In a world of constantly evolving technological innovation, the idea of therapy through an online platform seems like a natural next step. In the past, telephone and email-based therapies were developed in an attempt to keep up with the demand for greater accessibility and affordability in mental health. Today, more and more people are seeking therapy or counseling through online video chat, choosing to meet with their therapist in the convenience of their own home or other location of their choosing.
What is online therapy?
Online therapy is any form of counseling delivered via the internet. It has several names: e-therapy, distance therapy, internet therapy, and web-therapy. A number of platforms can be used like texting, voice messaging, and audio messaging. One of the emerging and most popular forms today uses video chat to speak to a therapist in real time using a secure video conferencing platform. Examples of this are Skype, VSee, etc.
What are the advantages of online therapy?
There are a number of advantages from choosing online therapy over visiting a therapist in-office.
Access. Online therapy is more accessible for people who have limited mobility or are located in more remote areas. All you need is a computer or mobile device and an internet connection. Those with limited mobility are free from worrying about how to deal with the commute, parking, and whether there is wheelchair access or elevators in the building.
Comfort. Many people feel more at ease in the comfort of their own home. Online therapy can promote a more open and comfortable scenario when talking to a therapist.
Keeping appointments. It can be easier to commit to regular appointments with online therapy. By avoiding travel, traffic, and other detours, you may find it more convenient to maintain regular sessions with your therapist.
Stigma. Even though going to therapy has become very mainstream in this day and age, some people still feel a certain degree of stigma associated with acquiring mental health services. Online therapy may provide access to services for those who are reluctant to reach out for in-person services.
What evidence is there that online therapy helps?
We recommend that severe and complicated psychiatric conditions be dealt with in person with a clinical psychologist/psychiatrist, however other common and less severe problems can be managed through online therapy including anxiety, depression or low mood, or even couples counseling. To date, there is not much research available testing the effectiveness of online therapy, however, the results from the few available studies are promising.
A large-scale study that included over 98,000 patients between 2006 and 2010 looked at the number of psychiatric admissions and the days of hospitalization in those patients both before and after 6-months of online therapy using video-conferencing. Both measures decreased by an average of 25%1.
An earlier, large-scale study considered other factors in their assessment of the effectiveness, for example, the type of therapy, the tools used to measure the outcome of therapy, the presenting problem of the patients, the therapeutic approach of the therapist, and the communication modality. With these factors accounted for, the study concluded that there were no differences in the effectiveness of online therapy compared to in-person therapy2.
Can I really connect with my therapist?
One of the main concerns for therapists and clients alike is in the development of a strong therapeutic alliance. This refers to the relationship between you and your therapist. Essentially, the therapist’s goal is to develop a positive working relationship with you so that you both can engage with each other and promote healthy change. The likelihood of improvement is small without a strong alliance. One concern that some people have expressed is whether a good therapeutic alliance can be developed if the sessions are not taking place face to face. Although there is very little research looking at this issue, a recent study examined this question comparing online therapy to in-person therapy. For symptoms of depression and generalized anxiety, clients rated their impressions of the therapeutic relationship with their therapists equally high, both at the midway point and at the end of their treatment3.
Some things to keep in mind about online therapy
Here are some general topics to consider before deciding to request online therapy. Note that providers of online therapy should already be aware of these factors and should be able to answer any of your questions.
Insurance coverage. Some companies may not cover online therapy or out-of-province providers. Check with your insurance coverage prior to seeking online therapy.
License. Is the therapist licensed in the province you live and do they have the appropriate credentials?
Confidentiality/privacy. It is important to ensure that the video conferencing tools used by your online therapist meets standards for confidentiality concerns. Normally this would mean that the platform should have end-to-end encryption for full privacy between you and your therapist.
Crisis situations. Therapists may have limits in what they can do for a client in a crisis situation if they are located far away. It can be helpful to provide your online therapist with an emergency contact if they are located at a distance.
Serious psychiatric illnesses. This form of therapy is not recommended if you have a serious psychiatric illness or are experiencing other complications which would require direct contact with the therapist or an in-patient team.
Written by: Mayte Parada, Ph.D. Psychology, Montreal Therapy Centre
- Godleski, L., Darkins, A., Peters, J. (2012). Outcomes of 98,609 U.S. department of veterans affairs patients enrolled in telemental health services, 2006-2010. Psychiatric Services, 63, 383-385.
- Barak, A., Hen, L., Boniel-Nissim, M., Shapira, N. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions, Journal of Technology in Human Services, 26, 2-4.
- Hadjistavropoulos, H.D., Pugh, N.E., Andersson, G. (2014). Therapeutic alliance in internet-delivered cognitive behavior therapy for depression or generalized anxiety. Clinical Psychology and Psychotherapy, 1002/cpp.2014