Running head: ONLINE THERAPY

Online Therapy

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Online Therapy

Introduction

Online therapy, often referred to as online counseling, involves engaging a therapist or counselor over the internet without the need of visiting the counselor at their office for a face-to-face consultation. Many people are opting for this method of counseling and slowly replacing it with traditional face-to-face therapy due to its convenience. People prefer online therapy to face-to-face therapy for its convenience and low cost as well as the ability to access any counselor they may not have a chance of seeing face-to-face. In addition, online therapy has made it possible to express one’s feeling without disclosing one’s identity to the counselor bringing about the dis inhibiting effect where clients feel free to say anything considering they do not feel judged based on what they say due to anonymity created by the internet (Alleman, 2002).

However, online counseling hinders crisis intervention considering that the counselor may be serving a total stranger whom he or she may never know. Moreover, online therapy may not allow complete diagnosis of the mental condition of the client since communication occurs online where the counselor never has a chance to examine the client on a face-to-face basis to look for clues from the behavior of the person (Cook & Doyle, 2002).

Problem Statement

            Online therapy is changing the society from using the traditional therapy as people feel that the internet is the source of all their answers, and where they prefer going online rather than telling their problems to a professional, face-to-face. The internet knows no borders, making it rather easy to access services from any part of the world from behind one’s desk and at the click of a button. This has made online therapy possible; considering it is cost effective where one is able to cut traveling costs as well as convenient in terms of scheduling the counseling at one’s most preferred time. Online therapy allows people to seek help from professionals beyond their reach, differing from face-to-face encounters, and offers people in an undeserved area access to therapy (Griffiths, 2001).

The internet also has a disinhibiting effect that allows clients to give information without having to feel liable. The disinhibiting effect has various impacts on the client, one of them being that they make them feel empowered to express their problems without fear or without shying away (Alleman, 2002). Some of the factors that make up the disinhibiting effect are anonymity, where for instance the client can create a different name to use while engaging the counselor so that they are not known. This gives clients the ability to say anything since no one would know their identity and they feel less vulnerable to victimization thereby telling the counselor what they would want them to know. In this case, the counselor may not have the ability to get all the information that would help him/her form a diagnosis.

Another effect of online disinhibition is in relation to physical presence where the client is not visible to the counselor and because one cannot see them, they get courage to write, and in some cases talk, about themselves openly. Another issue relates to the ability of clients to choose when to have therapy since they can log onto the computer at any time, and more still, they are able to answer back whenever they want, making it hard for counselors to control the therapy since the client has the power of control (Griffiths, 2001).

Online therapy, in relation to legal and ethical issues such as globalism, social change and diversity, should also be taken into account. Globalism – the ability to access therapy from anywhere in the world as long as there is internet connection – for instance, has enabled online therapy be practiced and accessed from anywhere in the world, allowing interaction between people who may not have had a chance of meeting. The ethical issue in online therapy in relation to globalization is the fact that a counselor may not be in a position to take responsibility of the client in case of crises. Moreover, this factor has brought diversity to the field of counseling since different practices belonging to different regions are brought into play, creating diverse services. The social effect of online therapy is that of making all people equal despite their social status gender or authority since the internet does not recognize social status and anybody can say anything to anybody. However, many researchers argue that due to its dis inhibiting effect, the client is empowered to express themselves without fear, and are able to say what they may not have felt comfortable saying in a face-to-face setting (Corey, Corey & Callanan, 2010).

Integrated Literature Review

            Online therapy is defined as any type of professional therapeutic interaction that makes use of the internet to connect qualified mental health professionals and their clients (Rohclen, Zack & Speyer, 2004). This definition however, is not all-encompassing considering that with the internet, it is hard to know whether the person is a professional or not in specific regard to online therapy, and whether they are licensed. Moreover, the issue of payment is another problem where clients may not be sure of the charges and not all may be aware of the payment procedures followed. Most of the counselors or therapists may accept credit cards while others will arrange other methods of payment with their clients. According to Rohclen, Zack & Speyer (2004) online counselors have come up with several pricing models where some use flat rates for certain messages, per minute charges for time spent and/or package deals. This may raise an issue where the internet may not be as fast as face-to-face therapy as a client may spend a lot of time to respond to various messages and to send them. This could raise costs to the client and a client may be forced to either terminate the service if a package is over while she still has more questions to ask or incur additional cost for extra services.

