Trust, how easy is it to establish in online therapy?

The working alliance between client and therapist can be defined as the extent to which both work collaboratively and purposefully and connect emotionally (Horvath & Lubarsky, 1993). Trust is the key foundation for this relationship to be effective and this has been proven by many studies, to be a key aspect affecting the process and outcome of a therapeutic intervention. It is considered to be the largest significant single factor affecting the outcome of successful therapy in face-to-face counselling.

Trust is the foundation of any therapeutic relationship. Trust building is a first step in any counselling interaction. It is a tricky stage in any relationship but with a client preparing to share their personal world, sometimes for the first time ever, this can be a make or break stage in anyone's therapy. Below, is the Oxford dictionary`s definition of trust. The ‘someone’, will be the counsellor, the ‘something’ will be the process and relationship.

“Firm belief in the reliability, truth, ability or strength of someone or something”

In traditional face-to-face counselling, trust is just as vital. We maximise our safety at the beginning of our search for a therapist, looking at websites, validation, past client testimonials, checking qualifications, professional membership and so on. After all of this, we rely on our senses within the therapy room. A good therapist establishes trust by helping to build rapport, showing congruence and so on.

So, what would be so different with establishing trust with online therapy?

Firstly, let us establish what online therapy includes. Online therapy can come in several formats, email, messenger/chat, or via video conferencing such as Skype or Facetime.

One factor will be the trust in the process itself. Just as much as a client in face-to-face therapy would not be happy with a venue which was open and not sound proofed, a client needs to trust that all details and conversations are safe. This can be a tangible concern if therapy is via email or messenger. All mail correspondence needs to be secure and proven to be so. Video sessions such as Skype and Facetime are more naturally secure. Some clients may need educating about internet security to help them understand the risks or lack of risk, offering an informed choice.

For anyone with difficulties sharing personal and emotive feelings with a stranger, email methods can be more effective due to anonymity. The client can work with someone out of their living or working area with them not having to “risk” being seen going into a therapist office. This can all lead to a sense of greater security and thus help to build trust in the process.

Trust in the therapist is another story. There can be a concern of not “meeting” the therapist. Some people report feeling more vulnerable, that the therapist could be “anyone”. This is quite interesting as there really is no greater risk than if you were face-to-face. One client reported “Until I took the plunge with Skype counselling, I felt that I could not rely on my intuition/sense that you were trustworthy, it was like feeling I might be blind” (anon). This client reported that this fear was soon over come once commencing online therapy. She could pick up on non verbal communications such as facial expressions and body language.

Haberstroh et al.’s (2007) study of clients who partook in online counselling sessions suggests that trust was important from the sample interviewed. They found that participants varied in their trust of a communication forum which was devoid of visual and auditory feedback (email and chat rather than video conferencing). For some this seemed to alleviate interpersonal pressure and encourage self-reflection and a feeling of safety when disclosing personal issues, although for others, the missing interpersonal cues possibly had the affect of limiting their self-expression and level of trust. Young’s (2005) study on perceptions of clients who used online counselling also suggests trust is an important factor in online therapy. She highlights that the lack of perceived privacy and security during online chat sessions and the fear of being caught while conducting online sessions were significant concerns reported by e-clients.

To summarise, trust is a vital part of relationship building in any therapeutic context. Therapy comes in various formats from email, chat room, and video conferencing (such as skype), face-to-face and group therapy. Each one carries its own limitations when building trust. Each potential client needs to understand what is important to them, what they require from therapy and their own strengths and weakness. For some people, online therapy will be a positive and effective option and should not be dismissed through the lack of knowledge of how the on line process can work.