E-therapy: A Look at the Benefits
Most of us would not have pursued a career in mental health helping (broadly including here counselling, psychotherapy, psychology, social work, and psychiatry) if we were not aware of and keen to extend to those in need the many benefits that the face-to-face therapeutic encounter brings. Accustomed to this format, we can easily dismiss online technologies as a viable way of delivering professional health services. But let’s look for a moment at what we would be dismissing. Note: the following list of benefits does not include those emanating strictly from interactions with clients vis-a-vis social media sites.
There is greater flexibility and accessibility
When distance professional services are available, those who have mobility problems or live in remote areas have as much possibility of getting counselling as those living two doors from the professional’s office. Beyond mobility and geography issues, there are simply some clients who may deterred from getting counselling if they have to front up to the counsellor’s office to access it. This group may include those with special needs, such as deaf people, agoraphobics, people with severe time constraints, and those who experience stress or stigma with the idea of traditional counselling (Dunaway, 2000). There may be some who get regular face-to-face counselling, but occasionally need support between sessions for crisis intervention; online counselling can be there at such times for these clients (Kolmes, 2010). With the worldwide web, neither relocating to another state nor living in another country from the therapist is a barrier to getting service (although time zone differences still need to be negotiated!), and even language barriers are overcome with contemporary software (Kanani & Regehr, 2003).
Clients benefit, therapeutically and cost-wise, from the online clinical environment
The U.S.-based Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2009 that Oregon’s RodeoNet tele-psychiatry program found that direct costs associated with e-therapy consultations were approximately 50 percent less than face-to-face consultations, with reduced travel costs and increased levels of assistance leading to the decrease in costs of providing care. That care was deemed to have been helpful by 90 percent of respondents in the survey, many of whom stated that they would not have sought therapy had only face-to-face options been available (SAMHSA, 2009).
A study by Haberstroh, Duffey, Evans, Gee, & Trepal (2007) found that online counseling was viable because it provided clients with a therapeutic relationship that included five primary benefits. Three were: (a) perceived anonymity, (b) convenience, and (c) accessibility — as we discussed above. In addition, the Haberstroh et al study found two relatively understated benefits of online therapy (when accessed with non-visual, non-voice means such as email or chat systems): (d) that clients increased their capacity for self-reflectiveness as a result of the therapeutic writing, and (e) clients perceived that they were being served by a trained, competent, and empathic online counsellor (Haberstroh et al, 2007).
Psychological research is simpler; healthcare surveys are facilitated
The use of confidentiality protocols and anonymity features associated with online studies mean that the stigma often linked to completing healthcare surveys and mental health questionnaires is reduced or eliminated (Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006).
The internet is a source of health information
As more and more professionals (and potential clients) turn to the internet to meet their needs, the number of professional services offered online expands accordingly. In a study of online therapists, 63 percent described their services as education or advice; only 18 percent described them as therapy or counseling (Maheu & Gordon, 2000). Websites containing health information and resources have proliferated, as has the tendency to take up services after searching for them online, so this balance of advice/information versus counselling may have shifted since the study, but one thing seems certain: more and more people search the internet first (rather than gain referrals from friends or related professionals — say, their general practitioner) when they perceive a mental health need.
Health professionals can introduce and market themselves online
Both a website and an online page — the latter of which can be strictly professional — can let actual and potential clients know of services offered; products sold (such as books or other items); and seminars, courses, and webinars to be held. Certainly, professionals can clearly display their philosophy and the orientation of their training, in order to attract more suitable clients. In the comfort of their own home or other chosen location, clients and those enquiring can search and contact a professional for help in resolving relational and other life issues. They can do this without the barriers imposed by geography, time constraints, guilt, shame, or stigma (Giota & Kleftaras, 2014).
