Online Therapy
It's the third day of my vacation and I'm starting to think about the various plans I've lined up for while I'm here. For the last year I've been in the process of doing the background work that goes into setting up an online therapy website, and one of the steps I've taken was to attend an online training with Elizabeth Zelvin, a therapist whose clinical practice is exclusively online. I've been procrastinating, primarily around the building of the website. Believe me, I have no excuse. I have a wonderful web designer, Nick Wigzell, who is going to build the architecture and design the site, and I have a spouse who is designing the back end practicalities of an online business. The place where I'm mainly stuck is in writing the website itself, the front end description of what online therapy actually is. I thought it would help if I wrote a blog about what I understand and believe about online therapy. Talking to therapy folks who are not online therapy savvy is typically frustrating - it scares most therapists to think about doing therapy online, and many of them don't believe that it can possibly be effective. The research belies this.
Meanwhile, what is online therapy? Are there any benefits to online therapy versus face-to-face therapy? What are the pitfalls of online therapy? Are there folks who seem to benefit more from online therapy versus face-to-face (f2f)? What kind of people should avoid online therapy and why?
Now, despite the fact that I haven't yet conducted an online therapy practice, I have a fair amount of experience conducting online chat rooms, as I worked for AOL many years ago as a chat room facilitator. I understand the dynamics of how relationships develop online, I understand the power of lines of text between people and how easily, unless you are careful and attentive to what you are saying and how you are saying it, your words and the words of others can be misinterpreted and misunderstood. I understand the need for clarity, and also for protocols to define online relationships. What follows comes from picking the brains of those who have gone before, along with my own research.
Types of online therapy
There are two main types of online therapy: synchronous and asynchronous. Synchronous therapy sessions happen in real time which means that they are immediate and in the moment. For example, chatting via instant messaging or in a chat room would be examples of synchronous therapy sessions.
What are the benefits of chat room therapy?
As anybody who has ever talked in a chat room knows, things happen fast. Chat room therapy is no different apparently. It's extremely fast-moving and it behooves the online client to either have or develop the ability to multi-task and follow fast-scrolling text. Just like any chat room, it's possible for the online-savvy therapy client to benefit from a lot of the same qualities that accompany f2f therapy, such as expressive communications, and on-the-spot interactions with the therapist, who is able to respond immediately to what the client is saying. Chat room therapy also provides structure to clients, somewhat replicating the idea of standard, scheduled appointments that happen in f2f therapy. Chat room therapy provides some consistency and a sense of ongoing relationship between therapist and client, and allows for the growth of a therapeutic relationship between participants.
What are the benefits of email therapy?
Email therapy is of great benefit to clients whose typing skills are slow. Chat therapy is speedy, but email therapy allows clients to go at their own pace. Without the discipline of a typical 50 minute therapy hour, which is standard for both online synchronous therapy and face-to-face therapy, people have plenty of time to write their therapy email in a reflective and thoughtful way. There's less of an on the spot feel than in face-to-face therapy, and for some folks removing this pressure is an added advantage. For clients who enjoy writing and expressing themselves in the written form, there's an extra familiarity that comes from writing. Conversely, for some clients the emails provide the distance that they need to feel comfortable and safe. They have control over how much or how little intimacy is fashioned and feel that they have more control over the session via email. In a typical f2f therapy session, the therapist answers a client's question or responds to a concern and then the words effectively vanish. In contrast to this, clients are able to retain their connection to the therapist via the written word in email therapy. Communications via email can be read again and again, allowing the online client time to absorb what the therapist has to say in their own time. The speed of therapy via email is a slower. Another benefit is the absence of structure. There is no need to schedule sessions and client and therapists can write and respond at their own pace. Email therapy is typically cheaper than synchronous therapy, and this often guides an online client's choice of the type of therapy they will select.
What kind of people seek out online therapy?
All kinds of people can benefit from online therapy. For example, busy parents who can't find babysitters or have very little time in which to leave their homes for therapy. People with disabilities who can't easily access transportation or accessible therapy offices. There are people with facial/bodily disfigurements who do not feel able to leave their homes or feel reluctant to be seen in public due to the social stigmas attached to physical differences. There are people with stutters who do not feel encumbered by their stutter online. Not everybody lives near places providing mental health services, and the online therapist is their only possible resource. Some sexual abuse survivors, both male and female, have significant anxiety about seeking face-to-face services with a therapist. These and other folks wary of face-to-face contact have the option to pursue online therapy.
Who is best suited for online therapy?
As I've already written. people who do well communicating via the written word are good candidates for online therapy. Plus it helps if you are able to maintain online relationships. It also aids in rapid communication if you have nimble fingers and are fairly internet savvy.
Who is ill-suited for online therapy?
Online therapy is not a good option for people who are very depressed and suicidal, or those who refuse medication or face-to-face therapy. It isn't usually possible using online therapy to create and sustain adequate therapeutic supports for them. Having said that, Azy Barak has an online practice specializing in services for suicidal clients, but he is a rarity. If you have big trust or safety issues, it's harder to develop a trusting therapeutic relationship with a therapist online, which means that it's also more challenging to be effective as a therapist. Not impossible, just more challenging. Some of the challenges that surface in any online relationship, will surface too in online therapy, but the ante is upped. For example, if you are dependent on the internet for contact with the outside world, this means that losing your modem, a dial tone, or the server going down creates hardship for a while. But this becomes an even larger challenge in therapy, where it's easier to feel abandoned by your therapist, even though he or she has no contact over the vagaries of errant IP's. This means that sometimes time needs to be spent on explaining why the therapist wasn't at the chat room at the appointed time, or why the email didn't get through that you were depending on for solace and support. Online therapy is not covered by most Health Insurance plans, so unless you have credit cards or a regular income it can be prohibitively expensive.
