Online counselling is fast becoming a popular model for support for young people, with key national services such as Lifeline, Kids Helpline, Suicide Call Back Service and headspace adding online counselling to their service provision. Find out more about the evidence behind the benefits and the potential disadvantages of online counselling.
This article will assist with:
- understanding the evidence behind online counselling
- understanding the pros and cons
- applying a considered approach to it’s use.
What are the benefits and disadvantages of online counselling?
Already numerous studies suggest that internet counselling, when combined with cognitive behaviour therapy, can be effective on a variety of clinical issues.7, 12, 13
Web counselling refers to counselling services through the internet and includes, for example, emails, chat rooms and web cameras. This type of counselling goes by so many names such as cyberspace counselling, e-therapy, e-counselling and tele-counselling.8
There is increasing debate about the effectiveness of this form of counselling in comparison to traditional counselling. To balance this debate, this post looks at some of the benefits and disadvantages of online counselling.
Web counselling is easily accessible to all those who wish to use it. Online therapy overcomes barriers that may preclude others from seeking therapy. For example, individuals residing in rural or remote areas where there is no counselling services can benefit from the accessibility of online counselling.
Those that are physically disabled or unable to leave their home can also easily access such services with little inconvenience. Those that have visual and hearing impairments can also benefit from such services. Web counselling has also shown to be effective in encouraging children and teenagers to receive therapy as they seem to be more comfortable with using the internet.12
Online therapy is convenient. Both the therapist and the client have the convenience of corresponding with each other at a range of variant times. This style of therapy can take away the hassle of scheduling and setting appointments more common in traditional settings. This also creates an opportunity for the therapist to extend their services to more clients as appointments can be potentially scheduled over 24 hours and reach a larger geographical region.
For those individuals who are ambivalent about therapy or who may be uncomfortable with traditional models of therapy, may find online counselling more suitable whereby it has been found that online therapy is preferred by those who are uncomfortable with talking face to face with someone about their problems or who are suffering from social phobias, agoraphobia or anxiety disorders.5
Web counselling has been shown to be more economical for both the therapist and the client. Especially for those therapists who are unwilling or cannot afford to rent commercial space thereby lowering overhead costs of capital, property, commuting and administration procedures when compared to traditional counselling services.1
Online counselling may also be effective in eliminating social stigma associated with receiving therapy. For those who are uncomfortable with receiving therapy, online counselling allows access to such services in private without having to visit the counselling centre. Counselling can take on a whole different image when executed by the client in their own home through the computer. It may also allow the client to feel less stigmatised without having to be seen by others in the waiting room, the administrative staff or any other person who just happens to be walking past at the time the client walks through the door.
Because of this, online counselling clearly does offer the client a degree of anonymity that may reduce such social stigma and therefore prompt them to seek assistance when they might otherwise have hesitated.
The absence of face to face contact can also prompt clients to communicate more openly without concerns for bias of race, gender, age, size or physical appearance.6 This may lead to an increased level of honesty and therefore higher validity in the case of self disclosure. The internet clearly offers a level of anonymity that is perceived by many users as non-threatening through allowing an 'invisibility' that can be disinhibiting.2
Variant ways to communicate
Most communication through the internet is in written form. Online counselling, in which the mode of communication is often through writing via emails or a chat room, allows both the client and the therapist to pay close attention to their communication and reflect on their thoughts and feelings prior to it being expressed. This may be a particularly suitable way of communication for those clients who experience difficulty expressing themselves in words. Clients may also be able to communicate better in this environment as they are not affected by the therapist's nonverbal cues.
Research suggests that writing during times of distress is particularly useful for clients as it is considered to provide a vital avenue for emotional healing.7 Given that online counselling is an interactive form of therapeutic writing, interventions delivered in this environment may be quite effective in encouraging clients to express themselves in more thoughtful, self reflective and insightful ways. Having a written record also allows the client to have a reference point in future discussion, review and in the assessment of change and progress.
While on one hand, the benefits of online counselling have been considered,3 online counselling has also been criticised in terms of its absence of verbal and nonverbal cues, difficulties in maintaining confidentiality and security, overall effectiveness, technological difficulties and in its limits of being able to guarantee the therapists credibility.
Absence of verbal and nonverbal cues
While some advantages were presented previously in the absence of verbal and non-verbal cues through online counselling, there are also disadvantages in not having such cues when counselling.
Verbal and nonverbal interactions are considered essential for gauging what the client is feeling and for identifying the discrepancies or incongruences between verbal and nonverbal behaviours. Online counselling has been criticised for lacking such important elements of the micro skills of counselling.
