Online counseling

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Online counseling
MeSH D000068237

Online counseling is a form of professional mental health counseling that is generally performed through the internet. Computer aided technologies are used by the trained professional counselors and individuals seeking counseling services to communicate rather than conventional face-to-face interactions. Online counseling is also referred to as teletherapy, e-therapy, cyber therapy, or web counseling. 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. An increasing number of clients are using online counseling as a replacement for office visits. [1]

Contents

While some forms of telepsychology and telepsychiatry have been available for over 35 years, [2] the development of internet video chat systems and the continued increase of the market penetration for the 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 created 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 1980s, and online communication became more common, virtual self-help groups naturally developed. These self-help groups may be considered a precursor to online counseling. When the World Wide Web became public in the early 1990s and mental health professionals began to create websites offering mental health information, some began to receive requests for personal help and started 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 web pages that offered online treatment for psychological complaints. Afterward, 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 counseling

Advantages

Online counseling offers several advantages. These include:

Disadvantages

Some of the disadvantages of online counseling include:

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] [23]

Mental health

Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level. [24] 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. [25] Severe situations, such as suicidal ideation or a psychotic episode, might be better served by traditional face-to-face methods, [26] 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. [27]

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] Research has come to show that the effects and benefits online counseling has to offer is equivalent or comparable to in-person counseling. [28] This suggests that therapeutic effects can be available to patients without having to go into the office, wait in a waiting room, or even leave the home. Client satisfaction surveys have demonstrated a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods. [29]

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 cannot 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. [30] [31]

Smoking cessation

The effectiveness of real-time video counseling for helping people to stop smoking is unclear. [32] Few studies compare the effects of video and telephone counseling on smoking cessation. [32]

New technological applications in online counseling

Online counseling has evolved with the newer developments of technology and therapeutic programs. There are now apps and programs being developed to make the complex processes of therapy and planning manageable for the patient through their smartphone. This makes certain resources more readily available to the patient in the form of self-monitoring, self-improvement courses, treatment and care management, and data collection of personal trends and symptoms. [33]

"MyCompass" is a specific self-help program that many online counselors use for their patients. This tool helps track factors associated with treatment plans including, mood, personal log data, and diary entries. These collections allow the program to examine therapeutic factors and present the individual and their practitioner with how these different factors influence and impact one another. [34]

Online counseling and COVID-19

Online counseling increased dramatically in 2020 during the COVID-19 pandemic as many countries issued lockdowns to control the spread of the virus. [35] Consequently, mental health professionals were unable to meet with their clients in person, so continued treatment online. [13] In addition to this transition, the pandemic and associated quarantine caused many people to become anxious and depressed, which resulted in an increased demand for mental health services. Because online counseling became so prominent during this time, the overall use of online counseling increased even as social distancing eased. [36]

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral 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, to help a person change behavior, increase happiness, and overcome problems. 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. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types 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 human science, behavioral 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 began with a focus on vocational counseling, but later moved its emphasis to adjustment counseling, and then expanded to cover all normal psychology psychotherapy. There are many subcategories for counseling psychology, such as marriage and family counseling, rehabilitation counseling, clinical mental health counseling, educational counseling, etc. In each setting, they are all required to follow the same guidelines.

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 and colleagues beginning in the 1940s and extending into the 1980s. Person-centered therapy seeks to facilitate a client's actualizing tendency, "an inbuilt proclivity toward growth and fulfillment", via acceptance, therapist congruence (genuineness), and empathic understanding.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.

Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed, and departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal. MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship.

<span class="mw-page-title-main">Play therapy</span> Childrens mental health therapy method

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

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.

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 refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.

<span class="mw-page-title-main">Equine-assisted therapy</span> Physical or mental therapy using horses

Equine-assisted therapy (EAT) encompasses a range of treatments that involve activities with horses and other equines to promote human physical and mental health. Modern use of horses for mental health treatment dates to the 1990s. Systematic review of studies of EAT as applied to physical health date only to about 2007, and a lack of common terminology and standardization has caused problems with meta-analysis. Due to a lack of high-quality studies assessing the efficacy of equine-assisted therapies for mental health treatment, concerns have been raised that these therapies should not replace or divert resources from other evidence-based mental health therapies. The existing body of evidence does not justify the promotion and use of equine-related treatments for mental disorders.

<span class="mw-page-title-main">Writing therapy</span> Technique for self-guided improvement

Writing therapyis a form of expressive therapy that uses the act of writing and processing the written word for therapeutic purposes. 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 can be administered in person with a therapist or remotely through mailing or the Internet.

Gay affirmative psychotherapy is a form of psychotherapy for non-heterosexual people, specifically gay and lesbian clients, which focuses on client comfort in working towards authenticity and self-acceptance regarding sexual orientation, and does not attempt to "change" them to heterosexual, or to "eliminate or diminish" same-sex "desires and behaviors". The American Psychological Association (APA) offers guidelines and materials for gay affirmative psychotherapy. Affirmative psychotherapy affirms that homosexuality or bisexuality is not a mental disorder, in accordance with global scientific consensus. In fact, embracing and affirming gay identity can be a key component to recovery from other mental illnesses or substance abuse. Clients whose religious beliefs are interpreted as teaching against homosexual behavior may require some other method of integration of their possibly conflicting religious and sexual selves.

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.

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.

Family therapy is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.

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 (n = 85) had a dropout rate of 37.9% (range: 33.0% to 43.0%).

Many health organizations around the world have denounced and criticized sexual orientation and gender identity change efforts. National health organizations in the United States have announced that there has been no scientific demonstration of conversion therapy's efficacy in the last forty years. They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the Hippocratic oath to do no harm and to refrain from attempts at conversion therapy.

References

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