Cyber/Online counselling

Introduction

The psychotherapy session using computers from Stanford and UCLA in 1972 is considered as the

beginning of online counseling. The accessibility of internet to wider civil society increased access

to virtual communication mediums parallelly for people. This led to increase in virtual self-help

groups on the internet and their immense popularity. The information on sources related to online

counselling was first created by Martha Ainsworth. In 1995, Martha Ainsworth began searching

for a competent therapist because she had some psychological complaints. Her travel requirements

made it difficult for her to consult a face-to-face therapist, and therefore she needed an effective

alternative online therapist. She only found a dozen webpages that 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 and by the year 2000, this clearinghouse

contained over 250 websites of private practices, and more than 700 online clinics where a therapist

could be contacted.

According to metanoia.org, the first service to offer online mental healthcare was "Ask Uncle

Ezra", created by staff of Cornell University in 1986 for students. By mid-1995 several fee-based

online services offering mental health advice had appeared. Between 1994 and 2002, a group of

trained volunteer crisis counselors called "Samaritans", began providing suicide prevention

services via email. There has been continuous increase in number of online counselling therapists

and groups due to increase in web-based services and anonymity associated with virtual sessions.
Advantages and Disadvantages of Online Counselling

A. Online counselling offers several important advantages. These include:

Increased Accessibility: Online counseling is filling the unmet need for clients located in areas

traditionally under-served by traditional counselors. Rural residents, people with disabilities and

expats, along with under-served minorities often have an easier time finding a suitable therapist

online than in their local communities. It also makes counselling accessible to clients who face

difficulties in keeping appointments during normal business hours, while decreasing the number

of missed appointments for in-person therapy.

Along with accessibility of therapists, online counselling also enables accessibility of information

to the clients. In face-to-face counselling, information is stored only with the therapists. On the

other hand, in online counselling, the transcripts of communications between the therapist and

clients is available to therapist as well as clients both. This allows people seeking therapy to

monitor changes.

Increased Comfort and Convenience: Online counselling offers higher comfort and convenience

for clients and therapists alike. Therapists or clients do not need to travel or move out of their

comfort zones for their sessions. College students, working professionals and individuals who have

limited time or restricted travel conditions have the convenience of seeking help from where ever

they are located.

Anonymity and Privacy: Online counselling offers more anonymity and privacy as compared to

face-to-face interactions. This confidentiality allows people with social anxieties to seek help
without feeling discomfort. People who face hesitancy, stigmatization, or anxiety during personal

interactions also benefit greatly through online counselling.

Less expensive: Online counselling is less expensive than face-to-face counselling. Lesser costs

makes it more accessible to individuals with limited income.

B. Some of the key challenges of online counselling include:

Finding the right match for therapeutic needs of clients: While the online counselling platform

offers ease and convenience to the clients, it does not guarantee right match for the therapeutic

needs of the clients. Using online counselling as a stand-alone therapy may fail to address needs

of clients who require individual and focused therapeutic sessions. Emotional and visual contact

is absent during the online counselling sessions. This absence prevents therapists from sensing

negative feelings like anger, terseness, or irritation in clients. As resolving emotional concerns is

one of the main underpinnings of counselling, online counselling may provide limited benefits to

the clients as compared to face-to-face counselling.

Establishing authenticity of therapists or counsellors: Counsellors and therapists are

professional care providers and hence require license to undertake clients for counseling as a part

of their mandatory professional requirements. Psychologists and professional health care providers

require license of a particular state where they practice to take clients. As internet allows clients to

choose therapists all across the world, establishing legitimacy and authenticity of the therapists or

counsellors is difficult.
Data privacy and protection: Online counselling uses technology aided devices and internet as

the main medium for communication between the therapist and the client. All the personal and

sensitive information of patients is stored on internet sites or devices. This increases the risk of

data theft. It is important to establish the safety of the site and verification of therapist or client

before beginning an online counselling session

How It Works
Primary tools for communicating in online therapy include:

• Email
• Text messaging
• Real-time chat
• Internet phone
• Videoconferencing
• Mobile device apps
• Telephone
• Chat room assistance
• Live calls

Such services may be accessed via a desktop computer or laptop, but mobile apps are also
becoming an increasingly popular option.

History of Online Therapy

Distance communication between a therapist and client is not a new concept. Sigmund Freud
utilized letters extensively to communicate with his clients. Self-help groups began emerging on
the internet as early as 1982. Today, there are numerous sites offering mental health information
as well as private e-therapy clinics.

