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In Brief
- Research now demonstrates that psychotherapy delivered via e-mail, video, chat, voice or texting can effectively treat cognitive, emotional and behavioral disorders.
- Even brief therapeutic communiqués using mobile phones can help combat eating disorders, alcohol abuse, cigarette smoking and anxiety, among other problems.
- The number of electronic tools for treating mental health troubles is rapidly increasing.
Gabriela (not her real name), a 42-year-old investment counselor, has been receiving therapy by computer chat for more than a year now. She fell into a deep depression after her last breakup and needed an ear she could count on to be consistently supportive and objective. She had face-to-face therapy years ago after she lost a child, and she thinks it is overrated. With chat therapy, she can look back at the e-trail and relive therapeutic moments. She can also see her progress in black and white.
Linda (also not her real name), 57 and divorced, has been receiving chat therapy for more than two years. She participates in one session a week and pays less than half what she would pay for an in-person encounter. “And there’s no wasting time on chitchat about the weather,” she says. “We get right down to business.” Her therapist has helped lift her out of a debilitating depression that began when she was trying to console a grieving friend. But she has never seen her therapist; she has never even heard his voice.
This article was originally published with the title Distance Therapy Comes of Age.
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8 Comments
Add CommentThis article looks like it contrives to sell the benefits of technology without question. Please,let's not get carried away with the virtues of the computing tin can. That therapy by computer is supposed to replace a qualified therapist is a shallow take on the whole theraputic experience. The obsession with technical gadgets is becoming farcical. Humans need to stay connected to each other by human time controlled and structured encounters using all those physical elements that we as humans have evolved over millions of years. The electronic tin can is becoming the absolute intermediary and ruler and that needs to be controlled. Computers are becoming a wide scale addiction and when the smart guys and gals start justifying that addiction, then we as humans are in trouble, to where we could possibly lose many of our inate natural mental abilities. Gabriele loses a child and looks back at a face to face experience from years agao and feels that face to face is over-rated sounds dumb. Gabriele obviously needed to speak up at the time. Surely the writer of this article could come up with something a little more convincing than one isolated case castigating the human to human contact factor. Just as there are second rate mechanics, second rate professionals, there are second rate therapists and where there are involved clients working hard towards insight and wellness, there are those who are not. The work in any therapeutic scenerio always rests with first the client.
Reply | Report Abuse | Link to thisThe human contact of the face to face encounter helps to re-wire the clients brain over a period of time through self-examination and exploration. Verbalizing within the close proximity of a qualified therapist, human to human, has a socializing effect on the patient. There are many venues that doctor and patient can explore, real time, face to face. Trust is the 1st key element and that trust is expressed through a human, not a machine.
There is absolutely no way that good valuable face to face therapy is going to be a cheap endeavour, so, if this is an effort to setup a process that will save many many $$$, then fine... but the experience will be in isolation and limited. Re-reading textual output from a computer session to look back on one's own therapeutic expression in print could be economized further by the client simply purchasing a good book recommmended by a good doctor and a self-help group, and/or just some good friends. If someone is really in trouble, then face to face therapy by a doctor is necessary for competent assessment and timely intervention.
Dear Robert -
Reply | Report Abuse | Link to thisGreat article. E-therapy will continue to grow and weave itself into the fabric of our daily lives. The convenience, cost savings and ability for anyone with an internet connection to be connected with experienced and valuable experts is a game changer in Medicine and is poised for rapid adoption in the coming years. I'm the founder of LiveExperts.tv, an online live video expert community, and have beta launched the site this month. We have received a great response thus far and have experts ranging from Neurologists to relationship therapists to help those in need. We look forward to the market adopting to this kind of therapy to complement existing therapeutic methods.
Thanks,
Julian Mossanen
CEO, LiveExperts.tv
As a counselor who has used telephone counseling for at least 20 years, I feel confident saying that this mode of delivery works very well for both the therapist and the client. I am now at the start of using chat, video, and email and am looking forward to working with clients via these venues. For years, I have used email informally with clients and found it effective. I believe some people are more comfortable "texting", particularly younger clients who communicate countless times/day in this manner. As with all potential clients, I, as the therapist, must determine, along with the client, which modality will be best, or if none of these will work as well as face to face. And, of course I have a disclaimer on my website along with a warning that some issues/situations cannot be addressed using these venues. It is always up to the therapist to be ethical, first and foremost regardless of how therapy is conducted.
Reply | Report Abuse | Link to thisV.E., you say that:
Reply | Report Abuse | Link to this"Humans need to stay connected to each other by human time controlled and structured encounters using all those physical elements that we as humans have evolved over millions of years."
