Online counseling

Last updated
Online counseling
MeSH D000068237

Online counseling is the provision of professional mental health counseling services through the Internet. Computer aided technologies are used by the trained professional counsellors and individuals seeking counselling services to communicate rather than conventional face-to-face interactions[17] . Online counselling is also referred as an e-therapy, cyber therapy, or web counselling[18]. Services are typically offered via email, real-time chat, and video conferencing. [1] Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling. Increasing number of clients are using online counseling as a replacement for office visits. [1]


While some form of tele-psychology has been available for over 35 years, [2] the advent of internet video chat systems and the increasing penetration of broadband has resulted in the continuing growth of online therapy. Some clients are using videoconferencing, live chat and email services with a Mental health professional in place of or in addition to face-to-face meetings. [2]


One of the first demonstrations of the Internet was a simulated psychotherapy session between computers at Stanford and UCLA during the International Conference on Computer Communication in October 1972. [3] Although this was a simulation and not actual counseling, the demonstration indicated an interest in the potential of online communication for counseling. As access to the internet, bulletin boards and online services became more available in the 1980's, and online communication became more common, virtual self-help groups naturally developed, and may be considered a precursor to online counseling. When the World Wide Web became public in the early 1990's and mental health professionals began to create websites offering mental health information, some received requests for personal help, and a few began to respond to these requests, leading to the advent of online counseling. [4]

Information on sources related to online counseling was first created by Martha Ainsworth. In 1995, Martha Ainsworth began searching for a competent therapist because she had some psychological complaints. Her travel requirements made it difficult for her to consult a face-to-face therapist, and therefore she needed an effective alternative online therapist. She only found a dozen webpages that offered online treatment for psychological complaints. Afterwards, Martha Ainsworth wanted to reach the general public with her experiences and founded a clearinghouse for mental health websites, named Metanoia. By the year 2000, this clearinghouse contained over 250 websites of private practices, and more than 700 online clinics where a therapist could be contacted. [5]

According to, the first service to offer online mental healthcare was "Ask Uncle Ezra", created by staff of Cornell University in 1986 for students. [6] By mid-1995 several fee-based online services offering mental health advice had appeared. [7] Between 1994 and 2002, a group of trained volunteer crisis counselors called "Samaritans", began providing suicide prevention services via email. [8] There has been continuous increase in number of online counselling therapists and groups due to increase in web-based services and anonymity associated with virtual sessions. [19]

Advantages and Disadvantages of Online Counselling

A. Online counselling offers several important advantages. These include:

Increased Accessibility: Online counseling is filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents, people with disabilities and expats, along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities. [2] It also makes counselling accessible to clients who face difficulties in keeping appointments during normal business hours, [9] while decreasing the number of missed appointments for in-person therapy. [10]

Along with accessibility of therapists, online counselling also enables accessibility of information to the clients. In face-to-face counselling, information is stored only with the therapists. On the other hand, in online counselling, the transcripts of communications between the therapist and clients may be available to therapist as well as clients both. This allows people seeking therapy to monitor change[ citation needed ].

Increased Comfort and Convenience : Online counselling can offer higher comfort and convenience for clients and therapists alike [ citation needed ]. Therapists or clients do not need to travel for their sessions. College students, working professionals and individuals who have limited time or restricted travel conditions have the convenience of seeking help from where ever they are located.[ citation needed ]

Anonymity and Privacy : Online counselling offers more anonymity and privacy as compared to face-to-face interactions.[ citation needed ][ clarification needed ]

Less expensive: Online counselling is less expensive than face-to-face counselling.[ citation needed ] Lesser costs makes it more accessible to individuals with limited income.

B. Some of the key challenges of online counselling include:

Finding the right match for therapeutic needs of clients: Online counselling does not guarantee right match for the therapeutic needs of the clients. Using online counselling as a stand alone therapy may fail to address needs of clients who require individual and focused therapeutic sessions[ citation needed ]. Emotional and visual contact can be absent during online counselling sessions. This absence prevents therapists from sensing negative feelings like anger, terseness, or irritation in clients. As resolving emotional concerns is one of the main underpinnings of counselling, online counselling may provide limited benefits to the clients as compared to face-to-face counselling.[ citation needed ]

Establishing authenticity of therapists or counsellors: Counsellors and therapists are professional health care providers and hence require license to undertake clients for counseling as a part of their mandatory professional requirements. Psychologists and professional health care providers require license of a particular state where they practice to take clients. As internet allows clients to choose therapists all across the world, establishing legitimacy and authenticity of the therapists or counsellors is difficult[ citation needed ].

Data privacy and protection: Online counselling uses technology aided devices and internet as the main medium for communication between the therapist and the client. All the personal and sensitive information of patients is stored on internet sites or devices. This increases the risk of data theft. It is important to establish the safety of the site and verification of therapist or client before beginning an online counselling session [ citation needed ].

