How Does E-Therapy Really Work?

Everything You Wanted To Know About E-Therapy: Part TWO

Do you want to get to therapy more regularly but something keeps getting in your way? E-therapy might be the solution. If you’re still trying to discern whether e-therapy could be a good fit for you, I recommend starting HERE. If you’re already comfortable with the idea of e-therapy and want to know more about how it actually works, read on!

I’m excited about e-therapy because it has amazing potential to truly enhance our work together. Online counselling offers exciting new treatment options for clients and therapists. But, like most technology, e-therapy is most effective when users truly understand its capabilities and give due consideration to its strengths and limitations. 

This post is designed help you understand the technical side of e-counselling. I’ll discuss the delivery options available to you and how they work. By the end of this post, you should have a better understanding of which online tools are best suited to meet your needs, and how we could use technology to further your success in therapy.

What is E-Therapy? 

E-therapy—also known as virtual therapy, e-counselling, telepsychology or cyber-counselling—is a therapeutic intervention that takes place online instead of in person. 

You can choose between TWO communication formats: VIDEO or TEXT-BASED (written).

For both video and text-based modalities you can use your computer, smart-phone or tablet. Your therapist should always use a secure, PHIPA-compliant software for your privacy and protection.

1. VIDEO Communication:  

Video counselling is very similar to an in-person session except that we meet in virtual space, on our respective screens! It feels a lot like a FaceTime, Skype or Zoom call. However, your therapist should not use one of these common applications as they do not meet security standards. 

People choose video-counselling because it’s most like meeting face-to-face. But it has the convenience of saving travel time, overcoming mobility issues, and it offers access to your therapist from anywhere (i.e., if you are traveling or if your therapist does not live locally).

2. TEXT-BASED Communication:

Choosing text-based therapy means we’ll communicate in writing. You can choose from a “chat” or messaging style conversation or an email-style exchange. 

Some clients find themselves less inhibited communicating in writing instead of meeting face-to-face. The software I use provides a written record of the conversation the client can re-visit to track progress, or for comfort or motivation between sessions. Writing may make people pause and think about their responses versus ranting, venting, exploding, or blurting, which is more typical in live conversation.

 E-therapy has evolved strategies to compensate for lost body language including bracketing (said enthusiastically), inserting description (“I’m writing late at night, and feeling in the flow”), or even inserting emojis to indicate feeling or mood 😎. 

If you choose TEXT-BASED therapy you can choose two formats:

1. CHAT / MESSAGING:

A chat conversation is a series of text messages that occur in real time (“synchronous”). Many people have become comfortable with instant messaging or “texting” and a chat session is similar to the exchange you would have with a friend or colleague using the messaging software on your smartphone. Research is suggesting that some populations do particularly well with text-based counselling, and millennials may every prefer it (although there are exceptions to every rule).[1]

 2. EMAIL:

Our email conversation may or may not take place in real time. The advantage of using email vs. chat is that we can craft longer responses. The software I use also lets us insert comments so we can build upon or refer back to previous or ongoing exchanges.

A real-time session would involve a series of back and forth messages (“synchronous”). The software I use will split our screens so the conversation ends up looking like a more drawn out version of chat. Or you can post your session at a set appointment time and I will similarly respond at a set time hours or days later (“asynchronous”). Asynchronous appointments let you write your session at a time that feels convenient for you. You can wait until you’re “in the mood.” This also gives you space for reflection or to ad to your notes as the week goes on, which can be especially useful if you’re tracking thought records, goal-setting, etc. For asynchronous work you must be mindful to send me only a previously-agreed upon number of pages or words, and vice-versa.

Other uses for E-therapy:

E-therapy has also evolved some other uses that are noteworthy:

1. Checking-in between sessions: Email or messaging software can be used as a way to give clients connection and support between sessions. Some clients may fare better if they have check-ins between sessions or if they can send progress reports, accountability updates, thought records, metrics on personal goals, journal entries, or other forms of homework. Not everyone needs this additional support, but it can be a valuable touchstone for clients in crisis or who need extra attention at certain stages of their treatment. Check-ins do need to be pre-arranged in keeping with boundaries and expectations on both sides. 

2. Document sharing: The software I use permits sharing of documents or links during our conversation or between sessions. These might include forms, readings, or document templates such as CBT thought records or goals-setting wheels. It also lets me review homework we might have agree upon. If we are using chat or email software, you have a written transcript of our session that you can refer back to whenever you like.

3. Group Therapy: E-therapy is a great tool for connecting groups of people who may be seeking connection and support for specific issues, conditions or challenges, and who are for various reasons unable or not interested in in-person meetings. These groups can create community while also offering anonymity, which can be appealing and sometimes disinhibiting. Split screen technology helps make groups more effective.

4. Couples and Family Therapy: Online therapy can be useful for long-distance couples. It can also be effective for high-conflict couples or family counselling. It may be particularly helpful for some couples to communicate in writing as this creates time and thought for reflection, and can abet a less-charged environment during a period of separation, anger, or grief.

Is there anything else I need to know? 

The software I use does require a short time for set-up (less than ten minutes initially, a fraction of that time to login after you’re set up). Tech support is always available and there’s an app for your phone. This is a small hassle, but once you’re up you never have to worry about security concerns ever again—a very worthwhile trade-off. Do anticipate some learning curve, as with any new software. You can read more here.

Does it really work?

The research and statistics on e-therapy are still being established, and research outcomes indicate that online therapy can have very similar results to in-person therapy.[2] But results vary for individuals. Considering and exploring your own needs, expectations and desires with respect to the therapeutic alliance, and your own comfort-level with technology, will help you better assess whether e-therapy is likely to be effective for you. Understanding the technological options available also empowers you in your decision-making. 

Is it right for you?

You are the best person to answer this question. Maybe the answer is “sometimes, under the right circumstances” or “in a pinch”: you might want to book a virtual session while you’re traveling or on vacation, perhaps while you’re at home with your first baby, or staying close to home to care for sick and aging parents, etc. It doesn’t have to be all or nothing. You may choose to do virtual sessions to maintain continuity or to address certain issues, or because there are no other options considering current circumstances. OR you may find that something about doing therapy in writing makes you open up and blossom. It’s all about making it work for you.

 E-therapy is still a new and evolving technology. As a practitioner, I think it’s important to acknowledge this, and to have open and ongoing dialogues to discern the practices and strategies that best enhance YOUR individual experience. This risks sounding platitudinous, but the plain truth is that we’re still learning how to do e-therapy well. E-therapy is a promising tool, but the aim is to use it wisely, and this can only be done collaboratively. I’m excited and optimistic about the digital future of therapy, even while I remain committed to the idea that true, human connection is always at the heart of healing.

If you would like more information, contact me for a FREE 20-minute phone consultation or book an appointment here. 

[1]See: http://www.ohtn.on.ca/rapid-response-online-mental-health-counselling-interventions/

[2]This recent Canadian study is very forthright about metrics for e-therapy. See: Ontario HIV Treatment Network (2018) – “Online Mental Health Counselling Interventions” - http://www.ohtn.on.ca/rapid-response-online-mental-health-counselling-interventions/