their range of services and one can only believe that the number will increase in years to come. However, in all of the discussion on this topic, one subject is usually overlooked. That is, the new challenges that therapists face in this brave new world. I have been working with online clients for about a year now and I am in a good position to talk about the differences between sitting in front of a computer screen and a “live” client.
The first thing you realise is that the dynamic of the relationship is different. Communication is via video call, email or phone so there is no physical presence in front of you. I often use email as a means of communication between sessions. Clients send me written assignments, journal entries or just their thoughts. This makes the written word and verbal communication extremely important. Unlike face to face therapy, body language and facial gestures play a lesser role, (of course, this can help in a video call). Analysis of mails in particular is very important and looking for signs of automatic thoughts and core beliefs between the lines can be challenging. Often, there is an email exchange with clarification and challenging questioning to find out what is really being said. Often these responses are instant when sent to a smart phone or when the conversation is being held on IM. As a therapist this means, you have to be on top of your game, intensely analysing statements that come very quickly back at you. The wording is also highly important in establishing what is going on under the surface with the client. Looking for clues means going into the very essence of the words used. Often clients when questioned about the use of particular words and phrases can relate these back to a thought that they were have at the time and sometimes they were not even aware of the connection. As clients often come from different cultures, it is essential to have or quickly learn to deal with the nuances in the culture and the language. I have clients from all over the world stemming from the US, Africa, Asia and Europe. All of them see the world through their cultural influences and are all very different.
Secondly, therapists who use video technology to run sessions have to rely on a good connection. Without this, it is an impossible task. Clients who are already troubled find it very traumatic to have the link constantly broken or they have to keep repeating themselves. Even the best encrypted software systems rely on a good internet connection to run video technology. This can make the difference between success and failure with a particular client, especially when working across time zones. This brings in a different point. Anyone who is really serious about online therapy must be prepared to work evenings, weekends and to a time suitable for a client. The beauty of the concept is that you can work with people in other countries. However, this means you can forget 9 to 5. Many, as I do, usually work with the online clients before or after seeing clients in their practice. This can be exhausting if you do not take care of yourself physically and mentally.
It is only a matter of time before online therapy is seen as a viable alternative to face to face therapy. Regulation and establishments offering official training will surely come. Of course, this is the way it should be. However, I hope that it is not regulated to such an extent that it fails to help the very people who most need it. That is clients who are housebound, in rural areas or prefer not to visit a therapist’s office. It is an exciting new world for therapist and client alike. Help is being given to people who would not normally get it but this also brings challenges for everyone involved.