Is Online Psychotherapy a Practical Alternative to In-Person Therapy?

Online psychotherapy, sometimes referred to as e-therapy, is not a new concept. Even Sigmund Freud wrote letters to his patients as a method of therapy. In fact, its high demand has seen the growth of foundations like the International Society for Mental Health Online, a centralized portal for information and guidelines for customers interested in online psychotherapy. To be clear, online psychotherapy involves tools that allow for both the therapist and patient to complete sessions or communicate via the Internet and other integrated software applications. Tools may include email, instant messaging, real-time chat like Skype, or video conferencing.

Online Therapy Exceeds Expectations 

As a way to reduce medical costs and improve access to mental health services, Internet technologies in psychotherapy has gained significant popularity. But in spite of its increased demand, the question remains: is e-therapy as effective as conventional, face-to-face therapy? Some initial studies have revealed that traditional delivery methods of therapy were comparable to online psychotherapy. To confirm this theory, clinical researchers from the University of Zurich put it to the test.

What The Research Showed

First, researchers reviewed the care 62 patients received from six therapists, with most suffering from moderate depression. The research team divided the patients into two groups, and randomly assigned each one to either traditional psychotherapy or online psychotherapy. The treatment consisted of eight sessions using various techniques based on cognitive-behavioral therapy, which the patients could complete orally and in writing. Patients treated online performed one predetermined written task, which asked about their own negative self-image. 

The results of the study showed that by the end of the treatment 53 percent of the patients who had online therapy indicated a decrease in depression or were no longer depressed, as compared to 50 percent of those patients who received conventional therapy. Even after three months, researchers noted that the depression found in the patients treated online continued to decrease, while the depression suffered by those patients treated with conventional therapy either stayed the same or increased.

With this particular study, researchers asked patients to rate their treatment. Ninety-one percent of the patients treated with conventional therapy and 96 percent who received online therapy reported their contact with their therapist as "personal." Overall, patients from both groups rated their satisfaction level with the care they received as good.

Another note of interest was that the patients receiving online therapy used both the online contact and homework given by the therapist to progress in their treatment, often rereading correspondence from their therapist. Overall, the Zurich researchers concluded that online psychotherapy is effective and may be a practical supplemental method.

Pros and Cons of Online Psychotherapy

Even with all the notoriety, online psychotherapy has its disadvantages. As stated by Dr. Jon Grohol, Psy.D., in his recent article "Skype Away: Online Therapy is Still Exciting!," online therapy has its place, but it cannot deliver on therapy's most important benefits, such as the ability to witness nonverbal behavior. Just as a picture paints a thousand words, nonverbal cues are difficult to interpret with an iPhone™ or tablet, and can handicap a therapist. There's also the question of intimacy. Is Skyping your therapy session going to deliver the same form of face-to-face intimacy that an office visit would? Another issue Dr. Grohol raises -- and it's a point worth making -- is that Skype has not been certified as HIPAA compliant. Would the demand for this convenience drop if consumers were aware of this?  Dr. Grohol seems to think so.

As of this date, Skype technology has not been approved for confidential, private mental health sessions. However, other health solutions, such as iCouch offers a secure video platform and HIPAA compliant tools for scheduling and secure messaging.

Detractors aside, patients see some huge advantages to online psychotherapy. For instance, geography is no longer a limitation to doctor selection. Patients can see a therapist half way around the world if they choose. Interviews cited in an article by New York Times writer Jan Hoffman, titled "When your Therapist Is Only a Click Away," suggests that many psychologists see this delivery system of mental health care as well suited to treat agoraphobia, anxiety, depression, and obsessive-compulsive disorders. It is an opportunity for patients to get treatment who otherwise might not receive it.

Other Advantages to Online Psychotherapy

One of the biggest advantages to online therapy is convenience. Not having to drive to and from the doctor's office saves time, and it's convenient. Some patients also report that they feel more relaxed and less anxious about talking through difficult issues because of the "disinhibitory effects" of online communication. There's also the advantage of decreased costs; patients may not be taking the entire 60 minutes of time with their therapist.  Also, there is something to be said for having an online therapist on-demand, whenever and wherever a patient might need one.

Depending upon the mental health issue and the comfort level with computer technology by the patient, this may seem like the road to take. However, for more aggressive mental illnesses, it may not be the best delivery method for optimal mental health.