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JustBen July 15th, 2004 10:03 AM

In-Roads to Online Therapy
Washington Post: Sex Therapy On Call

A very interesting article about online sex therapy that manages to address many issues that impact other online treatment areas as well: privacy, the licensing quagmire, anonymity, interstate practice, and so on. Several therapists make the argument that they're reaching people who wouldn't otherwise seek any treatment at all. I tend to agree. Thoughts?

MaraZampa July 15th, 2004 12:00 PM

Re: In-Roads to Online Therapy
Actually i'm not sure to be in the right forum, i was just searching for some ideas for studing the nurses stress: levels, factors that create stress... Thank you in advance to everyone that will answer to me...

loftus75 July 21st, 2004 08:04 AM

Re: In-Roads to Online Therapy
I have the same issues with online therapies that I have with online relationships, that is too many of our senses are not available during such a process. If therapy, in whatever context or content, were simply spoken or written language then it would not be a problem. However when we first meet our clients/patients or as described in the UK, Users, we use sight, sound, smell and touch. These senses are just as important in the therapeutic relationship as is the words that are spoken. For example, when a client presents us with an oxymoron, well spoken, articulate, but then is clearly unable to deal with their own personal hygiene, that cannot remain seated for more the 30 seconds, or sweats profusely and shows signs of extreme nervousness...Or has a repetitive behaviour which would not be seen online, all these aspects would then be reliant on self reporting, in my experience this is not the ideal, in fact it is far from the ideal.

For those individuals that would like to preamp their therapy with an outline of the processes, I'm sure most therapists would be happy to explain their particular interest, if they are not then one might want to look for someone else for assistance.

It's my view, and I suspect I'm not alone with this thought, that these approaches devalue our profession and give substance to the popular press's image of what therapy is or what it is about. Sadly all too often psychology is presented as an answer too ills, in my view it should be presented as a science with a specific agenda, that is to understand human behaviour and cognition and to apply these to the betterment of man kind.

BTW, having said all this I still like Frazer :), but I don't think I'd make an appointment to see him:)

JustBen July 21st, 2004 08:37 AM

Re: In-Roads to Online Therapy
You make some excellent points, loftus, and I'm inclined to agree with your overall assessment of modalities: face-to-face therapy is clearly superior to online therapy. Some patients in the US, however, aren't making a choice between traditional and online therapy; they're making a choice between online therapy and nothing at all. (It's a matter of geographic isolation, which probably isn't such a big deal in the UK.) Do we risk "devaluing our profession" by delivering online treatment for these people? To my mind, the question is backwards. I think we risk devaluing our profession by not treating these people. After all, any kind of help we can offer, even if it's inferior to the "real thing", is better than abandoning them.

But this article brings me to an area that I'm not so sure about. Some people wouldn't go to an office to seek "sex therapy", but they would accept services online. Is this a similar situation to the geographically isolated people mentioned above? After all, we still have a patient who's making a choice between online modalities and none at all. Also, how about social anxiety disorder sufferers? Aren't many of them in the same boat?

It's something that I still haven't made up my mind about yet.

P.S. "Users" is a perfectly dreadful term; I don't know how you stand it :)

loftus75 July 22nd, 2004 06:03 AM

Re: In-Roads to Online Therapy
I hear what your saying JustBen about people that may be isolated or due to geographical location has limited resources to seek out f2f contact with a therapist. However, my argument isn't that advice shouldn't be available, only that treatment should not be delivered in this medium. If someone were to break a leg while hiking, we may try to support the damaged limb until full medical help is available, we do not suggest that anything beyond first aid is offered unless the situation is life threatening and it's the only way left to save that life. Equally if someone is psychotic, it is most likely to be a friend,neighbour or family member that would ask for help, and here advice should be given, not therapy by proxy. For neurosis, those people seeking help if they are unable to get to a suitable resource, then help should be made available to get the help to them.

I have lived in various parts of the world, and I have no problem imagining scenarios where none of the above would work, the outback of Australia, some of the more isolated regions within the USA, and other parts of the world may have real problems finding on sight or suitable help. However, there are times when we need to recognise the limitations of our profession, we can not be all things to all men. And instructions over a wire, whether that be from a professional or friend, remains advice, it is not a therapy, though I'm certain some won't see it this way.

I would suggest, that to say anything is better than nothing simply does not apply here. If anything will do they may be just as well off talking to a pet, a tree or their car, if simply talking was enough then the advice should be get the words out. Beyond that, how can the user know they are getting educated and informed advice if it is online?

P.S Your right, the term User really leaves me cold, can't imagine who thought it was a good idea, frankly I don't use it myself unless I'm talking about an addict and even then it's only in certain contexts:)

JustBen July 22nd, 2004 08:58 AM

Re: In-Roads to Online Therapy
Point taken, loftus. I was getting the terms "therapy", "treatment", and "advice" all mixed up. In reality, I don't think that psychotherapy can be carried out online...though I occasionally use the term "e-therapy" ( Your first-aid metaphor is excellent, and I was actually thinking along the same lines.