Substantial research has been conducted on this issue, with many researchers highlighting the benefits and disadvantages and many suggesting that the practice will continue to grow tremendously. This is due to the benefits to clients who feel more comfortable with online therapy than face-to-face therapy where majority may feel ashamed to state their problems to another person. Majority of the literature has recognized the main issue in online therapy as the ethical issue of lack of comprehensive diagnosis where a therapist may not be in a position to take liability in relation to the client’s problems. According to Brown and Lent (2008), “although online therapy has numerous benefits, an equal number of legal and ethical issues must be resolved before those benefits can be fully realized.” One of the problem that Brown and Lent (2008) mention is the licensure of counseling and therapy provision where every state has its rules of conducting therapy, which may not apply to another state. The problem arises on how to control this considering that online therapy can be done anywhere irrespective of geographical barriers.

Another issue of online therapy is crisis intervention that all literature seems to mention. Online therapy currently does not stand a chance of providing crisis intervention since the counselor might not know the clients and where they live, making it hard to provide intervention when the client needs immediate attention. With online therapy allowing provision of therapy across borders from the comfort of a computer desk, and considering the anonymity a counselor my not be in a position to take liability of the client and in case of any problems the therapist may be held responsible for what happens to the client. The counselor should be in a position to take full responsibility of the clients’ actions and should come up with a way of ensuring they can offer intervention management such as recommending another counselor to offer the intervention, probably one closest to the clients’ place of residence. Most of the research conducted has criticized the ability of online therapy to handle severe mental cases since intervention and facial expressions are more needed in such severe cases. Critics argue that online therapy only applies to people who are seeking answers to daily problems that are not likely to need crisis intervention (Abbott, Klein & Ciechomiski, 2008).

In relation to this issue, Suler (2004) says that, “Everyday users on the internet … have noted how people say and do things in cyberspace that they would not ordinarily say and do in the face-to-face world.” Suler refers to this as the disinhibiting effect where people feel open to say anything on the internet. One of the six factors that contribute to the disnhibiting effect is dissociative anonymity, where a person feels that the counselor does not know them giving them the ability to avoid responsibility of what they say over the internet. The second factor is invisibility where clients cannot be seen by whomever they are communicating with. For instance, people might know you through emails, but they cannot see you when you are writing giving you more courage to express anything over the internet. The third factor is a synchronicity, where interaction does not happen in real time, since responding may take some time, unlike face-to-face where communication is in real time. With this, people can search their minds deeper for more information as they do not have to reply immediately, contributing to a dis-inhibiting effect that allows people to say more. Fourthly, Suler (2004) sites the factor of solipsistic interjection where a person reading emails from another person, perceives it as his own imagination of a character such as in a book, and when sending back, considers that he is not writing to a person like himself. The fifth factor is dissociative imagination where the person or client feels that there is a difference between cyberspace and reality, giving them the dis inhibiting effect where everything seems to be imagined, and which they can have when they are offline with no one holding them responsible. Last is the minimized authority or none to speak of, where the clients feel they are equal to the counselor, therefore feel they can say anything they would not say in the presence of an authority figure. Cyberspace does not recognize authority and anyone can interact with whomever they please. According to Rohclen, Zack & Speyer (2004) the disinhibition effect can enhance expression of ones feelings and a reflection of their problems to help them in their treatment through writing emails and texts that allow self-disclosure.

Critical Analysis Narrative

            According to Rohclen, Zack & Speyer (2004) online therapy has not been well defined and its definition is under debate, considering that it has several names such as online counseling, cyber therapy and email therapy hence creating a debate about what it really is to some people. This may be just a matter of opinion or in relation to the procedures used, such as email. The terms ‘online’ and ‘cyber’ have the same meaning in this issue while therapy and counseling are interchanged. Out of the literature reviewed, it is evident that online therapy started as a way of reaching out to the under served consumer who could not use traditional therapy due to various reasons such as lack of time for attending a session, costs involved, as well as the growing number of users. However, all the sources do concur that online therapy has not replaced traditional therapy considering verbal and facial impressions are needed for a better diagnosis. This makes the service unsuitable for all cases especially the severe ones such as suicidal thoughts where family would need to be informed. This raises issues concerning the effectiveness of online therapy in diagnosing mental conditions that could need more care considering that the behavior of the person is not comprehensively analyzed. Some people may not have the ability to express themselves through writing especially if they have mental conditions that could alter their thoughts.

