Online Therapeutic Approaches
Pinning My Colours to the Mast
Sitting re-reading my previous post on the subject of online therapy where I firmly pin my colours to the mast about what I beleive to be true ie: that online therapy can be just as effective and helpful to clients as face to face therapy, for some reason, I’m reminded of the words of Jeffery Masson in his book “Against Therapy”.
In his crituque of Carl Rogers Person-Centered Therapy, Masson states that “…the circumstances of therapy are artificial.” (Masson, J. pp232)
He is of course talking about all therapy and makes no distintion between online and inperson work. Perhaps because online work had not emerged as a viable and useful option at his time of writing?
The Process of Therapy is Inherently Contrived
The process of how inperson therapy works developed over many years, with many contributions from a multitude of areas and certainly didn’t arrive preformed and ready for use. Online therapy is simply following in the traditions of these other therapeutic developments.
The prospect of having to sit down with, at least at first, a complete stranger and perhaps begin to divulge our inner-most secrets and fears in the hope that this process will lead to a form of understanding, healing and growth within ourselves may not be a completely comfortable thought for most people.
I may not agree with everything Masson says but in this case he makes a factually accurate point. The process of therapy is inherently contrived.
Successful Therapy Relies On The Relationship Between The Therapist and The Client
For instance, how many of us, in our normal every day lives would start a conversation about our feelings, being completely honest, sharing our thoughs and fears as we wait at the bus stop?
How would we react to other’s if they started telling us what was really going on in their lives when we said “good morning, how are you?” as we walk in to the office?
What is beyond doubt is the process of psychotherapy does indeed produce beneficial results for a large proportion of those who engage with it, however, it also has to be acknowledged that, for some it does not.
There can be many reasons why the process of psychotherapy can be less than successful. Personally I beleive one of the main reason for this, which, as it turns out is also one of the most important factors in therapy being successful, is the relationship between the therapist and the client.
Barriers to Therapy
Perhaps the client might feel the therapist does not connect or understand where they’re coming from, who they are as a person. For me, if this happens then it is incumbant on the therapist to offer help in referring the client on to another practioner if they are unable to work through this together. Truth is that the client may not want their help and will probably stop engaging with the therapist.
Perhaps the client is attending sessions under duress, only there due to pressure from loved ones or the legal system, civil or otherwise. Perhaps it may be that the client feels they are unable, for whatever reason to connect to the theraputic modalities being offered.
What these issues may have in common is a detrimental effect on the ability of the therapist and the client to form a therapeutic relationship at what is described as relational depth.
All of these may certainly be valid and they present across all forms of therapeutic encounters, whether these are face to face or online.
Previously, I touched on some of the difficulties we may face when working online, most of which were to do with contracting and the mechanics and technical issues that can arise. These are not the only issues we may face.
There are indeed both Pro’s and Con’s of working online and I would encourage any therapists thinking of working online, to get themselves as informed as possible.
Cons of Working Online
If we start by looking at what might be some of the Cons or difficulties presented by working online.
Some people may not like the idea of sitting in front of a computer or device and find the prospect of speaking candidly in this way quite intimadating.
Others may feel that psychotherapy is effective and real/authentic only if they are in a face to face setting.
There can be difficulties with what may be called “Meta language”. The pauses we use when speaking and the intonation in our voice or the movement that we might unconciously make when communicating.
These can be good indicators or leads to what may being going on that therapists can pick up on. They also help a client to feel connected when they recieve these from the therapist.
Without this visual aspect the therapist will undoubedly miss some ques but should still be able to pick up on quite a lot if they are listening well. This will also be mitigated to a degree if using video sessions.
If the therapist feels they missed something or are unsure about what’s been said it’s always good practice to ask a person to clarify the point.
It often helps someone to re-phrase their statements and they will likely gain more understanding for themselves through this process.
This works well with both face to face and online therapy.
Would online therapy be recommended with those who have to deal with pronounced mental health issues? No.
For those who display these types of conditions I would encourage them to work with highly skilled mental health professionals who can provide the level of support needed to best facilitate their well being.
Communication aids. In my own face to face practice I will sometimes use a whiteboard to share/explain a concept or to help in discovering and investigating what a person is attempting to communicate.
This can be difficult to do online if you don’t have a camera set up at a board. It means, we as therapists may have to think differently about how we communicate with our clients. Purchasing animation softeware may be a way to help this process, if we’re creative and can afford it.
It is also true that some types of therapy may not be as well suited to working online. Modalities such as Play Therapy as well as Drama, Music or Art Therapy will have difficulties due to the nature of online working. If someone has a specific desire to engage with these I would recommend they attend face to face sessions in person as soon as it is practical for them to do so.
These are some of the issues that clients and therapists may face, although there will always be a way to mitigate these issues, at least to some degree, it would be unrealistic and unprofessional not to recognise they exist.
So What About The Pros Or The benefits Of Working In The Online Environment?
Availability: While it’s true the number of people moving their therapeutic relationships online is growing quickly these are only a small fraction of the people asking for help.
This can be seen if you’ve ever tried to book a face to face session at most inperson practices. They tend to be under immense pressure and securing an appointment may take weeks due to this.
With more thereapists moving their practice online there is currently a lot of opportunity available to be able to start working with someone in a relatively short space of time.
This is also true if you want to have multiple sessions within a shorter timespan, although it has to be done with the clients benefit uppermost.
Engagement: There is some good information starting to come to light that those who engage with therapy online have a higher attendance rate. This may be due to the convienence of being able to have a session in your own home or in place you feel more comfortable.
The need to organise travel to and then walk into a place that people may know is a therapists office is also removed. No matter how much better the world is getting in our attitudes towards psychological issues there is definitely still a stigma involved. Removing the need for inperson sessions can be a big help in feeling comfortable and people becoming willing to ask for that help.
Anxiety: For those who suffer with Anxiety (social or otherwise) the option of being able to engage with a therapeutic professional in an environment where they already feel secure can be of tremendous benefit.
Location: There can be major discrepancies between the kind of support available to individuals if they live in a rural setting or a cityscape. Online therapy can help to fill that void and to allow those with less real world options the ability to level the playing field and to gain the support they would most benefit from.
What this post is not saying is that Online Psycotherapy is better than Face to Face or vice a versa. There is definitely a place for both within the therapeutic world map.
Different people will react differently to the concept of each, which is as it should be. What I would encourage is for those who may benefit for working online, especially in our current situation, to reach out. There are trained and qualified professionals ready and waiting to help.So what about the Pro’s or the benefits of working in the online environment?
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