On or off? Counselling in the 21st Century

Study

Last year the Daily Mail* published the results of a study conducted by the University of Zurich**.

The university wanted to look at the effectiveness of online counselling compared to traditional face to face therapy.

To investigate how effective this method was, researchers asked six therapists to treat 62 patients suffering from moderate depression.

At the end of their study, 57 percent of patients who underwent online treatment were free of depression, compared to 42 percent of those who had traditional therapy.

So what is online counselling?

Online counselling makes use of a number of technological tools to connect therapists and therapeutic content with clients. These include:

Websites: These are made up of a collection of pages to deliver information about a specific subject or theme. Search engines like Google have made it easier to research particular issues online.

They can also be used to deliver pre-prepared therapeutic courses direct to clients. See http://www.talkingsense.org/category/help-yourself for an NHS based example.

Email: Therapists and clients can work together using the written word via email. This is ‘asynchronous’ communication because there is a time delay between responses. This gives the client and therapist time to think about and structure questions and responses.

It also provides some space and distance to explore themes and issues from the comfort of their home.

Forums: Forums manage user-generated content by its members. They generally contain threads (topics) around particular themes. They can provide a sense of community and support for its participants but may not involve qualified therapists.

Chat rooms/instant messaging: These are real-time Internet based conversations between a number of users at the same time using instant messaging technology or Internet Relay Chat (IRC).

They are often monitored by volunteers to maintain a code of conduct and safety.

Online cameras (webcams) are increasingly used with instant messaging and for a video connection between participants over the Internet (such as Skype). Tools such as Skype are now used by therapists such as myself to connect with clients remotely.

It can be via secure video, text only or audio only (like a phone conversation). This can be useful if it is not geographically possible to work together face to face or if the client prefers to work with the counsellor from the comfort of their home.

Social networks such as Facebook and Twitter also provide online communication between users in a chat room environment, allowing for real time and asynchronous interactions between individuals and groups.

Virtual reality/graphical multiuser environments: Some chat rooms use a computer generated representation of an individual, called an avatar. The avatars are able to move around in a virtual environment and interact with other avatars. Examples include www.secondlife.com and www.meez.com.

One-to-one virtual therapy sessions are also possible with a therapist’s avatar. They can provide a sense of anonymity and safety for an individual. They can also encourage fantasy and disinhibition. They are therefore full of potential but need careful management.

Choice

As you can see there are plenty of options for accessing support and counselling online, and an increasing amount of research is showing that it is a valuable addition for both clients and therapists.

Counselling organisations such as BACP have dedicated guidelines (http://wam.bacp.co.uk/wam/Search.exe?DETAIL=4039) regarding the provision of online therapy, and society as a whole expects to be able to access an increasing amount of services online.

However, it is expected that online therapy will always be an addition, rather than a replacement for face-to-face counselling. Some issues are not appropriate for online counselling, and there will always be advantages and disadvantages to the different counselling methods and tools.

For more information

See: http://onlinetherapyinstitute.com/

* Daily Male article: http://www.dailymail.co.uk/femail/article-2385437/The-future-therapy-Online-counselling-proven-MORE-effective-face-face-sessions.html

** Zurich study: http://www.mediadesk.uzh.ch/articles/2013/psychotherapie-via-internet-wirkt-gleich-gut-oder-besser-wie-im-sprechzimmer_en.html

Literature:

Birgit Wagner, Andrea B. Horn, Andreas Maercker. Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders. July 23, 2013. Doi:10.1016/j.jad.2013.06.032