The web has entered dynamically into all aspects of our lives: For tracing our next job or home, for our ‘obedient fellow traveller/guide’ (GPS!), for discovering our next exotic destination, or for digging out our chances for love.
However easy or hard it may be to find any of this, the wealth of information we can access online is unbeatable, even though we can certainly still make unwise choices. The internet is usually just a quicker route to where we want to be, but sadly it cannot guarantee the quality of the destination.
What happens though when this medium is also the ‘final destination’? What happens when we choose the therapist we want to work with from the endless online profiles, but we also have all our sessions online?
We may certainly save a tedious trip in the traffic, or in the crowded tube to get on time to our therapist’s venue and we usually pay less, but does it really work, as well as when we face our therapist in person (on top of facing our fears, anxieties and frustrations)?
A recent study at the University of Bristol showed that although the effectiveness of computerised, impersonal CBT programmes is questionable, when the latter was actually delivered ‘live’ (e.g. via skype) by a ‘real therapist’, it did respond efficiently to the needs of depressed clients’ and indeed 38% of them recovered to non-clinical scores after four months of therapy.
Furthermore, a literature review published in the Counselling Psychologist illustrated how helpful online therapy can be (and will be even more in the future) for specific client populations, especially individuals who are isolated, who are expatriates, or do not have access to face-to-face sessions for various reasons. Moreover, the University of Leipzig convincingly supported the claim that internet-based CBT can be as effective as face-to-face therapy for the treatment of depression.
It is common lore nowadays that CBT and counselling can best help clients when they are individually-tailored and they take into account the unique personality of the client. Thus, some of us will feel ‘more at home’ sitting on the therapist’ couch, while others will prefer the comfort of our own armchair at home, while ‘e-facing’ our therapist. Therefore, perhaps the real question is not which form of therapy is best, but rather how clients that in fact prefer counselling via skype, can make the most out of it.
As practitioners of ‘remote therapy’ we need to research and develop a new set of tools suitable for this form of interaction with our clients, as we have done for face-to-face sessions. Indeed, we have to think ‘outside the box’ as we knew it, in order to use creatively the new opportunities offered and equally address the limitations. I am currently exploring such opportunities by exchanging information and reflections with my clients via email, by working collaboratively through electronic CBT protocols and also by negotiating with them updated counselling contracts, which will allow them to benefit from my ‘implicit presence’ in-between our sessions, while keeping a clear framework of boundaries.
Nevertheless, as psychotherapy is essentially a collaborative process, clients need to do their part, to make this work in the best way for them. Thus, I believe that some basic ‘guidelines’ could be the following:
If the practitioner offers to exchange (send or receive) reflection notes with the client in-between the sessions via email, the latter should certainly make use of this opportunity, as therapy does not only happen during the hour of the session, but also during the week when we think about the changes we want to make in our lives, when we try out new behaviours and when we reflect on our ongoing life experience.
When therapists encourage email communication within the week, clients should make sure they are absolutely clear about this additional aspect of their counselling contract, in terms of the frequency and content of such communication, in order to maintain safe boundaries for both sides.
As clients normally engage in online sessions from their home, they should make sure they protect the confidentiality of their sessions or email correspondence with their therapist, as the latter can only guarantee all that from their own end.
As there is more flexibility in online counselling, it is probably a good idea to choose a less busy, internet-wise, time for our session, to ensure - as much as we can - a good internet connection and thus a satisfactory sound and image during the video conference. A poor internet connection can cause really frustrating and counter-productive interruptions to the process.
Being in the comfort of your home can easily produce the temptation to cancel or postpone sessions. Indeed, the counselling process requires a lot of energy and reflection and we sometimes feel like ‘we just do not have it’. But when we actually cancel, we sabotage our own benefit, as regularity and consistency are really important factors for effective therapy.
Perhaps, what we are mostly missing on skype conversations is the direct eye contact: We just know that we are looking at each other, but we do not really feel it, as we do when we meet our therapist in person. Does this mean that the – essential - connection and therapeutic rapport cannot be established on skype?
I feel that this lack of direct eye contact could in fact be used constructively, if we focus more on what our therapist is actually saying, rather than how they stare at us, or how they listen to us and ultimately on what we are saying to ourselves.
As Rogers eloquently put it, ‘as the therapist listens to the client, the client comes more to listen to himself or herself (…) becoming more real, more congruent, more expressing of what is actually going on inside’.
Dr. Nicholas Sarantakis is a Counselling Psychologist and a university Lecturer in the U.K. He is a humanistic/integrative psychotherapist drawing on client’s own strengths, potential for growth, creativity and meaning-making. Nicholas is also an active researcher, currently leading a project on Existential-Experiential group psychotherapy and he has a developing record of peer-reviewed publications. For more details visit Nicholas' website.