Online Counselling: What does the evidence
tell us?
Michelle Blanchard, Senior Research Officer,
Inspire Foundation & PhD Candidate, Orygen Youth Health
Research Centre, Centre for Youth Mental Health, University of
Melbourne
With a significant increase over the last few years
in the number of Australian providers offering online counselling
(also known as internet therapy), this post examines the evidence
for these interventions.
Defining online counselling
Firstly some definitions. Online counselling
can either occur as asynchronous or synchronous communication.
Asynchronous communication is not in real time. A good
example is the use of email to engage in dialogue. Due to the
nature of the technology hours, or even days may pass between one
email and the next. Sychronous communication is communication
which occurs in real-time, for example via a program such as Skype
or MSN messenger when the clinician and client can either speak
(using a Voice Over IP program) or type. In terms of the
content of sessions conducted online, they do not vary
significantly from what would occur face to face, although some
forms of therapy such as Cognitive Behavioural Therapy and
Acceptance Committment Therapy lend themselves more to this
approach.
What does the evidence tell us?
Only a few studies have examined programs using
asynchronous communications to deliver a treatment involving
therapist contact (Tate and Zabinski, 2004). Numerous
privacy, reimbursement, and ethical concerns have limited the
widespread use of such techniques (Tate and Zabinski, 2004).
However, behavioural treatments for less sensitive disorders have
been delivered via e-mail eg weight management (Tate and Zabinski,
2004) with some success.
Synchronous communication is more interactive and
better mimics face-to-face interactions, as every sentence typed is
immediately displayed on the screen for other participants to
respond to in real-time (Tate and Zabinski, 2004). The major
disadvantage of synchronous communication is that it has not been
systematically evaluated (Tate and Zabinski, 2004). While
there is anecdotal evidence that acceptability of this form of
communication is high, there are a number of challenges including
technological difficulties (servers become overloaded at peak
times), typing speed effecting the flow of conversation and levels
of participation (Tate and Zabinski, 2004). There are a number of
ethical issues which have been identified in relation to the
provision of internet therapy (Midkiff and Wyatt, 2008). These
include boundaries of competence, basis in science, avoidance of
harm, confidentiality, avoidance of false or deceptive statements,
forums, testimonials, solicitation of clients, fees, and informed
consent (Midkiff and Wyatt, 2008). Therapists delivering
etherapy are strongly advised to ensure that all clients provide
informed consent prior to any therapy taking place. Ensuring
that both client and therapist are competent in the medium that the
therapy is taking place is also key. For example, if the therapy
takes place over email, both therapist and client need to have good
written communication skills (Midkiff and Wyatt, 2008).
So is it worth it?
While there are some legal, ethical and technical
challenges to conducting therapy online, Zack argues that
overcoming these is worthwhile in order to provide a service needed
and desired by an important segment of the help-seeking population
(Zack, 2008). This is particularly relevant for young people.
We know that 70% of young Australians who are experiencing a
mental health difficulty do not seek help and those who do rarely
receive timely or appropriate care. Online counselling
provides a cost effective option for these young people.
References
Midkiff DM, Wyatt J. Ethical Issues in the
Provision of Online Mental Health Services (Etherapy). Journal of
Technology in Human Services. 2008;26(2):310 - 32.
Tate DF, Zabinski MF. Computer and Internet
Applications for Psychological Treatment: Update for Clinicians.
Journal of Clinical Psychology/In Session. 2004
2004;60(2):209-20.
Zack JS. How Sturdy is that Digital Couch? Legal
Considerations for Mental Health Professionals Who Deliver Clinical
Services via the Internet. Journal of Technology in Human Services.
2008;26(2):333 - 59.
Michelle Blanchard, Senior Research Officer, Inspire
Foundation & PhD Candidate, Orygen Youth Health Research
Centre, Centre for Youth Mental Health, University of
Melbourne
With a significant increase over the last few years in the
number of Australian providers offering online counselling (also
known as internet therapy), this post examines the evidence for
these interventions.
Defining online counselling
Firstly some definitions. Online counselling can either
occur as asynchronous or synchronous communication.
Asynchronous communication is not in real time. A good
example is the use of email to engage in dialogue. Due to the
nature of the technology hours, or even days may pass between one
email and the next. Sychronous communication is communication
which occurs in real-time, for example via a program such as Skype
or MSN messenger when the clinician and client can either speak
(using a Voice Over IP program) or type. In terms of the
content of sessions conducted online, they do not vary
significantly from what would occur face to face, although some
forms of therapy such as Cognitive Behavioural Therapy and
Acceptance Committment Therapy lend themselves more to this
approach.
What does the evidence tell us?
Only a few studies have examined programs using asynchronous
communications to deliver a treatment involving therapist contact
(Tate and Zabinski, 2004). Numerous privacy, reimbursement,
and ethical concerns have limited the widespread use of such
techniques (Tate and Zabinski, 2004). However, behavioural
treatments for less sensitive disorders have been delivered via
e-mail eg weight management (Tate and Zabinski, 2004) with some
success.
Synchronous communication is more interactive and better mimics
face-to-face interactions, as every sentence typed is immediately
displayed on the screen for other participants to respond to in
real-time (Tate and Zabinski, 2004). The major disadvantage
of synchronous communication is that it has not been systematically
evaluated (Tate and Zabinski, 2004). While there is anecdotal
evidence that acceptability of this form of communication is high,
there are a number of challenges including technological
difficulties (servers become overloaded at peak times), typing
speed effecting the flow of conversation and levels of
participation (Tate and Zabinski, 2004). There are a number of
ethical issues which have been identified in relation to the
provision of internet therapy (Midkiff and Wyatt, 2008). These
include boundaries of competence, basis in science, avoidance of
harm, confidentiality, avoidance of false or deceptive statements,
forums, testimonials, solicitation of clients, fees, and informed
consent (Midkiff and Wyatt, 2008). Therapists delivering
etherapy are strongly advised to ensure that all clients provide
informed consent prior to any therapy taking place. Ensuring
that both client and therapist are competent in the medium that the
therapy is taking place is also key. For example, if the therapy
takes place over email, both therapist and client need to have good
written communication skills (Midkiff and Wyatt, 2008).
So is it worth it?
While there are some legal, ethical and technical challenges to
conducting therapy online, Zack argues that overcoming these is
worthwhile in order to provide a service needed and desired by an
important segment of the help-seeking population (Zack, 2008).
This is particularly relevant for young people. We know
that 70% of young Australians who are experiencing a mental health
difficulty do not seek help and those who do rarely receive timely
or appropriate care. Online counselling provides a cost
effective option for these young people.
References
Midkiff DM, Wyatt J. Ethical Issues in the Provision of Online
Mental Health Services (Etherapy). Journal of Technology in Human
Services. 2008;26(2):310 - 32.
Tate DF, Zabinski MF. Computer and Internet Applications for
Psychological Treatment: Update for Clinicians. Journal of Clinical
Psychology/In Session. 2004 2004;60(2):209-20.
Zack JS. How Sturdy is that Digital Couch? Legal Considerations
for Mental Health Professionals Who Deliver Clinical Services via
the Internet. Journal of Technology in Human Services.
2008;26(2):333 - 59.