About 18 months ago I joined the International Society for Mental Health Online (www.ISMHO.org) to get up to speed on all the current thinking and research being conducted into online mental health services. For those of you who are interested, it's worth checking out their website. You can also watch for my eTherapy site, coming soon to an internet near you, at www.JassyTimberlake.com.
Meanwhile, what is online therapy? Are there any benefits to online therapy versus face-to-face therapy? What are the pitfalls of online therapy? Are there folks who seem to benefit more from online therapy versus face-to-face (f2f)? What kind of people should avoid online therapy and why?
Now, despite the fact that I haven't yet conducted an online therapy practice, I have a fair amount of experience conducting online chat rooms, as I worked for AOL many years ago as a chat room facilitator. I understand the dynamics of how relationships develop online, I understand the power of lines of text between people and how easily, unless you are careful and attentive to what you are saying and how you are saying it, your words and the words of others can be misinterpreted and misunderstood. I understand the need for clarity, and also for protocols to define online relationships. What follows comes from picking the brains of those who have gone before, along with my own research.
Types of online therapy
There are two main types of online therapy: synchronous and asynchronous. Synchronous therapy sessions happen in real time which means that they are immediate and in the moment. For example, chatting via instant messaging or in a chat room would be examples of synchronous therapy sessions.
What are the benefits of chat room therapy?
As anybody who has ever talked in a chat room knows, things happen fast. Chat room therapy is no different apparently. It's extremely fast-moving and it behooves the online client to either have or develop the ability to multi-task and follow fast-scrolling text. Just like any chat room, it's possible for the online-savvy therapy client to benefit from a lot of the same qualities that accompany f2f therapy, such as expressive communications, and on-the-spot interactions with the therapist, who is able to respond immediately to what the client is saying. Chat room therapy also provides structure to clients, somewhat replicating the idea of standard, scheduled appointments that happen in f2f therapy. Chat room therapy provides some consistency and a sense of ongoing relationship between therapist and client, and allows for the growth of a therapeutic relationship between participants.
What are the benefits of email therapy?
Email therapy is of great benefit to clients whose typing skills are slow. Chat therapy is speedy, but email therapy allows clients to go at their own pace. Without the discipline of a typical 50 minute therapy hour, which is standard for both online synchronous therapy and face-to-face therapy, people have plenty of time to write their therapy email in a reflective and thoughtful way. There's less of an on the spot feel than in face-to-face therapy, and for some folks removing this pressure is an added advantage. For clients who enjoy writing and expressing themselves in the written form, there's an extra familiarity that comes from writing. Conversely, for some clients the emails provide the distance that they need to feel comfortable and safe. They have control over how much or how little intimacy is fashioned and feel that they have more control over the session via email. In a typical f2f therapy session, the therapist answers a client's question or responds to a concern and then the words effectively vanish. In contrast to this, clients are able to retain their connection to the therapist via the written word in email therapy. Communications via email can be read again and again, allowing the online client time to absorb what the therapist has to say in their own time. The speed of therapy via email is a slower. Another benefit is the absence of structure. There is no need to schedule sessions and client and therapists can write and respond at their own pace. Email therapy is typically cheaper than synchronous therapy, and this often guides an online client's choice of the type of therapy they will select.
What kind of people seek out online therapy?
All kinds of people can benefit from online therapy. For example, busy parents who can't find babysitters or have very little time in which to leave their homes for therapy. People with disabilities who can't easily access transportation or accessible therapy offices. There are people with facial/bodily disfigurements who do not feel able to leave their homes or feel reluctant to be seen in public due to the social stigmas attached to physical differences. There are people with stutters who do not feel encumbered by their stutter online. Not everybody lives near places providing mental health services, and the online therapist is their only possible resource. Some sexual abuse survivors, both male and female, have significant anxiety about seeking face-to-face services with a therapist. These and other folks wary of face-to-face contact have the option to pursue online therapy.
Who is best suited for online therapy?
As I've already written. people who do well communicating via the written word are good candidates for online therapy. Plus it helps if you are able to maintain online relationships. It also aids in rapid communication if you have nimble fingers and are fairly internet savvy.
Who is ill-suited for online therapy?
Online therapy is not a good option for people who are very depressed and suicidal, or those who refuse medication or face-to-face therapy. It isn't usually possible using online therapy to create and sustain adequate therapeutic supports for them. Having said that, Azy Barak has an online practice specializing in services for suicidal clients, but he is a rarity. If you have big trust or safety issues, it's harder to develop a trusting therapeutic relationship with a therapist online, which means that it's also more challenging to be effective as a therapist. Not impossible, just more challenging. Some of the challenges that surface in any online relationship, will surface too in online therapy, but the ante is upped. For example, if you are dependent on the internet for contact with the outside world, this means that losing your modem, a dial tone, or the server going down creates hardship for a while. But this becomes an even larger challenge in therapy, where it's easier to feel abandoned by your therapist, even though he or she has no contact over the vagaries of errant IP's. This means that sometimes time needs to be spent on explaining why the therapist wasn't at the chat room at the appointed time, or why the email didn't get through that you were depending on for solace and support. Online therapy is not covered by most Health Insurance plans, so unless you have credit cards or a regular income it can be prohibitively expensive.
About 18 months ago I joined the International Society for Mental Health Online (www.ISMHO.org) to get up to speed on all the current thinking and research being conducted into online mental health services. For those of you who are interested, it's worth checking out their website. You can also watch for my eTherapy site, coming soon to an internet near you, at www.JassyTimberlake.com.
posted by Jassy @ 6:00 AM
2 Comments:
At 7:32 PM,
Damon Gale said…
Hello,
This above post is quite informative and is useful too. I really liked it. Thank you too much...
online therapy
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