Does Therapy Need to be Face to Face, In Person to be Beneficial?

[image by Wrote]

It was inevitable that with the emergence of more and more of our lives online that the field of therapy would see more and more benefit from doing therapy online, but even still, lots of questions remain for both practitioners and clients. In an article from Monday (thanks to John Saddington for pointing me to the article) the title says it all, Therapy online: Good as face to face? The article begins by talking about a study on the topic of depression:

Participants were randomly assigned to either receive online cognitive behavioral therapy in addition to usual physician care — which may include antidepressant medication — or to continue their usual care and be placed on a waiting list. The intervention consisted of up to 10 55-minute sessions, five of which were expected to be completed by the four-month follow-up.

Of the 113 people who did online therapy, 38 percent recovered from depression after four months, compared with 24 percent of people in the control group. The benefits were maintained at eight months, with 42 percent of the online therapy group and 26 percent of the control group having recovered.

The level of benefit shown in the study is about the same as could be expected from traditional therapy, although the researchers did not compare the two as part of the experiment, said Dr. Gregory Simon, a psychiatrist and researcher at Group Health Cooperative in Seattle, Washington, who wrote the editorial that accompanied the study.

Benefits of Online Therapy
This article and a slew of other articles out there talk about the many benefits of doing therapy online. Things such as:

1. Providing therapy to those with limited/no access to see a therapist.
2. Some studies show that therapy over the internet allows clients to put down their guard, be more open and vulnerable than in person.
3. Often the stigma of going into see a therapist is removed.
4. According to some studies, like the one above, the benefit of therapy online is similar to that in person.

These are just a few of the more common benefits.

What other benefits can you think of?

Limitations of Online Therapy

1. Some experts say that online therapy limits some of the visual cues in gesture, as well as “speech intonations.”
2. Some see a limitation in rapport building when not done in person.
3. Possibly a lack of accountability.  It’s easier to miss or terminate therapy online than in person.
4. State licensing.  The major boards in the area of psychotherapy don’t allow people to practice in state’s outside of where their license is issued.   Therefore ethical questions come up if someone in California for example is doing online therapy with someone in TX.
5. Sometimes people who seek online therapists have missed crucial steps in ascertaining that their therapist had the proper credentials, or the proper ethical and legal paperwork is not filled out as easily as it would be in person.
6. HIPPA, HIPPA, HIPPA.  Need I say more.

These are just a few of the more common limitations.

What other limitations can you think of?

Personally
I’m excited about this emerging area of online therapy, but at the same time I have questions.  So I’m willing and ready to embrace it, but as I do that I’m also proceeding slowly and cautiously to make sure that I don’t move forward in any unethical manner.  For example, I have always been quick to jump online whether it was blogging, being on Facebook, Twitter, etc.  But after sometime of engaging in those areas of technology I have had to go back and re-think some of the ways that I use and engage in that venue.  I’m sure that I will continue to re-think how I do online therapy, but I want to proceed more slowly this time so that I get the most benefit out of it, and that my clients get the most benefit out of it.

I have counseled thousands of people over the last 16 years, both in pastoral and clinical settings.  And I have also spent thousands of hours online.  And I’ve more recently begun to practice more and more online therapy/counseling with others.  That doesn’t make me an expert in online therapy, but I think it makes me qualified enough to see that there are huge benefits of doing online therapy.

I don’t see online therapy as replacing traditional, in person therapy, but rather I see it as just another avenue of seeking and doing therapy, as well as an added benefit and compliment to those who want both.

The article at the top asks the question if “therapy online is as good as face to face?”

Well, the June issue of Family Therapy Magazine was titled Therapy 2.0, and was dedicated to the topic of online therapy. Therapists have been exploring and pushing the boundaries of online therapy for the last 10-15 years, but it hasn’t been until now that we are starting to see the “tipping point” with the availability of the right tools for the profession.  I therefore want to close with a quote from an article written by Kathleene Derrig-Palumbo, Ph.D, MFT, who is the founder and CEO of MyTherapyNet.com.

It is often said that online therapy eliminates face-to-face contact, which is said to hinder the therapy process. Should this be the case, efficacy of treatment could be negatively impacted. There are two points to consider in this argument. This first is that with video-conferencing face-to-face contact is restored. The second point, looking back at Sigmund Freud, he did not sit with the client face-to-face–he sat behind the client, so as to minimize the potential of projection. There are some therapists who believe that physical contact or presence is necessary in some cases, and certainly in those cases the therapist should consider and act upon what is consistent with the best interests of the client. (The AAMFT, Family Therapy Magazine, pp. 25-26)