Tech support? Therapists analyse benefits of digital age

More and more of us are going online to manage everyday aspects of our lives, from banking to buying a new car. Some of us are now also using the internet to seek emotional support.

In the past few years, the number of groups offering online guidance to individuals going through a tough time has risen sharply. Here in Ireland, charities, mental health groups and other support organisations have been quick to respond to the needs of others by setting up supports that can be accessed using PCs, smartphones and tablets.

Bodywhys, a voluntary organisation that helps people affected by eating disorders, developed an online support group and an email service in 2004, following this up with an online service specifically for under-18s, a few years ago. The group's chief executive, Jacinta Hastings, says the services have been well received.

“We developed our online service as a way of offering support to people who couldn’t attend a face-to-face group due to their location, or for people who wanted the anonymity and were afraid of going to a face-to-face group because of worries about people looking at them, or comparing themselves with other group participants,” she says.

“When we hear about online supports, there is often negativity in terms of cyberbullying and such things, but what we have found is that when a group is run properly, and the facilitators are skilled at keeping the space safe for everyone, there can be huge positive benefits for people.”

Hastings believes online support can be a helpful first step towards seeking face-to-face treatment as the experience of being accepted and supported can give individuals the tools and courage to contact professionals offline.

While support groups have been proactive when it comes to using the internet, many traditional psychotherapists and counsellors have been somewhat wary of working with clients online.

Some cognitive behavioural therapists offer Skype-based therapy sessions that can be bolstered with additional supports such as email and instant messaging, but therapists from other schools have been less inclined to go down this route.

This is partly because of ethical considerations but also due to a concern that online counselling is simply not as effective as face-to-face sessions.

The Irish Association for Counselling and Psychotherapy (IACP), which was established in 1981 to identify, develop and maintain professional standards for therapists and counsellors, says it is in the process of formulating a policy on online therapy that is due to be introduced this year.

This policy will advise on the specific training and experience required for its 3,700 members to start working online.

The association’s national director, Naoise Kelly, says the IACP is mindful of the fact that some members want to offer an online component and could see advantages to this, particularly for those with physical limitations or who experience social anxiety.

Nonetheless, he says, therapists and counsellors have been slow to go online because of a belief that online sessions affect the quality of the therapeutic relationship.

“It really is different from face-to-face counselling, and therapists will need to fully understand the issues and ethical matters involved before starting to engage in online therapy,” he says.

Among the other issues Kelly highlights are weakened communication, as therapists might not be able to see changes in facial expression, vocal intonation and body language. Other problems include issues of confidentiality, data protection and storage, an inability to respond to crisis situations, a lack of statutory regulation and training, possible problems with contracts and payment arrangements, and a lack of information about its efficacy.

Reservations
The Irish Association of Humanistic and Integrative Psychotherapists (IAHIP) also has some reservations about online therapy sessions.

Dermod Moore, a psychotherapist and member of the IAHIP's governing body, says that while newly trained therapists are increasingly interested in working online, more established practitioners are still wary of doing so.

“The internet is still relatively new and we haven’t yet found a way to establish a secure enough framework to allow any deep work to happen online.

“I think it is really good for the type of contact that doesn’t require much intimacy or depth, but I seriously doubt whether it can help people establish strong bonds, as one does over time in face-to-face sessions with psychotherapists,” he says.

“The internet is the refuge for the lonely. It can be useful in allowing people to say something personal in complete anonymity, but they still remain in isolation much of the time.

“In order for someone really to be heard, particularly when they are working with difficult issues such as shame, it is important that they are in the presence of someone who can hear them and respond in a positive manner.”

Moore believes online therapy sessions are a possibility once a therapeutic alliance has been established, particularly in situations where clients may be away for some time.

Supervision
Antony Keane, a Dublin-based teacher and psychotherapist, can also see a role for online therapy once a strong client-therapist bond has been built and says it could be used for supervision of clients in situations where other commitments get in the way.

“I think online work will increase. It is especially useful in frontline services as the initial point of contact for clients and is a great way to promote help-seeking behaviours for those in crisis,” he says.

“My preference is for face-to-face work with clients because I work from a relational perspective. The immediacy of contact with the client is important for me as this is what I am accustomed to and so I have not actively pursued online work,” Keane says.

“However, I would be happy to do so once the therapeutic relationship was well established and think that, in time, other therapists will too.”