According to Rohclen, Zack & Speyer (2004) one of the benefits of this service is accessibility to all people that have access to internet. Brown and Lent (2008), and Abbott, Klein & Ciechomiski (2008) all cite this as one of the major benefits of online therapy. However, computer illiterate people are not considered in terms of whether they could benefit from this service. Rohclen, Zack & Speyer (2004) suggest that such people could use help from others, which might invade on the privacy of clients who rely on help in sending and receiving information, for instance via emails. This would hinder the ability of the client to disclose what they might need to disclose. Moreover, internet sites are quite diverse and people might be used to some, and not understand others, which could create some problems during communication. Not all counselors are trained in offering online therapy and this could cause problems if such therapists were to offer online therapy.

In addition, Suler (2004) considers the disinhibition effect of internet as the major contributor driving people to opt for online therapy. Disinhibition has been considered a benefit that makes clients express themselves since they can reflect on their lives and say what they may not have said on a face-to-face basis. Research has not provided the disadvantages of this effect in a detailed manner, one of which is that any kind of information could be given if the client remains anonymous. Moreover, with this effect, there is bound to be lack of confidentiality when messages are sent to the wrong recipients or when computers are hacked into. Considering the article by Suler (2004), one gets to think that the only reason one opts for online therapy is its disinhibition effect. However, it is important to consider that many online therapy clients have had a face-to-face interaction with their counselor who might have recommended the online therapy to fit the schedule of the client. In addition, emails might reveal to some extent the identity of a person considering that several details are used in opening an email account, and also through the payment of services offered especially through credit cards.

Moreover, the issue of the internet allowing provision of therapy across regions and borders further comes with problems where cultural differences may cause barriers, such as language and miscommunication is likely to come up. However, Abbott, Klein & Ciechomiski (2008) further suggest that due to increased interaction between the client and the counselor as a result of frequent or daily exchange of information, a strong relationship could be established between the two parties.

Online therapy is indeed taking effect and more and more people are likely to use it for its convenience since it can be accessed from anywhere. It is however recommended that more research be undertaken to come up with better ways of enhancing communication between the providers and consumers. The major issue of online therapy is its effectiveness in diagnosis considering it does not include visual and audio communication. While online therapy may be advantageous, more research is needed in order to come up with better practices of providing the service to the client.

Problem Resolution

            Online therapy, according to majority of the researches conducted, has many benefits to the clients as well as to the therapists who will have a chance to cover the under served areas as clients get more access to therapy. However, to realize the benefits, a lot has to be done to address the emerging issues that make it unfavorable or not recommendable to all kinds of clients. These problems include inability to deliver crisis intervention, lack of the ability to take liability of the clients’ actions due to anonymity, and licensure where different laws demand different practice of online therapy in different states and regions. The main issue is that of minimizing anonymity. The solution fitted to solve this problem is that of making arrangements between the client and the counselor where communicating is done not only over the internet but also through phone calls and face-to-face interactions. This should be done before engaging in online therapy to allow the counselor examine the client. In cases where a client may want to receive services from a therapist outside his or her state’s licensure the client can make an arrangement with a counselor near them as in case intervention will be needed, the client will have a professional ready to intervene. The rationale behind the problem is allowing identity to be disclosed so that counselors can take full responsibility and make right diagnoses during the first few encounters.

Majority of the issues in online therapy occur due to anonymity where the counselor cannot execute crisis intervention, and where laws used may not apply to the client. This solution therefore involves a face-to-face encounter with a therapist that will examine the client to diagnose the mental condition. After a diagnosis, a client can have the choice of engaging in online therapy with the same therapist or request to engage with another therapist who shall be recommended by the therapist who conducts the face-to-face interview after consulting and who will brief them on the condition of the client. The counselor or therapist that conducts the interview will remain in contact with both the client and the recommended therapist in case intervention is needed. To ensure that intervention can be handled, there is need to have contact details of a trusted family member or a person who spends majority of their time together with the client to inform the counselor in case there is need for crisis intervention (Robinson, 2009).