Medical uses and effectiveness

Although there is some preliminary support for the possibility that online counseling may help populations that otherwise underutilize traditional in-office counseling, the question of the effectiveness and appropriateness of online counseling has not been resolved. [2]

Mental health

Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level. [11] J. Suler suggests that people functioning at a particularly high level, and who are well-educated and are artistically inclined, may benefit the most from using text-based online counseling to as a complement to ongoing psychotherapy. [12] Severe situations, such as suicidal ideation or a psychotic episode, might be better served by traditional face-to-face methods, [13] although further research may prove otherwise. [2]

Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory. [14]

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition. [2] Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods. [15]

Nutrition counseling

Nutrition counseling specific to conditions is available by many consultants online using Skype or another face-to-face program. This is especially effective for people with a busy work schedule, and others who can't make it to an office regularly. Online consulting for imbalances in blood lipid levels, blood sugar regulation, and other health conditions make it easier to manage when using nutritional approaches. [16] [17]

Smoking cessation

The effectiveness of real-time video counseling for helping people to stop smoking is unclear. Only few studies compare video and telephone counseling. [18]

See also

Related Research Articles

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Person-centered therapy, also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy, is a form of psychotherapy developed by psychologist Carl Rogers beginning in the 1940s and extending into the 1980s. Person-centered therapy seeks to facilitate a client's self-actualizing tendency, "an inbuilt proclivity toward growth and fulfillment", via acceptance, therapist congruence (genuineness), and empathic understanding.

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  1. 1 2 Mallen, Michael J.; David L. Vogel (November 2005). "Introduction to the Major Contribution Counseling Psychology and Online Counseling". The Counseling Psychologist . 33 (6): 761–775. doi:10.1177/0011000005278623. S2CID   145615146.
  2. 1 2 3 4 5 6 Mallen, Michael J.; Vogel; Rochlen; Day (November 2005). "Online Counseling: Reviewing the Literature From a Counseling Psychology Framework". The Counseling Psychologist. 33 (6): 819–871. doi:10.1177/0011000005278624. S2CID   145429569.
  3. Lasar, Matthew (2011). "ARPANET's coming out party: when the Internet first took center stage". Ars Technica. Retrieved 19 June 2021.
  4. Ainsworth, Martha. "E-Therapy: History and Survey". Metanoia. Retrieved 19 June 2021.
  5. Alleman, James R. (2002). "Online counseling: The Internet and mental health treatment". Psychotherapy: Theory, Research, Practice, Training. 39 (2): 199–209. doi:10.1037/0033-3204.39.2.199.
  6. Lang, Susan. "For two decades, Dear Uncle Ezra, world's first online advice column, has aided the perplexed, the shy and the confused". Cornell Chronicle. Cornell University. Retrieved 19 June 2021.
  7. Ainsworth, M. "E-therapy: History and survey" . Retrieved 22 May 2014.
  8. Zack, Jason; Stricker, George (2004). Kraus, Ron (ed.). Online counseling: a handbook for mental health professionals. Amsterdam: Academic. ISBN   978-0124259553.
  9. Change, T.; Yeh, Krumboltz (2001). "Process and outcome evaluation of an on-line support group for Asian American male college students". Journal of Counseling Psychology . 48 (3): 319–329. doi:10.1037/0022-0167.48.3.319.
  10. Glueckauf, R.L.; Fritz; Ecklund-Johnson; Liss; Dages; Carney (2002). "Videoconferencing-based family counseling for rural teenagers with epilepsy". Rehabilitation Psychology . 47: 49–72. doi:10.1037/0090-5550.47.1.49.
  11. Stofle, G.S. (2001). Choosing an online therapist. White Hat Communications.
  12. Suler, J (2000). "Psychotherapy in cyberspace: A 5 dimensional model of online and computer-mediated psychotherapy". CyberPsychology & Behavior. 3 (2): 151–160. doi:10.1089/109493100315996.
  13. Zelvin, E. (2004). Online Counseling Skills Part I: Treatment Strategies and Skills for Conducting Counseling Online. Academic Press.
  14. Cohen, G.E.; Kerr, B.A. (1998). "Computer-mediated counseling: An empirical study of a new mental health treatment". Computers in Human Services. 15 (4): 13–26. doi:10.1300/J407v15n04_02.
  15. Dongier, M.; Templer, R.; Lalinec-Michaud, M.; Meuneir, D. (1986). "Telepsychiatry: Psychiatric consultation through two-way television: A controlled study". Canadian Journal of Psychiatry . 31 (1): 32–34. doi:10.1177/070674378603100107. PMID   3512068. S2CID   27055160.
  16. Mittnacht, Anne M.; Bulik, Cynthia M. (1 January 2015). "Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study". International Journal of Eating Disorders. 48 (1): 111–122. doi:10.1002/eat.22319. PMID   24976176.
  17. Mittnacht, A. M. and Bulik, C. M. (2015), Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study. Int. J. Eat. Disord., 48: 111–122. doi: 10.1002/eat.22319
  18. Tzelepis, Flora; Paul, Christine L; Williams, Christopher M; Gilligan, Conor; Regan, Tim; Daly, Justine; Hodder, Rebecca K; Byrnes, Emma; Byaruhanga, Judith; McFadyen, Tameka; Wiggers, John (2019). "Real-time video counselling for smoking cessation". Cochrane Database of Systematic Reviews. 2019 (10). doi:10.1002/14651858.CD012659.pub2. ISSN   1465-1858. PMC   6818086 . PMID   31684699.

18. American Psychological Association. (2015). What you need to know before choosing online therapy?. American Psychological Association. Retrieved 15 April 2021, from

19. Chester, A., & Glass, C. (2006). Online counselling: a descriptive analysis of therapy services on the Internet. British Journal Of Guidance & Counselling, 34(2), 145-160.

20. Li,Lau, P., Jaladin, R., & Abdullah, H. (2013). Understanding the Two Sides of Online Counseling and their Ethical and Legal Ramifications. Procedia - Social And Behavioral Sciences, 103, 1243-1251.

21. Novotney, A. (2017). A growing wave of online therapy. American Psychological Association, 48(2), 48. Retrieved 15 April 2021, from