Psychotherapy 2.0 – online therapy. What does it mean for the patient and who is it best for?

Distant communication between the therapist and the client, contrary to belief, is not a new concept at all. Actually, it was already used by the father of psychoanalysis, Sigmund Freud, intensively using letters to communicate with his patients.

In turn, self-help groups started to appear on the Internet as early as 1982. Surprised? I was surprised myself ☺ Nowadays, many therapists conduct sessions using the Internet, and even whole e-therapy clinics have been established.

Online therapy and the patient-therapist relationship

One of the biggest concerns of online therapy is that therapists do not have the opportunity to fully observe the patient, which is usually an integral part of the assessment and diagnosis. The tone of voice, body language, walking, greeting and general behaviour provide insight into a person’s well-being. However, we already know from research^[1] that the main component of effective therapy is the relationship between the therapist and the patient. Is it possible to develop it online?

It’s been proven that way! In a research review published in the World Journal of Psychiatry^[2], patients treated by videoconferencing reported “high satisfaction”.

My experience with online sessions

In my experience, online sessions appeared two years ago after I received an e-mail from a patient whose work is related to constant travel. The variable schedule and different locations made stationary therapy practically impossible. At first, after reading the message, I was full of fears and doubts, but I made this attempt and it turned out that for both of us this form of contact is fruitful and rewarding. Therefore, when another patient who lived in a small town came forward and her access to specialists was very difficult, my decision to work online was immediate.

For whom online therapy is the best solution?

This method of therapy primarily allows for regular therapeutic meetings when the patient’s life or work situation is not convenient. The possibility to participate in the session from any place in the world allows to start the therapy, e.g. a manager who works every week from three different countries; to continue it as a student who went away as part of a student exchange program; or to make it possible for a foreign patient who, after working in Poland, decided to come back home to continue the therapy at the same time. It was this form of meeting that made it possible for those and many other patients with whom I work or have worked to take up, continue or complete the treatment.  

What are the main concerns when it comes to Internet therapy?

Patients’ fears are about whether they will feel at ease when the screen is separating us. Some people are not fans of talking on the phone or video with anyone. There are questions asked about the safety of communicator I use and whether they can choose the one the feel most comfortable with. At first they talk about stress and a strange feeling, but after a few minutes the session starts naturally.

Remote therapy vs. classic in-office therapy

In terms of the process, remote work is no different from the therapy conducted in the office. It is always preceded by a one-time consultation, which allows me to understand the problems and situation of the person who comes forward. This allows me to offer the best form of help, adapted to the needs and possibilities of the patient. We always try to find a chance for a personal meeting, at least one. Such a contact is very valuable although it does not prejudge the success of the therapy. The proof of that are successful processes in which we have never seen the client “in real life”. 

Couple therapy online

What was probably the biggest challenge for me was the question of whether I could work with couples online?! Will we see each other clearly, will a session in three, two persons or in three locations have the same strength as in the office, what will happen when emotions reach their zenith? My doubts lasted until… a Polish couple living abroad came to me. Here, too, it turned out that the online sessions are almost identical to personal meeting and you can expect the same results as during a visit in the office. This consistency and involvement in the process are the key to successful online therapy for couples. Today I have many more couples working with me remotely. The reason for this is the lack of access to a qualified therapist at home or the lack of childcare during the session. In order to get the best possible benefit, I encourage partners to be in the same place during the online session. Occasionally, tripartite video meetings are also effective. When a couple is not together, however, it is more difficult to look into each other’s eyes and speak straight to the partner, and in couples’ therapy these are important and touching moments.

What is important for online sessions?

1.Try. Before the meeting, try to familiarize with technology, turn on the webcam, put your laptop in a place where you’ll be comfortable and feel safe. If you’re distracted by seeing yourself, just turn it off, you’ll feel much more natural, just like in the office.

2.If you do not live in an empty apartment, set the radio or music player at the door of the room where you are going to talk. It will silence the conversation and ensure discretion. When there is no such place in the house, some people decide to have a therapy session in the car, which also gives you the comfort of seeing the surroundings and being sure that no one is around.

3.Remember that on the other side there is a live and safe therapist, and you are only one screen away. Talk to him about your feelings and fears.

---

April 18th 2020

text: Barbara Sławik picture: leon seibert

^[1] Wampold, 2015

^[2] Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry. 2015;5(3):286-304. doi:10.5498/wjp.v5.i3.286