Traditional counselling relies heavily on the characteristics of both verbal and nonverbal cues as a form of communication and as a way of gaining insight into the thoughts, feelings and behaviours around the clients presenting concerns. Online therapy does not give an indication of characteristics such as voice tone, facial expression, body language and eye contact. This can potentially impact negatively on the counselling outcomes as the therapist has no opportunity to observe and interpret such cues.5, 8, 13
Confidentiality and security
Mental health practitioners have an ethical responsibility to protect and maintain the confidentiality of their clients. With online therapy the security of the client's records and information could be jeopardised and confidentiality is at greater risk of being inappropriately breached given the written nature of the medium.
Although most sites strive to have security systems to protect confidentiality, it is as good as the latest version of the security software used. Practitioners will have to continuously upgrade their technology to prevent security breaches.6
Professionals and laypeople alike have continuously questioned the effectiveness of online therapeutic interventions. There is currently little research supporting the lack of effectiveness of counselling that is provided solely through such a medium.11 The lack of face-to-face interaction could increase the risk of misdiagnosis by the therapist.10 Because of this, online therapy is currently deemed inappropriate for diagnosis of clinical issues such as chronic depression and psychotic.
It is not unusual for computers to fail and internet connections to falter. For example, those who are in remote areas may have less than perfect transmission that drops out regularly or there is always the possibility of servers crashing and network connections faltering. The ability to benefit from online therapy is also partly determined by the client's computer skills and knowledge, especially if the communication setting involves installing and learning new software and/or hardware. This may disrupt the session and can potentially be distressing for the client.
The client receiving online therapy has little or no assurance about the qualification and credentials of their therapist. This exposes the client to the exploitation of inexperienced individuals pretending to be bonafide counsellors. Thus it is important to refer young people to credible counselling services such a Lifeline, Kids Helpline and eheadspace.
As online counselling services grow and continue to gain momentum in popularity, attention will have to be given to the construction of legal and ethical codes. Particularly because the internet surpasses state and international borders, there are many legal and regulatory concerns. For example, is it legal for a practitioner to provide chat room services to clients in a jurisdiction that is outside their licensed or accredited practice boundary?
If no one knows who is treating whom, how is quality service ensured? If a practitioner does not know where a client is, how can they call for help in the case of an emergency, such as suicidal threats?4 These are some of the questions that therapists will have to consider before they embark on providing such services.
Online therapy is growing rapidly. The Internet is not just for chatting with friends and relatives anymore. Although the Internet has made communication easier with emails, chat rooms, and instant messaging services, many people have also found the World Wide Web to be helpful in obtaining information about mental health, including specifics on disorders, medication, and treatment. It was only a matter of time before the availability of easy communication and mental health resources merged together to form what is now known as online counselling.
Online counselling clearly does pose some unique problems and also some unique possibilities for both the clients and the therapists. As such, both mental health practitioners and individuals who wish to engage in such services must be informed of both the benefits and limitations of this style of therapeutic approach.
The original content in this article was provided by the Mental Health Academy, a leading provider of professional development education for the Mental Health industry. For more information, visit www.mentalhealthacademy.com.au.
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- Dunaway, M.O. (2000). Assessing Potential of Online Psychotherapy. Psychiatric Times, 17.
- Elleven, R.K. & Allen, J. (2004). Applying Technology to Online Couselling: Suggestions for the Beginning E Therapist. Journal of Instructional Psychology,31, 223-227.
- Foxhall, K. (2000). How will the rules on telehealth be written. APA Monitor on Psychology, 31,38.
- Gedge, R. (2009). Retrieved from World Wide Web on 12th October 2009 from www.scu.edu.au.
- Griffiths, M. (2001). Online Therapy: A course for concern. The Psychologist, 14, 244-248.
- Haberstroth, S., Duffey, T., Evans, M., Gee, R., & Trepal, H. (2007). The experience of online couselling. Journal of Mental Health Couselling, 29, 269-282.
- Pelling, N. (2009). The use of Email and the Internet in Couselling and Psychological Services: What Practitioners Need to Know. Couselling Psychotherapy, 5.
- Oravec, J.A. (2000). Online Couselling the and Internet: Perspectives for Mental Health Care Supervision and Education. Journal of Mental Health,9, 121-135.
- Recupero, P.R. & Rainey, S.E. (2005). Informed Consent to E-Therapy. American Journal of Psychotherapy, 59, 319-331.
- Richards, D., & Vigano, N. (2011). Online counselling. Encyclopedia of Online Behaviour. Vol. 1.
- Shaw, H.E., & Shaw, S.F. (2006). Critical Ethical Issues in Online Couselling: Assessing Current Practices with an Ethical Intent Checklist. Journal of Couselling and Development,84, 41-53.
- Trepal, H. Haberstroth, S. Duffey, T., & Evans, M. (2007).Considerations and Strategies for Teaching Online skills: Establishing Relationships in Cyberspace. Cousellor Education and Supervision, 46, 266-279.