Promising Treatment Methods for Today and the Future
Long Distance Therapy:
Promising Treatment Methods for Today and the Future
Online or long distance therapy has a variety of mediums, methods, and names; video therapy, online therapy, telephone counseling, telepractice, remote consultation, and e-therapy are just a few labels used for this service that is beginning to gain ground with therapists. As computer technology increases and access to the Internet is accessible to more people, the opportunity rises for more people to receive assessments or therapy via one of these methods. Although many counselors and patients have little experience with online therapy, research has shown that once patients have experienced online assessments or therapy, their belief in the value of it increases by 90 to 100 percent following a session (“Telepractice” 2012, p. 24).
Many therapists are interested in learning more about online therapy and more patients are willing to use the method as an assessment or therapeutic tool. However, because many of the methods and technology are new, there are still many concerns from both therapists and patients about whether or not they are ready to embrace the technology. Because informed consent and confidentiality are a priority to therapists and clients, it is unsurprising that confidentiality is the top concern among therapists that may prevent them from utilizing online therapy (Wells et al. 2007, p. 456). Other concerns that therapists have are liability, misinformation provided by clients, inadequate training to perform online therapy, providing service to clients resident in a state the therapist is not licensed to practice, inequality of Internet access for clients, and Internet speed or technical problems (Wells et al. 2007, p. 456). However, these hurdles for therapists in providing online therapy have many remedies that are easily handled with further training for the provider. In receiving the necessary training to confidently provide online therapy, providers can offer more benefits to current and future clientele.
Therapists must understand the technical and ethical obstacles to providing online therapy before they engage in it with patients. The top concern, confidentiality, is both a technical and ethical issue. The use of the Internet “to deliver therapeutic interventions opens several areas of potential risk to online consumers, [including] greater risk for breaches in confidentiality” (Childress 2000, p. 4). A variety of mediums can be used depending on what is most appropriate for the situation, including e-mail, video conferencing, voice chat, or text chat. Breaches in confidentiality can occur in three places, on the therapist’s side, on the client’s side, and between the therapist and client. On the therapist’s side, the problem may occur if the website or computer is not secure from hackers, other staff members, or family members. The same problems exist on the client’s side. Between the therapist and client, unencrypted data may be lifted by hackers through unsecure networks and wireless services. A therapist who is not confident that he can provide a secure situation for his clients is not ready to offer online services.
Another issue that concerns many therapists is whether misinformation will be provided by clients, and this is often rooted in the idea that online contact lacks the physical cues that face-to-face assessments or therapy offers (Wells et al. 2007, p. 457). This concern is understandable since many therapists rely on being able to see a patient’s body language, affect, tone of voice, and other signals in interpreting how to perform therapy. E-mail, instant messaging, and even telephone or voice chat sessions can suffer from this issue. A therapist relies on receiving accurate information from the client in order to provide assessment, treatment, and the best outcome, and some therapists question whether or not they will be able to do that if the client is not present in person.
These concerns are valid and highlight the need for continuing research about online therapy as well as further training for therapists offering the latest knowledge, technology, and ethical solutions. The potential for positive outcomes far outweighs the negative when it comes to online therapy. For instance, with online therapy, providers can offer services to underserved areas or to homebound patients, group and family therapy, to traveling patients, and other circumstances where in-person interaction is impossible (Wells et al. 2007, p. 454). The VA utilizes online videoconference therapy for its patients that live too far from VA hospitals, and offers both telephone and online chat for informational, therapeutic, and crisis intervention services
Current research about online therapy shows a variety of positive results. For example, the Australian Nursing Journal says, “In addition to reducing depression symptoms, we found that online programs were effective in reducing hazardous alcohol use” and that people using an online program “had a marked increase in their quality of life” (“Online Support” 2012, p. 21). Childress writes, “There is some evidence that persons may feel more comfortable self-disclosing through a computer” (200, p. 3). Although it seems counterintuitive that people would feel more comfortable about disclosing private things without being able to read the body language of the person they are communicating with, it may be that people feel more comfortable in the privacy of their own homes or without fear of a judging eye that allows them this freedom.
Therapists should not ignore research from other medical fields that have shown success with online assessment and treatment. For example, researchers in Britain discovered that “telehealth helped patients . . . avoid the need for emergency hospital care” (“Telepractice” 2012, p. 24). Therapists may not realize that the same model has been employed successfully by counselors for years via services like suicide crisis hotlines; there is no reason to believe that email, online chat, or other Internet-based services for therapy would not be as successful. Although some assessments may be better made in person, research with speech therapists dealing with cleft palate patients showed that their evaluations via videoconference were equal to those of evaluations done in person (“Telepractice” 2012, p. 24). The use of videoconference is much easier today than it was a decade ago, and can allow a therapist and client to see and hear each other, eliminating some of the concerns therapists have about not being able to read the visual or vocal cues they value.
Many concerns about online therapy exist, but increasingly tech-savvy therapists and patients will increase the demand for this type of treatment in the future. Continued research will highlight the areas in which online therapy is the most useful, or about how particular areas must be improved. Finally, the key to making online therapy a success for both the therapist and the client is making sure that therapists receive continuing education and updates on technology, methods, mediums, research, and techniques.
References
Childress, Craig A. (Jan.-Mar. 2000). Ethical Issues in Providing Online Psychotherapeutic Interventions. Journal of Medical Internet Research 2(1), 1-10.
Online Support Goes Beyond. (Aug. 2012). Australian Nursing Journal 21(2), 21.
Telepractice: Research Trends. (2012). ASHA Leader 17(12), 24-25.
United States Department of Veterans Affairs. Suicide Prevention. U.S. Department of Veterans Affairs: Mental Health. Retrieved 10 Nov. 2012 from http://www.mentalhealth.va.gov/
suicide_prevention/index.asp
Wells, Melissa, Mitchell, Kimberly J., Finkelhor, David, & Becker-Blease, Kathryn A. (3 Nov. 2007). Online Mental Health Treatment: Concerns and Considerations. CyberPsychology & Behavior 10(3), 453-459.