The solution has its benefits, which include allowing counselors to take full responsibility of the client and keeping records of the progress throughout the process. Moreover, the client’s residence will be known to the counselor and the right laws according to license can be used to give the right procedures. In addition, the counselors would be in a position to contact the client in case he or she misses online appointments through a phone call, which may further give a sign of progress through verbal conversation. This solution will create a chance for clients to track the progress of the client and can tell whether the client is improving or not.

One of the disadvantages of this method is reducing the disinhibiting effect that gives the client ability to express themselves without fear or feeling vulnerable especially when a person close to them finds out about their problem as many seek online therapy to avoid embarrassment. Moreover, many who find it hard to tell their problems to others especially if they are personal will refrain from the first encounter and end up not having therapy. However, this is solvable in part through engaging a different counselor from the one who handles the face-to-face intervention.

With implementation of this solution, there are bound to be challenges and barriers considering that many people may not be willing to give out their identity. Convincing clients that are already used to anonymity to reveal their identity as well as contacts of their family may alienate some clients. The barrier to implementation of this resolution is licensure where not all counselors may be licensed to operate in all states or regions, and this could hinder some of the counselors from practicing online therapy especially if they do not have training on online counseling.

Conclusion

Online therapy is quite beneficial for clients especially those who may not be in a position to access the traditional methods due to various reasons. Some of the main reasons that hinder consumers from accessing face-to-face therapy are lack of enough funds to engage a counselor, tight schedules leaving people with little time for counseling, and physical problems that hinder people from moving around. Another reason could be personality types, which can especially be seen with introverted people who do not feel comfortable telling their problems to others. Fear of victimization is also a factor. Online counseling has enabled such people access therapy from wherever they are at reasonable prices, as well as has given them courage to express their feelings. In addition, through writing, clients have a chance to reflect on their lives as they think about what to write (Wright, 2002).

However, despite the benefits of online therapy some issues must be addressed to ensure that services provided can be accounted. This is in order to reduce the likelihood of people misusing such services. Online therapy  should be designed to offer crisis intervention as well as keep track of the clients’ progress just as traditional therapy does. There is need for additional research in order to find out whether online therapy can be personalized to include those that might need extra care during the process. In addition, online therapy should be made available to all those that need it through insurance, considering that majority are opting for it due to its convenience and as a way of saving costs associated with running offices and having to travel. More can be done in this type of treatment to improve the interaction between the counselor and the client, such as use of visual and audio aids to enhance better diagnosis as wrong diagnosis is often associated with types of online therapy where only emails and texts are used.

Online counseling has the potential to be as effective as face-to-face therapy with proper training of counselors. Additional research is required in order to find out how to solve the ethical issues revolving around this topic considering the number of people in need of therapy. Today many people amongst the society cannot have access to traditional therapy due to various reasons, which could be solved by online counseling. More research should be carried out and better practices adopted before concluding that online therapy is as effective as traditional therapy (Anthony, 2000).

 

References

Abbott, J.M., Klein, B., & Ciechomiski, L. (2008). Best Practices in Online Therapy. Journal of Technology in Human Services, 26 (2/4): 360-376.

Alleman, J. R. (2002). Online Counseling: The Internet and Mental Health Treatment. Psychotherapy River Edge-, 39, 199-215.

Brown, S.D., & Lent, R.W. (2008). Handbook of Counseling Psychology. Hoboken, NJ: John Wiley and Sons

Cook, J., & Doyle, C. (2002). Working Alliance in Online Therapy as Compared to Face-to-Face Therapy: Preliminary Results. Cyberpsychology & Behavior, 5 (2): 95-105.

Corey, G., Corey, M.S., & Callanan, P. (2010). Issues and Ethics in the Helping Professions. Clifton Park, NY: Cengage Learning

Griffiths, M.D. (2001). Online therapy: A cause for concern? The Psychologist, 14, 244-248.

Robinson, E. (2009). Online counseling, therapy and dispute resolution: A review of research and its application to family relationship services. Australia: AFRC Briefing15.

Rochlen, A. B., Zack, J. S., & Speyer, C. (2004). Online therapy: review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60 (3): 269-83.

Suler, J. (2004). The Online Disinhibition Effect. Cyberpsychology & Behavior, 7 (3): 321-326.

Wright, J. (2002). Online counseling: learning from writing therapy. British Journal of Guidance & Counseling, 30 (3): 285-298.