Benefits and Disadvantages of Online Counselling
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.
Computer technology continues to evolve as an accessible,
convenient vehicle of communication. It is
understandable, as this technology for effective communication
evolves, why counsellors have begun
to use the internet to provide services to their clients through
electronic counselling media. Already
numerous studies suggest that internet counselling, when combined
with Cognitive Behaviour Therapy,
can be used effectively on a variety of clinical issues.
(Haberstroh, Duffey, Evans, Gee & Trepal, 2007;
Shaw, 2006; Trepal, Haberstroh, Duffey & Evans, 2007).
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
(Pelling, 2009; Centore & Milacci, 2008).
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.
Benefits
Accessibility
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 (Shaw & Shaw, 2006).
Anyone who has access to the internet can make use of such services
at their convenience. Even if
therapists are not available at all times, emailing for instance
may give the client the perception that they
are interacting with their therapist at the time of writing the
email and sending it (Centore & Milacci, 2008).
Convenience
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, agoraphobias or
anxiety disorders (Gedge, 2009).
Affordability
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 (Centore & Milacci,
2008).
Social Stigma
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.
Anonymity
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
(Griffiths, 2001). 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 (Dunaway, 2000).
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 (Haberstroh,
Duffey, Evans, Gee & Trepal, 2007).
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.
Disadvantages
While on one hand, the benefits of online counselling have been
considered (Elleven & Allen, 2004),
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 incongruence's between verbal
and none verbal 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 (Pelling,
2009; Gedge, 2009; Trepal, Haberstroh, Duffey & Evans,
2007).
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 is jeopardised and
confidentiality is at greater risk of being inappropriately
breached given the limitations of the medium.
For example, a client or therapist may accidentally send a
confidential e-mail to an unintended recipient.
This is done all the time on electronic mailing lists. Clearly,
this poses a significant risk for clinicians as
a possible breach in confidentiality. An issue of unauthorised
access to information through email for
instance also poses a confidentiality challenge in online
counselling. 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 (Griffiths,
2001).
Effectiveness
The effectiveness of online therapeutic interventions has been
continuously questioned. There is
currently little research supporting the effectiveness of
counselling that is provided solely through such a
medium. The lack of face to face interaction could also increase
the risk of misdiagnosis by the therapist
(Recupero & Rainey, 2005). Because of this, online therapy is
currently deemed inappropriate for clinical
issues such as chronic depression, psychotic disorders and other
issues such as sexual abuse and
violent relationships. Online therapy has also been said to
encourage dysfunctional behaviours. For
example: if a client suffers from social phobia, communication
through the internet does little to improve
the condition and may instead exacerbate it.
Technological Difficulties
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.
Therapist Credibility
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.
Ethical issues
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?
Will certain clients be excluded from services because they lack
the financial resources to access the
internet, and if so, would this be perceived as discriminatory? 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? (Foxhall,
2000). These are some of the questions
that therapists will have to consider before they embark on
providing such services.
There are other concerns surrounding the conduct of practitioners
engaged in online counselling including
informed consent, electronic records, and practitioner credentials.
Concern about the ethical and
professional implications of online counselling is growing
worldwide and professional groups associated
with counselling will have to address such issues imminently
(Oravec, 2000).
Conclusion
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 e-mails,
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.
References
Couselling. Journal of Mental Health Couselling, 30, 267-282.
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.
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.
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.
Computer technology continues to evolve as an accessible,
convenient vehicle of communication. It is understandable, as
this technology for effective communication evolves, why
counsellors have begun to use the internet to provide services
to their clients through electronic counselling media.
Already numerous studies suggest that internet counselling,
when combined with Cognitive Behaviour Therapy, can be used
effectively on a variety of clinical issues. (Haberstroh, Duffey,
Evans, Gee & Trepal, 2007; Shaw, 2006; Trepal, Haberstroh,
Duffey & Evans, 2007).
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 (Pelling, 2009; Centore & Milacci, 2008).
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.
Benefits
Accessibility
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 (Shaw & Shaw, 2006).
Anyone who has access to the internet can make use of such
services at their convenience. Even if therapists are not
available at all times, emailing for instance may give the client
the perception that they are interacting with their therapist
at the time of writing the email and sending it (Centore &
Milacci, 2008).
Convenience
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,
agoraphobias or anxiety disorders (Gedge, 2009).
Affordability
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 (Centore & Milacci, 2008).
Social Stigma
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.
Anonymity
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 (Griffiths, 2001). 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 (Dunaway, 2000).
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 (Haberstroh, Duffey, Evans,
Gee & Trepal, 2007). 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.
Disadvantages
While on one hand, the benefits of online counselling have been
considered (Elleven & Allen, 2004), 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 incongruence's between verbal and none verbal
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 (Pelling, 2009; Gedge, 2009; Trepal,
Haberstroh, Duffey & Evans, 2007).
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 is jeopardised and confidentiality is at greater
risk of being inappropriately breached given the limitations of the
medium.
For example, a client or therapist may accidentally send a
confidential e-mail to an unintended recipient. This is done
all the time on electronic mailing lists. Clearly, this poses a
significant risk for clinicians as a possible breach in
confidentiality. An issue of unauthorised access to information
through email for instance also poses a confidentiality
challenge in online counselling. 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 (Griffiths,2001).
Effectiveness
The effectiveness of online therapeutic interventions has been
continuously questioned. There is currently little research
supporting the effectiveness of counselling that is provided solely
through such a medium. The lack of face to face interaction
could also increase the risk of misdiagnosis by the
therapist (Recupero & Rainey, 2005). Because of this,
online therapy is currently deemed inappropriate for
clinical issues such as chronic depression, psychotic
disorders and other issues such as sexual abuse and violent
relationships. Online therapy has also been said to encourage
dysfunctional behaviours. For example: if a client suffers
from social phobia, communication through the internet does little
to improve the condition and may instead exacerbate it.
Technological Difficulties
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.
Therapist Credibility
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.
Ethical issues
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?
Will certain clients be excluded from services because they lack
the financial resources to access the internet, and if so,
would this be perceived as discriminatory? 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?
(Foxhall, 2000). These are some of the questions that
therapists will have to consider before they embark on providing
such services.
There are other concerns surrounding the conduct of
practitioners engaged in online counselling including informed
consent, electronic records, and practitioner credentials. Concern
about the ethical and professional implications of online
counselling is growing worldwide and professional groups
associated with counselling will have to address such issues
imminently (Oravec, 2000).
Conclusion
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 e-mails, 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.