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Does online therapy work as well as a face-to-face session?

Posted on 04 April 2017

The way we communicate has changed so dramatically over the past few years. Just walk down the street and look at the number of people staring at their smartphones (and sometimes tripping over the pavement!)

So, it’s not surprising that therapy is being offered online and via smartphone apps. in fact, it is surprising that it hasn’t taken off more quickly, but it is certainly on the up now, with both private companies offering services or apps and the NHS mental health services developing digital services on a big scale. The UK government is spending £60 million to develop digital technology in selected mental health trusts.

I’m not too sure about it myself. On the one hand, it gives people who are isolated, too busy or cannot visit a therapist a chance to get help, and that has to be a good thing. But, I worry that it takes away my ability to ‘read’ what is really going on with my clients and respond accordingly.

Many therapists are worried about the way things are going. For example, New York-based addiction specialist Paul Hokemayer who says ‘the dialogue that occurs online is much more shallow and transient. It’s like comparing an artificial sweetener to honey.’

I have noticed clients are beginning to ask my opinion of online therapy when they come to my anxiety hypnotherapy clinics in Harley Street or Henley on Thames, so I have been doing a bit of research to see what is out there so I can offer them the best and most comprehensive advice.

Firstly, I looked at some of the private sites which have sprung up recently. Not surprisingly, the United States has led the way. Things have taken off in a big way with sites such as talkspace and it is now possible to book sessions with qualified and experienced therapists online. Looking at the packages they offer, the service is based around written emails, but video sessions are also available. The video sessions may overcome one problem with online therapy and that is the lack of body language or non-verbal communication.

I know from my day to day work, especially with anxiety hypnosis, how important those non-verbal cues are. The way my clients sit, their facial expressions, how they position themselves, how they respond to what I am saying is all essential to the whole process of therapy. In the therapy business, reading non verbal cues is a complex and wonderful thing and much more easily achieved in a face-to-face session. The cues we send and receive are so subtle, so many and so complex that it is very difficult to get the full picture even with a video screen link.

On top of this, I worry about how a therapist would deal with an emotional upset in a client remotely.  Abreactions can happen and even be a productive part of therapy. I know how to utilise this in my hypnotherapy room but am not so sure it is possible over a video link.

I also believe that the very act of coming to my anxiety hypnotherapy clinic is the beginning of therapy. The work starts before my client walks in the door. It may be that online therapy is easier, and if that really is the only option then it may be better than nothing, but if at all possible that act of leaving the house and coming to my clinic is a part of the whole therapeutic process.

It may depend on the type of problem

The complexity of issues being dealt with might be an important factor in how well online therapy works. Where therapy is aimed at changing lifestyle and nothing deeper, for example online therapy seems to work very well.

For example, the American College of Cardiologists and the Heart and Strike Association of Canada report a success in using e-counselling with people with high blood pressure. In a joint study, they found that a group who received lifestyle support and counselling were much more successful in reducing their blood pressure than a control group.

The NHS starting to develop online services

Back in the UK, there has been a huge surge in NHS offering people with mental health problems webcam appointments. These have gone up nine-fold since 2012 and a majority of assessment interviews, when therapists make a judgement on the best form of treatment for the patient, are now conducted over the phone.

Five online resources have so far been vetted and are available via the NHS choices website reports mobi health news.

These are:

  • Beating the Blues, a CBT-based computer self-help course for anxiety and depression
  • Big White Wall, an anonymous, but monitored social network for people dealing with depression
  • FearFighter, a CBT-based self-help course for phobias
  • Ieso Digital Health, which offers live CBT therapy via secure instant messaging; and
  • SilverCloud, an online platform that offers programmes for different mental health conditions. 

Some of these sites are only available in certain NHS regions, others can be paid for.

There is considerable controversy about these initiatives, with experts who back them citing ease of access and those who don’t saying that they cannot provide the high-quality contact on which good therapy relies.

One critic of the system is Steve Flatt, director of the Psychological Therapies Unit in Liverpool, he told The Independent that remote therapies ‘fly in the face of what it means to be human.’ And went on to say that a webcam or a keyboard was a barrier to contact.

The clinical director of the IESO programme Sarah Bateup disagrees, saying that after reading thousands of transcripts of therapist/client interactions, (IESO works via an online messenger system) she is sure of the presence of a good client therapist relationship.

My position is probably closest to that of Helen Morgan, chair of the British Psychological Society. She says that the online route might work for some people but she is worried that some issues may be too complicated for this approach. She told The Independent: “I’m worried about the rise of quick and easy interventions for what are often very complex problems where people need to become known and understood and be in a room with someone building a relationship.”

I am sure that over the next few years online delivery of therapies will grow, it may feel more acceptable to the generation now growing up for whom new technology has always been a part of their lives. I still prefer to have my clients sitting in my hypnotherapy clinics so I can use my full range of proven therapeutic techniques.  It is this blend of tailored techniques that allow me to deliver excellent therapeutic results.

I know why interventions are successful, so it may well be that it is worth investing the time and money now, even if that does feel more inconvenient compared to accessing an online service. I can often sort the problem once and for all in a few sessions. That is worth the time, isn’t it?

Fiona Nicolson on Google+

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