jo ames August 28th, 2004 06:42 PM

Re: In-Roads to Online Therapy
I have been interested to read your discussion re: online therapy and I have to say I am both amused and bemused by some of the comments made!
I have practised as both a f2f and an online counsellor. In my experience, both have equal value to clients - dependant on their need and ability/willingness to access services. Online counselling/therapy is an alternative approach and it is not possible to measure online and f2f side by side. Different/enhanced training and skills are needed for both approaches and the relationship is 'conducted' differently, as are confidentiality protocols.
As a counsellor I would not normally give clients' 'advice' either f2f or online.
I confess when I first began online counselling training I too, was very sceptical of the concept of building and maintaining a therapeutic alliance online, however, as a counsellor I was prepared to be open to the experience and, having undertaken the process, I became aware that online therapy does have a place in todays society. Also, it is about client choice.
I do not consider providing (professional and accountable) therapy online as putting the counselling profession into disrepute, rather the opposite is true, clients now have access to more counselling services wherever they are in the world, irrespective of their pyhiscal ability to attend sessions, they can express themselves at a time that suits them by using email (asynchronous)and arrange to meet online if they want a 'real time' session (synchronous). Also, they will have a copy of everything they have said and their counsellors response - which can be useful in between sessions. In addition, there are also creative ways to work online, which does not necessarily rely on the written word.
So, in summary, I would say that yes, there are limitations and different considerations to working online (e.g. it is not appropriate for all presenting problems and online security can be an issue), however, there are also many benefits, which I think you may be dismissing before you consider them.

Also, I am amused at the thought that you find communicating online to be negative in so many ways and yet you appear to have quite clearly expressed your feelings on the issue, using this method!! ;)
I look forward to your response

loftus75 August 30th, 2004 07:28 AM

Re: In-Roads to Online Therapy
I suspect that much will depend on what discipline you are working in as to whether one might give credence to on-line therapy. I have trained and work in the CBT field, if I believed that counselling was simply a matter of expression I guess I might share your view. This is not to say I am discounting every other form of therapy, only that experience tells me on line communication is not a substitute for a f2f meeting, I would suggest this applies to all forms of relationships not just counselling.

I'm not sure what Jo's discipline is, but the notion that giving advice is somehow to be avoided seems a little too general. For instance, with the variety of therapeutic processes available, would it contravene some rule to suggest an appropriate from of counselling/therapy to a client or potential client? Or suggest the client be referred on?

I would also argue that all psychological approaches have limitations, we need to recognise that we cannot be all things to all men. I have no problem with the idea that an existing client that is already in f2f sessions can access their therapist online, I do have a problem with the idea that our profession may become little more than the equivalent of a fast food restaurant, I would suggest this reduces our professional standing, whether it brings it into disrepute is another matter.

Finally, when I served in the US Navy many years ago, I used to write to my wife several times a week. These were the days of snail mail and long letters were often used to express ourselves, it strikes me that Jo may be under the impression that expressing all feelings should be counted as a therapy, while this may have a therapeutic effect it would not qualify in my world as a worthy reason for intervention.

In the UK, where I now work, there is no shortage of people in need of help, there is however a shortage of funding. Many of my colleagues and myself, offer our services pro bono when we can, I suppose to some extent this colours my view of the therapeutic process. When dealing with drug addiction, severe behavioural disorders, dysfunctional families, etc., this exposure tends to leave one a little cynical of anything less than that which offers the maximum level of data.

I would suggest that as an online resource we also run the danger of becoming an outlet for the disenfranchised or confused who might be better served if they were 'advised' to seek out close family members or friends for help. We see these types of events when we look at magazines that have an agony aunt page. I say this having had to deal with clients that were drawn into the world of therapy unnecessarily and have been damaged as a result, empowering these people afterwards takes some effort.

Being in therapy has it's dangers, all to often clients are not advised of this, where they may have been happy to resolve a family or relationship issue with some simple advice, instead were placed under a psychological microscope resulting in low self esteem and sometimes much worse.

To this extent I suspect Jo and I will have to agree to disagree on the online issue.

JustBen August 30th, 2004 02:04 PM

Re: In-Roads to Online Therapy

Originally Posted by jo ames
Online counselling/therapy is an alternative approach and it is not possible to measure online and f2f side by side.

I'm not sure what you mean by "side by side" here, but I do want to point out that outcome studies are regularly conducted comparing the effectiveness of therapy and medication. If this is the case, what makes an outcome study comparing the effectiveness of face-to-face and online therapy/counseling so inconceivable?

Even when a client shows a preference for a particular kind of therapy, don't we have an obligation to at least tell them which of the available options is proven to provide the best outcomes?

Jacqueline September 2nd, 2004 08:13 AM

Re: In-Roads to Online Therapy
I have enjoyed reading everyone's thoughts on On-line therapy!
For me personally, I guess it depends on what the client is requiring. I do feel on-line therapy has a valuable place, for many reasons, such as those already mentioned. I feel on-line therapy requires alot of intuition from the provider as you will need to read in between the lines, as you are missing valuable aspects such as eye contact, body language, behaviour and much more. Where as I do not necessarily believe that on-line therapy is as good as face to face therapy, I would not like to omit it as I feel it is a valuable starting point for many. I guess that's exactly what it is for me, a starting point, I do feel going too deep into someone's inner self on-line could put them at considerable risk, what about suicidal ideation? Not everyone will admit to this, it is alright opening a can of worms but we as counsellors etc need to be able to contain the worms so they don't all surface at the same time and choke the client! As with all things I feel there is a balance to be sought.


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