Online counseling

Online counseling is the provision of professional mental health counseling services through the Internet. Services are typically offered via email, real-time chat, and video conferencing.^[1] Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling, and a growing number of clients are using online counseling as a replacement for office visits.^[1]

While some form of tele-psychology has been available for over 35 years,^[2] the advent of internet video chat systems and the increasing penetration of broadband has resulted in a growing movement towards online therapy. Clients are using videoconferencing, live chat and email with professional psychologists in place of or in addition to face-to-face meetings.^[2]

History

Since the beginning of the internet in 1972 several creative people perceived the potential of the internet for the therapeutic communication. At the time the internet went public, this launch went hand in hand with the development of the first self-help groups on the internet who were, in that time, very popular. In 1995, Martha Ainsworth had a couple of psychological complaints where she wanted to get rid off it, so she began searching for a competent therapist. Because of the fact that her travel requirements formed a difficulty to consult a face-to-face therapist she went searching for an effective alternative online. The result was that she found merely a dozen webpages who offered online treatment for psychological complaints. Afterwards Martha Ainsworth wanted to reach the general public with her experiences and founded a sort of clearinghouse for mental health websites, named Metanoia. This database seemed to be a very efficient store-room, as by the year 2000 this clearinghouse contained over 250 websites of private practices, and more than 700 online clinics at a therapist could be contacted.^[3]

Back in the eighties the first service that launched online mental healthcare into our lives was “Ask Uncle Ezra”. This service was initially meant for students of Cornell University in Ithaca, New York. The services' name, “Ask Uncle Ezra”, was chosen by Jerry Feist, the founder of the Director of Psychological Services. He worked together with Steve Worona and their service stayed operative until today. The real break-through of online mental healthcare took place in mid-1995, when several free-based public services for mental healthcare appeared, all with the common purpose to provide mental health advice. The founder of these public mental health services was Leonard Holmes, who developed “Shareware Psychological Consultation”. After 1995 David Sommers gave the world of online treatment a whole new dimension: he can be perceived as the pioneer of e-therapy. The core concept of his kind of treatment was the purpose to treat his clients only via the internet in an ongoing helping relationship.^[4]

Also worth mentioning are the so-called “Samaritans”, a group of trained volunteer crisis counselors, who have done pioneering work with suicidal persons. Between 1994 and 2002 they received an enormous number of e-mails, which they responded to in an anonymous way and without charge. In the area of online counseling, their work can be seen as extremely valuable, because they saved hundreds of despairing and suicidal persons. ^[6] It can be assumed that in the near future clients will choose more and more for a psychological treatment that is given via the internet, or at least that they will combine traditional face-to-face therapy with another form of online mental health care. This will also probably be the case for those who exercise a mental health profession: some will prefer to work in a traditional context, whereas others will be more likely to interact with their clients via the internet.^[5]

Benefits

The growing body of research into online counseling has established the efficacy of online therapy with treatment outcomes at least equal to traditional in-office settings.^[2] Online therapy has additional benefits unrealized by office-based treatments as it allows the patient to attend sessions at a higher rate than traditional sessions. The number of missed appointments is much less than with in-person therapy.^[6] There is some research to suggest that online counseling is more effective because a client is at greater ease and feels less intimidated than they would in traditional settings. This makes clients more likely to be honest and thus allow the counselor to provide better treatment.^[7]

Online counseling is also filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents and expats along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities.^[2] These access issues are solved with online counseling resources and result in clients receiving culturally or linguistically relevant treatment that they would not have otherwise been able to receive. African Americans tend to have an elevated rate of stress-related diseases and have lower access to traditional face-to-face treatments.^[8]

Online counseling has also been shown to be effective for clients who may have difficulty reaching appointments during normal business hours.^[9] Additionally, research is demonstrating that online counseling may be useful for disabled and rural people that traditionally under-utilize clinical services.^[2]

Effectiveness

Research from G.S. Stofle and J. suggests that online counseling would benefit people functioning at a moderately high level.^[10][11] Severe situations such as suicidal ideation or a psychotic episode might be better served by traditional face-to-face methods.^[12] Although further research may prove otherwise.^[2]

Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.^[13]

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition.^[2] Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.^[14] Researchers have suggested that counseling professionals themselves are more critical of newer technologies than their clients.

Nutrition counseling specific to conditions is available by many consultants online using Skype or another face-to-face program. This is especially effective for people with a busy work schedule, and others who can't make it to an office regularly. Online consulting for imbalances in blood lipid levels, blood sugar regulation, and other health conditions make it easier to manage when using nutritional approaches. ^[15][16]

Controversy

There is a split within the counseling field on the validity of online counseling. Some practitioners have suggested that online counseling cannot be considered psychotherapy,^[17] while scientific journals such as The Lancet have published studies that conclude that online cognitive behavioral therapy is as effective as traditional "in-person" therapy for the treatment of depression.^[18]

References