The growth in online counseling and mental health services has led to the foundation of the
International Society for Mental Health Online. This dramatic rise in the availability of online
health care has led to a need for information and guidelines for customers interested in receiving
mental health services via the internet.
In recent years, online sites and apps devoted to mental health services have become increasingly
popular.

Options such as Talkspace and BetterHelp provide a range of options and price points, making
these options appealing to those looking for affordable and convenient treatment options.

The prevalence of smartphones has led to a number of app-based options that are accessible and
often quite affordable. Evidence also increasingly shows that such options may be an effective
treatment option for some people.

A Verywell Report: Americans Find Strength in Online Therapy

Effectiveness

While online therapy presents some challenges, it has received support from many patients who
have utilized online mental health treatments. In a review of studies published in the journal World
Journal of Psychiatry, patients receiving mental health treatment through video conferencing
reported "high levels of satisfaction."1

Verywell / Alison Czinkota

Research also suggests that online therapy may be effective in the treatment of a number of health
issues. This is good news for many people, particularly those who live in rural areas where access
to mental health services may be limited.

In one study, researchers found that online CBT combined with clinical care was effective in the
treatment of depression, anxiety, and illness-related emotional distress. In some cases, the results
indicated that some patients actually had better outcomes with online treatment than those who
had traditional in-person CBT.2

Cognitive-behavioral therapy is one of the most well-studied forms of treatment and has been
shown to be effective in the treatment of a range of mental conditions including depression,
anxiety, PTSD, eating disorders, and substance abuse. CBT works to help people identify and
change negative thoughts and behaviors.

A 2015 study found that internet-based cognitive-behavioral therapy was just as effective as
traditional face-to-face CBT in the treatment of anxiety disorders.3 One 2017 review of studies
also concluded that online CBT was an affordable and effective option for the treatment of mental
health issues.4

Online therapy is not appropriate for everyone, but there are times when people might prefer this
approach.

For example, those who feel uncomfortable attending traditional face-to-face support groups might
benefit from internet-based options. Online psychotherapy services have some advantages and
disadvantages that should be carefully considered.

Convenience is often cited as one of the greatest benefits while unreliable technology and lack of
insurance coverage are potential downsides. Before you decide if online therapy is right for you,
think about issues such as confidentiality, ethical and legal issues as well as the qualifications of
online therapists.

How Cognitive Behavior Therapy Works

Online Therapists

Just as therapists and counselors in "real-world" settings can have a range of qualifications and
licenses, online therapists can also differ considerably in their training and credentials. While some
sites may promise a quick and easy path to becoming an online therapist, the fact is that the
educational and training requirements to become an online therapist are exactly the same as they
are for a therapist or counselor practicing in a traditional face-to-face setting.

However, the actual practice of online therapy is very difficult to regulate since therapists can
operate from anywhere in the world making it tough to enforce state laws regulating
education, training, and scope of practice.
Online therapy is appealing to mental health consumers, who often view it as a convenient,
economical and accessible alternative to traditional face-to-face therapy.

However, it also poses a number of unique concerns including questions about the confidentiality
of client information the appropriateness of using online therapy as a treatment method for various
psychological disorders. If you are interested in becoming an online therapist, then you should
check the laws in your state to determine the requirements for becoming a licensed therapist or
counselor.

The Online Therapy Institute also offers a good ethical framework for the use of technology in
mental health. These guidelines suggest the minimum practices and standards required for ethical
online therapy:

• Therapists should only work within the scope of their practice. In other words, online
therapists should only offer services that they are trained to provide.
• Online therapists should adhere to the laws and guidelines specified by their geographic
location. For example, in the U.S., only individuals who have received specific training
and have passed the required licensing process are legally allowed to call themselves
psychologists.
• Therapists should obtain knowledge, training, and supervision in online therapy practices
and techniques. This includes formal training (college or university courses), informal
training (workshops and conferences), and clinical supervision (either face-to-face or
online).
• Online therapists should have a solid understanding of technology. This includes how to
use the tools required to deliver psychotherapy online and how to ensure that client
information remains private and secure.

While research increasingly suggests that online therapy can be an effective option, that does not
mean that it is right for everyone. More serious forms of mental illness, including substance
addiction and psychiatric conditions including severe depression and schizophrenia, require more
than online treatment can provide.