Is Online Therapy Effective

The growth and availability of online therapy and counseling over the internet has been extraordinary over the last decade.  But how effective is therapy in the absence of the physical presence of the therapist, and how certain is it that the therapy a client receives is delivered by a competent, licensed professional adhering to the ethical guidelines of the profession?

The first time I encountered the idea of online therapy was a few years ago in an article in the September 25, 2011 issue of the New York Times entitled ” When Your Therapist Is Only a Click Away.” written by Jan Hoffman.  What made this article most memorable to me was the description of the client as she prepared for her therapy appointment:

She mixed herself a mojito, added a sprig of mint, put on her sunglasses and A Cell Phone with a Video Call in progressheaded outside to her friend’s pool. Settling into a lounge chair, she tapped the Skype app on her phone. Hundreds of miles away, her face popped up on her therapist’s computer monitor; he smiled back on her phone’s screen.

Although I can’t find any clinical correlation on the subject of drinking alcohol in the therapy session, I instinctively felt something wasn’t right with this behavior, and with the therapists acceptance or lack of awareness of it.  One of my mentors in the profession turned me on to a few facts of neurobiology and the impact of eating and chewing gum during counseling.  The act of chewing is a soothing behavior, visible in infants most clearly thanks to the pacifier, but present throughout the lifespan.

A study by The University of Nevada indicated that while chewing gum the physiological effects of stress were reduced and emotional affect is less discernible. , and fount that chewing reduced the stress hormone cortisol in study participants.  Additional studies including one published this past March by Swinburne University in Melbourne have shown that affect changes in reaction to stimuli, particularly from conversational stimuli, is greatly slowed while chewing, drinking or shortly after ingestion.  I have made it a personal policy to ask my clients to refrain from eating, or chewing gum in my office because of this knowledge.

  • Affect refers to the conscious experience of feeling or emotion.
  • Emotional Affect  this is a crucial component of the therapeutic process.

Studies have been conducted that show a variety of outcomes about online therapy.  

A Columbia University study indicated that internet-based therapy is no more effective then seeking advice from untrained friends and family¹.

A different research group at Columbia University found that remote therapy using high definition video conferencing was a viable alternative source of help when traditional psychotherapy is not accessible, and that outcome measures indicated 30% better outcomes if remote therapy was conducted between therapists and clients who had an existing relationship of face to face therapy².

More recent studies show that internet-based therapy is just as effective as face-to-face therapy, however these studies were conducted by an organization that trains remote therapy practitioners, using telephone surveys of therapists who have internet based therapy clients, leading to a question of bias³.

As The New York Times article discussed, there are many concerns with the practice and oversight of Online Therapy. The opportunities for exploitation and ethical violations, especially by those with questionable or lacking credentials, are innumerable. The protections of a mandated code of ethical behavior, mandated malpractice insurance, and legal jurisdiction, all are at best uncertain.

The most crucial concerns I have as a therapist are:

  • The reality that in therapy it is not uncommon for someone to face emotional content that leaves them feeling worse before they can begin to feel better.
  • The responsibility I have as your therapists to assess and address the possibility of self harm, or of a client who threatens harm to another.
  • The lack of ability to know for certain where a client is physically, what do I do if I need to call for emergency aid for the client.
  • The implications of unexpected technical difficulties, loss of cellphone signal, internet connectivity, or software crash, I do not like the idea of leaving a client feeling cut off or abandoned even if they understand the possibility of such technical difficulties.

I believe that Online Therapy is a preferable option to no support for people who cannot or will not see a therapist in person.  Working with a therapist in person is still better, however I believe it can be of great value as an addition or adjunct to in person therapy.  Though it falls short of full-fledged psychotherapy, is still a very effective source of help, and can provide a client who needs to travel for extended periods of time, or has a crisis when away from home with a means of reaching out to their therapist for help.

I continue investigating the legal and ethical precautions necessary to offer this kind of service as an adjunct to therapy for my traditional clients, and to allow for couples or family interaction

  1. 2007 Graduate School of the Arts and Sciences at Columbia University
  2. 2010 Columbia School of Social Work at Columbia Universit
  3. 2013  TeleMental Health Institute