I completely agree. And I also found the article weak. However, in contrast to those millions of years you speak of, professional therapy is a strange affair. Throughout most of our evolutionary history, I (confidently) guess that most discussions of the type have not been done as commercial transactions between strangers, but between members of the same social group (kin, tribe etc.) Long-distance can't replace all relationships, but the professional therapist cannot give you a hug, he cannot spend time with you engaging in non-therapeutic activities, etc. etc. It is already an "artificial" relationship. I think that it is better to have a face-to-face therapist, but in many cases the difference may not be worth the greater cost. This lowered cost also means that more people have access to therapy, but the greater privacy also means that more people can feel comfortable getting help.
The cost is lower because the expenses are lower for the therapist (no need for to rent a space). This makes it easier for psychologists to set up a practice, to do part-time work, etc. etc.
Moreover, if therapy can occur over long distances, then we each have access to a larger pool of therapists and the market not only becomes more competitive, but we are more likely to find the right therapist for ourselves.
This said, the advantage of transcripts/recordings is great, but it can and should be available with live therapists too; it is not an advantage specific to distance therapy.
Any type of support can be therapeutic whether it is in person or electronic or a letter. The comments about our communal disconnect however are right on target. This is why we have a therapy culture to begin with! Cultures that have much greater family and community support don't use much therapy. Hispanic culture for example with their large families and black Americans relying on extended family and the church rarely go to counseling.
Reply | Report Abuse | Link to thisA particular usefulness for the electronic medium is in poor rural areas where people may not own a car or be able to afford therapy but do have access to the internet. Internet mental health bulletin boards are a type of electronic group therapy that are also helpful for those who can't make it to the couch.
Still it's a sad state of affairs - our ever shrinking (nonvirtual) social networks. It reminds me of the movie Gattaca with the electronic kiosk therapy that Ewen McGregors character tried to make use of: The computer counselor just kept saying "I understand" "I understand" over and over. Carl Rogers doing back flips in his grave...
A computer equipped with voice recognition, an expert system and a speech synthesizer can conceivably be used as a therapeutic agent. It probably would operate best when programmed to offer Client-Centered Therapy. The program, Lisa was developed some years ago with this objective in mind. As technology advances, "Hal" can become anyone's therapist at any time or place at minimal cost.
Reply | Report Abuse | Link to thisSuggesting that it's "difficult to insure the confidentiality of online communications" is just nonsense. At iCouch.me and pretty much every other respectable online counseling provider, all communications are encrypted. It isn't "difficult." Trillions of dollars of financial transactions along with all kinds of health information is routinely transmitted online with very, very rare instances where such communications are compromised. Driving to the psychologist's office and sitting in a public waiting room is far more insecure than encrypted communications. Your neighbors can't see encrypted communication with your counselor, but they can see you entering a psychologist's office.
Reply | Report Abuse | Link to thisAs far as your nonsensical claim that, "Online services may turn out to be ineffective little research exists on the efficacy of online services" [sic], that's just complete baloney. Have a look at Mallen et al’s 2005 study in The Counseling Psychologist which reviews a vast body of research supporting the efficacy of online therapy. Just a cursory search of the online databases will reveal hundreds of studies on telehealth and distance mental health care. "little research exists" is just hyperbole -- not to mention completely inaccurate.
The tired cliches of the anti-online arguments are similar to the ones presented in C.W. Lamb's 1969 study that criticized the telephone as a valid tool for psychologists. However in 2000, a study established that over 98% of psychologists who were members of the APA used the telephone as a regular means of therapy, including 69% who conducted psychotherapy on the telephone and 79% who used it for emergency consultations. No one disputes the effectiveness of suicide hotlines. If the telephone is considered useful enough to save a life, then certainly there must be some therapeutic validity to that version of distance technology. There's an even stronger refutation to the anti-online nonsense at http://blog.icouch.me/aE4 where I go into further detail on the research and these attitudes that seem almost proudly against technology that would dramatically improve access for millions of people suffering from a wide variety of mental concerns.
Are there beneficial chat robots I recently replied to what might be a Yahoo answers suicide bait question Then I realized that a chat robot that just sifted YA as well as blogs to find what appeared to be suicide preferences could say things like "wow, that totally makes me think of those wacky suicide prevention things like 1800chillout" or "ha! I detect romance gone awry I just placed a personals ad for you, if you live until monday you can see who responded" or "You seem pretty dedicated to things making sense Have you considered going to irs.gov to file early so your relations can get all that refundy goodness theyd otherwise miss out on?" These might be phrased more kindly as well as effectively to prevent suicide
Reply | Report Abuse | Link to thisas lifesaving software goes you might prevent an actual death for every few hundred or thousand autoposts You might prevent many hundreds or thousands of emotively crummy suicide attempts as well.