Psychotherapy goes online in the age of coronavirus
Numerous studies support the efficacy of online counseling and say that clients don’t seem to mind.
By DR. MIKE GROPPERSOME PROFESSIONALS feel a client’s nonverbal cues are likely missed when they are not seen in the consulting room(photo credit: NEEDPIX.COM)
One hundred years ago, Sigmund Freud’s patients would lie down on the couch and were encouraged to free-associate, to say whatever was on their mind. Eventually, people began to recognize the psychoanalytic couch as the symbol of psychoanalysis.If Freud were alive today, he would probably find himself sitting in front of a computer, like so many other therapists in all corners of the world.I have been using videoconference therapy for many years, helping a relatively small number of clients. Some clients chose online therapy after they moved overseas, and other local clients found it difficult to come to my clinic.Regardless of the reason, I was open to this new avenue to practice psychotherapy. But what I was not prepared for was that the computer-client interface would become a mainstream way of doing psychotherapy.After all, few psychotherapists had any practical training in the use of online technology for therapy. When the whole world underwent lockdowns, therapists had to quickly transition into this modality not only to help those people who were already in treatment but also those individuals who were seeking help and unable to get to a therapist’s office. Therapists did not even have time to question the efficacy of this new way of doing treatment.I remember speaking, at the start of the lockdown, to a colleague, a professor of community medicine in New York. We spoke about this professional paradigm shift in doing therapy. In the middle of our brief talk, he acknowledged that he sees everyone online since the start of COVID-19. He abruptly ended our conversation and apologized since he was about to begin a therapy session on Skype. For many therapists like my colleague, the transition was fairly easy and amazingly felt quite natural as a type of therapy.Curious to see what I could learn about the effectiveness of online therapy, I turned to the professional literature to examine this topic.One of the largest studies is reported in Psychiatric Services (April 2012, 63:4 ). Linda Godleski and her colleagues did a meta-analysis of a total of 98,609 patients enrolled in the US Veterans Administration tele-mental health services from October 1, 2006, through September 30, 2010, throughout the United States.In the analysis (92 studies and 9,000 clients) they found that online therapy works just as well as traditional face-to-face therapy. Moreover, I wasn’t surprised to learn that some of the leading proponents of online psychotherapy are in fact here in Israel (Computers in Human Behavior 41; 2014). Israel leads the world in so many technological innovations, and videoconferencing therapy is not an exception. Most Israelis feel very comfortable going online for just about anything, so the idea of doing therapy online in Israel may very well fit into the country’s hi-tech culture.What about the therapeutic relationship?Does the therapist/client relationship get compromised as a result of using a computer screen to speak to a client?In fact, there are some professionals who feel that a client’s nonverbal cues are likely missed when clients are not seen in the consulting room. In addition, critics of online counseling question whether the heart and soul of psychotherapy, such as client transference, empathy and therapist countertransference can be well established via telecommunication (C. Roesler, 2017, Journal of Analytical Psychology).Nevertheless, numerous studies support the efficacy of online counseling and say that clients don’t seem to mind (Vera Bekes and Katie Aafjes-van Doorn, 2020, Journal of Psychotherapy Integration, vol. 30). In fact, in his book (1999) How to Use Computers and Cyberspace in the Clinical Practice of Psychotherapy, J. Fink described the manifestation of a “telepresence,” the feeling of being in someone’s presence without sharing physical space, the essence of what happens during online sessions.Since the lockdown of COVID-19, it has been my experience, as well as the experience of many of my colleagues, that a successful therapeutic relationship can be established online. This conclusion may be anecdotal, but it is backed up by the current literature on this subject.Still, specific training for therapists to learn skills on how to use the online counseling relationship effectively may be helpful to give both therapist and client the maximum benefit of this type of treatment.During these trying times, as psychotherapists strive to establish even better connections with clients, connecting with them has become even more complicated. Use of video interface and computer to deliver psychotherapy remotely, once the stuff of science fiction, has become the mainstay of the psychotherapy delivery system during the COVID-19 pandemic. I will leave it to futurists to predict what therapy will look like after COVID-19 is over.The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Ra’anana and global online accessibility, drmikegropper@gmail.com, www.facebook.com/drmikegropper.