Online technologies can be harnessed to create intervention initiatives
Clients who utilise online sites in their daily lives can benefit from tools available on a platform with which they are already familiar. That this strategy is successful is attested to by the sharp rise in both texting help lines (communicating through text messages from mobile phones) and via online chatting on the sites. This is as opposed to calling the traditional 1800 hotline numbers. Clearly, digital technologies are improving the therapeutic experience as well as the access to therapeutic interventions (Giota & Kleftaras, 2014).
Follow-ups, protocols, and reminders can flow
For many clients, successful treatment is a consequence of the medication taken, the regular journal entry made, or the commitment to daily exercise kept. Online technologies greatly facilitate the sending-out of daily, weekly, or monthly reminders to carry on with agreed programs and initiatives. Text messages and audio and video clips can explain the protocols to be followed, remind the client of what is to be done, and re-inspire those struggling to keep a commitment for which energy and motivation may be flagging (Postel, de Haan, & De Jong, 2008).
Online programs can be created to support clients in alleviating many conditions between sessions
Whether the support is delivered via mobile phone or online, whether it is mostly to supplant face-to-face therapy or as an adjunct to other modalities, help for conditions from anxiety and depression to avoidant personality disorder and borderline personality disorder can be delivered via online technologies (Giota & Kleftaras, 2014). In the Maheu and Gordon study (2000), 41 percent of the therapist-respondents indicated that they dealt with clinical problems such as mood, sexual, or adjustment disorders, and 22 percent stated that they addressed relationship issues, including grief and bereavement.
Clearly, the benefits of e-therapy abound, yet benefits can be dangerously confounded with risks, especially when there is not sufficient legal infrastructure surrounding distance services to ensure the safety of clients using them. The U.S.-based National Congress of State Legislatures reported the passing of the Californian Telemedicine Act as the only state legislation that focuses on e-therapy exclusively. Eighteen other U.S. states, however, have some form of legislation for e-therapy, with Montana and Puerto Rico requiring a license to practice e-therapy (Prabhakar, 2013). We can only hope that there will eventually be legislation to provide coverage to citizens of all 50 states (plus Puerto Rico and any other territories).
Similarly, there is need for legal provisions to protect clients in countries such as Australia, New Zealand, and Canada, with the huge growth of popularity in distance professional mental health services in these areas also.
- Dunaway, O. (2000). Assessing the potential of online psychotherapy. Psychiatric Times. Vol 17, No 10. Retrieved from: hyperlink.
- Giota, K.G. & Kleftaras, G. (2014). Social media and counseling: Opportunities, risks and ethical considerations. International Journal of Social, Management, Economics and Business Engineering, Vol 8, No 8, 2014, pp 2248-2250.
- Griffiths, F.E., Lindenmeyer, A., Powell, J., Lowe, P., & Thorogood, M. (2006). Why are health care interventions delivered over the Internet? A review of the published literature. Journal of Medical Internet Research, Vol. 8, no. 2, 2006. Available from: hyperlink.
- Haberstroh, S., Duffey, T.D., Evans, M., Gee, R., & Trepal, H. (2007). The experience of online counseling. The Journal of Mental Health Counseling, Vol 29, pp 269-282.
- Kanani, K. & Regehr, C. (2003). Clinical, ethical, and legal issues in e-therapy. Families in Society, Vol 84, No 2, p 155. Retrieved from hyperlink
- Kolmes, K. (2010). Ethical framework for the use of social media by mental health professionals. Retrieved from: hyperlink.
- Maheu, M. & Gordon, B. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, Vol 31, no 5, pp 484-489.
- Postel, M.G., de Haan, H. A., & De Jong, C. A. J. (2008). E-therapy for mental health problems: a systematic review. Journal of Telemedicine and E-Health, Vol. 14, no. 7, 2008, pp. 707-14. doi: 10.1089/tmj.2007.0111
- Prabhakar, E. (2013). E-therapy: Ethical considerations of a changing healthcare communication environment. Pastoral Psychology, Vol 62, pp 211-218. Doi 10.1007/s11089-012-0434-3.
This article was adapted from Mental Health Academy’s CPD course “E-therapy: Ethical Considerations”.