From couch to computer, online psychotherapy

Many people have discovered the convenience of using the Internet to both search for a therapist and schedule online sessions.

A man using mobile smartphone (photo credit: ING IMAGE/ASAP)
A man using mobile smartphone
(photo credit: ING IMAGE/ASAP)
One hundred years ago, Sigmund Freud’s patients would lie down on the couch and they were encouraged to free associate, that is, to say whatever was on their mind. It did not take long for people to recognize the psychoanalytic couch as the symbol of psychoanalysis. If Freud were alive today, he would not believe how much things have changed.
Linda’s IPhone buzzed 20 minutes before her therapy appointment. She made herself an ice espresso, headed outside to her patio, and sat down on a comfortable chair. She tapped the Skype application on her laptop, and hundreds of miles away her face popped up on her therapist’s computer screen and his face on her laptop. They greeted each other with a smile; she sipped her coffee and the session began.
Each year, more and more psychotherapy happens online. Many people have discovered the convenience of using the Internet to both search for a therapist and schedule online sessions. One of my clients from the center of the country was very clear about the reasons she preferred to meet me via Skype rather than in my office.
She hated driving on Israeli roads and did not want to waste time traveling to and from my office. Her preference was clear, and we scheduled a series of sessions. Another client lived on a kibbutz in the south and preferred doing online therapy, also known as e-therapy. Not only did she want to avoid the hassle of taking public transportation, but she also realized that the distance to my office would have made weekly therapy unrealistic. An American overseas college student was in treatment with me during his Israel year program. Before returning to the States, he decided to continue treatment and we used Skype for almost two years. I have also used online video conferencing when potential clients from the States Skype me to inquire about therapy when they arrive in Israel.
In looking at the literature on the topic, I learned that some of the leading proponents of online psychotherapy are here in Israel (Computers in Human Behavior 41; 2014). Israel leads the world in so many technological innovations, and e-therapy is no exception.
Nevertheless, there are real concerns and criticisms about online psychotherapy. Some professionals feel that a client’s non-verbal cues are likely missed when clients are not seen in the consulting room. In addition, critics question whether the heart and soul of psychotherapy, such as client transference and therapist countertransference can be successfully established via telecommunication. Proponents of online psychotherapy counter this concern by noting that there is the manifestation of a ‘‘telepresence,’’ the feeling of being in someone’s presence without sharing physical space, which occurs during online sessions (Fink, 1999).
It may also be the case that clients feel more comfortable with using online psychotherapy than do therapists. One study found psychotherapists to have higher levels of technophobia (fear of technology) than their clients have. Few psychotherapy graduate schools teach their students how to use technology as a part of their practice.
Online therapy effectiveness A 2007 National Institute of Mental Health research study found that clients who use online therapy are quite satisfied with the service. In addition, evaluation studies have reported results that e-therapy client progress matches or exceeds those treated in the space of traditional office therapy.
Who can benefit from online psychotherapy?
1. E-therapy can be good option for remote areas.
Some people live in rural areas or places where access to mental health is limited. This opens up more choices.
2. Online therapy provides greater accessibility.
Mobility can be a big issue when accessing mental health care. Individuals unable to leave their home for various reasons, physical or psychological, may find online therapy a useful alternative to traditional psychotherapy settings.
3. Trauma victims may be initially too scared to leave their homes and feel comforted by their own secure surroundings.
4. It benefits teens who cannot drive to the therapist’s office.
5. People in an abusive relationship who want to receive therapy without their partner knowing it may opt for e-therapy.
6. Younger people, especially millennnials, feel comfortable with this option when offered.
7. Clients in therapy when experiencing a crisis or setback can receive quick access and support from their therapist.
Clearly online psychotherapy can be a useful alternative or supplement to in-office treatment.
Bob Dylan had it right, “The Times They Are A-Changin’.”
Dr. Michael Gropper is a marital, child and adult cognitive- behavioral psychotherapist, with offices in Jerusalem and Ra’anana. He also provides online videoconferencing psychotherapy.