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]

Contents

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]

History

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 metanoia.org, 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

Cognitive behavioral therapy Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. It was originally designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety, alcohol and drug use problems, marital problems, and eating disorders. CBT includes a number of cognitive or behavior psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. There are also numerous types of psychotherapy designed for children and adolescents, such as play therapy. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders. Others have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Clinical psychology is an integration of science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

Counseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; and prevention and health. Some unifying themes among counseling psychologists include a focus on assets and strengths, person–environment interactions, educational and career development, brief interactions, and a focus on intact personalities.

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.

Couples therapy attempts to improve romantic relationships and resolve interpersonal conflicts.

The Dodo bird verdict is a controversial topic in psychotherapy, referring to the claim that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes. It is named after the Dodo character in Alice in Wonderland. The conjecture was introduced by Saul Rosenzweig in 1936, drawing on imagery from Lewis Carroll's novel Alice's Adventures in Wonderland, but only came into prominence with the emergence of new research evidence in the 1970s.

Telephone counseling refers to any type of psychological service performed over the telephone. Telephone counseling ranges from individual, couple or group psychotherapy with a professional therapist to psychological first aid provided by para-professional counselors. In-person therapists often advise clients to make use of telephone crisis counseling to provide the client with an avenue to obtain support outside of therapy if they cannot be reached in an emergency or at the conclusion of a therapeutic relationship.

Ego-dystonic sexual orientation is an ego-dystonic mental disorder characterized by having a sexual orientation or an attraction that is at odds with one's idealized self-image, causing anxiety and a desire to change one's orientation or become more comfortable with one's sexual orientation. It describes not innate sexual orientation itself, but a conflict between the sexual orientation one wishes to have and the sexual orientation one actually possesses.

The United Kingdom Council for Psychotherapy (UKCP) is a professional association of psychotherapy organisations and practitioners in the United Kingdom. It is restricted to registered clinical psychotherapists and psychotherapeutic counsellors.

A licensed clinical professional counselor (LCPC) is a professional who has been qualified to provide psychotherapy and other counselling services. LCPCs are trained to work with individuals, families, and groups to treat mental, behavioural and emotional problems and disorders. The main goal of LCPCs is to use counselling strategies to help people live a more satisfying life, which typically involves identifying a goal and finding potential solutions.

The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.

Child psychotherapy, or mental health interventions for children have developed varied approaches over the last century. Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one through the Child Guidance Movement, the other stemming from Adult psychiatry or Psychological Medicine, which evolved a separate Child psychiatry specialism.

Writing therapy

Writing therapy is a form of expressive therapy that uses the act of writing and processing the written word as therapy. Writing therapy posits that writing one's feelings gradually eases feelings of emotional trauma. Writing therapeutically can take place individually or in a group and it can be administered in person with a therapist or remotely through mailing or the Internet.

Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment. This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors that are suited to treatment of particular problems. According to one review, "it is widely recognized that the debate between common and unique factors in psychotherapy represents a false dichotomy, and these factors must be integrated to maximize effectiveness". In other words, "therapists must engage in specific forms of therapy for common factors to have a medium through which to operate". Common factors is one route by which psychotherapy researchers have attempted to integrate psychotherapies.

Behavioral health outcome management (BHOM) involves the use of behavioral health outcome measurement data to help guide and inform the treatment of each individual patient. Like blood pressure, cholesterol and other routine lab work that helps to guide and inform general medical practice, the use of routine measurement in behavioral health is proving to be invaluable in assisting therapists to deliver better quality care.

Remote therapy, sometimes called telemental health applications or Internet-based psychotherapy, is a form of psychotherapy or related psychological practice in which a trained psychotherapist meets with a client or patient via telephone, cellular phone, the internet or other electronic media in place of or in addition to conventional face-to-face psychotherapy.

Psychotherapy discontinuation, also known as unilateral termination, patient dropout, and premature termination, is a patient's decision to stop mental health treatment before they have received an adequate number of sessions. In the United States, the prevalence of patient dropout is estimated to be between 40–60% over the course of treatment however, the overwhelming majority of patients will drop after two sessions. An exhaustive meta-analysis of 146 studies in Western countries showed that the mean dropout rate is 34.8% with a wide range of 10.3% to 81.0%. The studies from the US had a dropout rate of 37.9%.

Trauma-informed feminist therapy is a model of trauma that incorporates sociopolitical context. The diagnosis of Post-traumatic stress disorder, or PTSD, was first recognized in 1980 and published in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The original PTSD diagnosis was formulated to fit symptomology of veterans returning home from combat; however, the diagnosis was modified by feminist psychologists treating patients with exposure to childhood sexual assault, chronic abuse, and gender-based trauma. Trauma-informed feminist therapy challenges both the traditional conceptualization of the PTSD diagnosis, as well as the overall standard approach to trauma treatment, by proposing new models of trauma that incorporate sociopolitical context. Initially feminist therapy began in the 1960s during the second wave of feminism and reflected the views of this movement through the conscious acknowledgement of a sexist power structure in American psychotherapy; currently, feminist therapy has expanded to reflect the ideas of the third wave of feminism which posit that the patriarchy is harmful to everyone.

References

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