Maanya Agarwal
Online Therapy has been an option for psychotherapy for a while but Covid 19 saw an exponential rise in its practice. Not only were therapists forced to move their regular sessions to remote methods, but the global pandemic also served as a traumatic event for many, with the death of loved ones and disruption of daily life, all of which increased the number of people in need of mental health aid (Sawamura, 2022). As its use has increased, so has the need to study its efficacy and how it compares to face-to-face therapy. While research was done on online therapy beforehand, newer research has opened us up to challenges that therapists and clients may face with the shift to online practices, which is extremely important to study to improve on those issues to come up with better treatment models.
Psychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviour (NIMH, 2022). A term used to describe treatment using verbal and psychological techniques for specific or general problems such as mental illness or any source of distress in life. Most types of psychotherapy include developing a therapist-client relationship, where a dialogue is created with the patient to help them overcome negative thoughts and behaviour patterns.
Psychotherapy is also done online, also called teletherapy or e-therapy (in video, text, and on-call formats), which has several advantages. These include increased accessibility for people living in remote areas and who may have physical limitations. It is seen to be more affordable due to the decrease in the costs for the therapist and may also be a more viable option for people who do not feel comfortable going for in-person therapy sessions (Kotera, 2021). Online therapy makes for an easier avenue to get started with the idea of therapy and mental wellness. Someone need not be under a clinically diagnosed condition to talk to a professional and online access can help one learn more about their mental health and become psychologically stronger due to the ease of it. McKenna and Bargh (2000) and Reynolds et al. (2006) found that clients who experienced uneasiness and social separation were more likely to create deep connections through online counselling than through face-to-face counselling.
While online therapy does bring in these advantages, there are also many disadvantages we need to be aware of that, some of which specifically arise when shifting to online therapy during the pandemic. Many of these are focused on challenges faced by psychotherapists. A study by Békés et al. (2021) analysed four of these different challenges in a longitudinal study from the start of the pandemic with a shift to online therapy: Emotional connection (feeling connected with patients, reading emotions, expressing or feeling empathy), Distraction during sessions (therapist or patient), Patients’ privacy (private space, confidentiality), and Therapists’ boundaries (professional space, boundary setting). These challenges were associated with a negative perception of the therapeutic relationship that in turn impacted the efficacy of therapy online. While three of the factors did seem to improve as therapists continued with online mode, distractions as a challenge still increased. These challenges also lead to a more negative attitude toward online therapy from the side of the clinicians which may lead to doubt in its efficacy. That perceived bias can cause clinicians’ expectancy effect to impact their behaviour and treatment of their patient negatively and thus lower the therapy’s effectiveness further. Moreover, mandatory versus voluntary use of technological innovations has been found to moderate the relationship between predicting factors and users’ attitudes (Venkatesh et al., 2003). Thus the involuntary nature of the transition to online therapy might hurt therapists’ attitudes toward using online therapy. Specific to COVID-19, the challenges of the abrupt transition, as well as the general distressing situation of the global pandemic and its uncertainties will also play a role in therapists’ approach.
Other general disadvantages that come along with online therapy can be related to body language as the need for non-verbal data ordinarily picked up from watching body language and other visual and verbal prompts changes the counselling dynamic (Situmorang, 2020). Online therapy may detract from the emotional salience of therapy, negatively impacting the therapeutic relationship and containment (Kotera et al., 2021, pp. 1-2). Furthermore, patients may also face a desire to internalise digital versions of the therapist or digital communications (e.g., developing transference through email exchanges). Clients that are more familiar with face-to-face intimate therapy may feel uncomfortable with the online shift and work better with direct human contact. There also comes a risk factor with serious mental disorders and emergency situations where due to the distance, quick and effective response is difficult during a crisis.
What research shows is while Online Therapy may be advantageous due to many reasons, specifically with its elevated need due to the global pandemic, There are significant challenges that need to be addressed to solidify the treatment option and its efficacy. The clinician must have relevant specialized information and have a certain level of familiarity with errors, miscommunication, and working with different societies. They should also screen potential patients requiring high levels of contact and those with serious pathology, hazardous behaviours, and trouble with reality testing (Situmorang, 2020). if the client's familiarity with technology and their expressive abilities in the online counselling process are evaluated, the treatment plan can be tailored and more effective. Furthermore, as the remote method becomes more of a reality, what we lack is instruction on online therapy skills in the general program/curriculum for graduate students. Organisations need to develop ways to address modern methods of acquiring proficiency and these skills and to advise on the best practices in formal instructive material to reflect and go along with the changes that have occurred in the counselling field.
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