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KM Psychotherapy Karen Morton MBACP
Psychotherapy & Counselling in Rickmansworth

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How does online therapy work? 4th April 2020

Whether you have had face-to-face therapy in the past, or whether this is the first time you are considering therapy, you will find that accessing therapy during the Coronavirus crisis is generally limited to online or telephone as advised by government guidelines. However, do not think that online therapy is a poor substitute for face-to-face therapy: there is increasing evidence claiming that online therapy can be just as effective as face-to-face.

Many therapists have been working online for years and it is growing in popularity.
Nonetheless, it is a different experience than face-to-face and will not be suitable for all. As it may be the only form of therapy available to you right now, it would be helpful to have an initial discussion with one or more therapists so you can consider whether it could work for you.


What is online therapy?
Terms like cyber therapy, e-therapy, online counselling, teletherapy and telemental health are interchangeable.

There are a variety of online options available. Whilst you do not have to be tech savvy, some basic knowledge will make things easier.

video
Video therapy is the most popular form of online therapy and is usually conducted via Skype, Zoom, WhatsApp, or FaceTime, etc. Some therapists only use one platform, whilst others will be more flexible and will offer a number of different platforms. This is the most similar to face-to-face as you are able to see your therapist’s face, and they will see yours.

audio
Telephone counselling also works similarly to face-to-face, but via the telephone or audio only, through platforms like Skype.

text-based
Using instant messaging or text, you arrange with your therapist a time to start a chat, and work in the same way as you would face-to-face.

email
This is an asynchronous method of therapy, meaning that, there will be a series of email messages exchanged between you and your therapist, responding at a time convenient, usually within 24-48 hours of receipt, but there will be no fixed time for he session as with video, telephone and messaging.

Some therapists only work online via video/webcam, some will additionally offer sessions via telephone, whilst email and messaging are not as mainstream.

How to find an online therapist
Some therapists only work face-to-face as a rule, and only work online if, for instance, their clients are away on business. More and more, however, therapists are embracing the online platform and with the current situation many are engaging with a new way of working. Qualified therapists with the British Association for Counselling and Psychotherapy (‘BACP’), as well as the other leading UK professional bodies, have guidelines which members must follow to assess their competency to additionally provide online therapy, this includes additional and adequate training, knowledge and proficiency for online working. You can find qualified and accredited online therapists on directories such as BACP, Psychology Today or Counselling Directory. Furthermore, therapists will indicate on their websites and profiles that they offer online therapy, and how they provide it.

A number of qualified and accredited therapists have additionally undertaken courses with a minimum of 80 hours certified training and are also accredited and registered with the Association for Counselling and Therapy Online (‘ACTO’), although this is not a current requirement for therapists providing online therapy. You can find their register of therapists here. ACTO confirmed to me at the time of writing that they currently have 210 members, double the members they had two years ago. It is anticipated that this number will increase dramatically, especially in light of the current situation.

How do sessions differ from face-to-face?
Sessions work in much the same way. You will have a scheduled appointment time and the framework for face-to-face therapy will apply.

It is always a good idea, whether working online or face-to-face to see if your therapist will offer a brief telephone conversation initially. Alternatively, this can all be done via email. If you agree to proceed, there will be information that the therapist needs to provide you with, such as their privacy policy and terms and conditions, as well as gathering some initial information about you. The first session, whichever medium you choose, will be similar to an initial session face-to-face. Any paperwork which has not been completed will need to be discussed and agreed and the therapist will ask you questions about your background, medical history and why you are seeking therapy and together you can discuss what you realistically hope to gain from it.

You will agree who will contact who (or initiate the chat), so that you are not both trying to reach each other at the same time, and what to do in case of interruptions in service. Clients working with video will need to remember that although they are in their own home, the same boundaries apply. For instance, you wouldn’t arrive to your therapist’s office in your pajamas or be eating your breakfast, would you?! The point here is that you do not take calls during your session and try to limit any distractions.


Starting online therapy
technology
You will need adequate internet connection to minimise connection difficulties. Make sure you have a landline or good mobile phone connection, even if you intend to use video calling. You may need this as a backup.

A computer is recommended if using video calling as this will replicate face-to-face more closely and feel more familiar. Check that your connection is adequate and that your camera (computer or separate webcam) show your face and shoulders and that the sound works. You may need to download software such as Skype; your therapist will discuss this with you prior to your first session.

before the session
Take a few minutes before the session to get comfortable and take a few deep breaths.
Make sure that you are in a quiet room where you feel comfortable and where you will not be overheard if you are using video or phone.

during the session
Communicate with your therapist if you do not hear or understand something. It is really important as your therapist may not immediately pick up on this as the visual cues may be missing.

after the session
Do take some time for yourself directly after the session. You are immediately in your surroundings and you may will need to take a bit of time before immediately launching back into your world. If you share a computer or device, ensure that you close or delete any relevant pages from your session to maintain your privacy.

Advantages to online therapy
There are benefits to online therapy, and there are significant differences as well.
accessibility
Firstly, you are not limited to therapists practicing in your area. You may live in a remote location where services are limited or non-existent. If there is a particular approach you have read about, or are familiar with, you can access that therapist easily, no matter where they are located in the country. Furthermore, online counselling is accessible for clients who are physically disabled or are unable to leave their home.

flexibility and convenience
As there is no travel time, you save time and do not have to concern yourself with getting there and back on public transport, on foot, or by car. Furthermore, both you and your therapist will have more flexible availability. You can arrange the same time each week, but equally if your work schedule is not consistent, it is easier to vary days and times each week.

suitability
Some clients find it easier to talk and are more comfortable with one of the online options. You may find that you share sensitive information more quickly than face-to-face, or conversely, it may take longer. Do communicate any concerns with your therapist as they come up so that they can support you. Online therapy also may be especially suited to children or teenagers who may be used to expressing themselves online and find this easier than speaking face-to-face, as well as adults with anxiety and agoraphobia, for example.

Issues to consider
You will also need to ensure you keep your information private from your end, especially if you are using a shared computer, as discussed above.

non-verbal communication
Subtle visual cues, such as body language, are limited with video calling, and are completely absent in text and phone therapy. This is not to say it is an inferior way of working, it is just different. It might take some time to adjust, especially if you are used to face-to-face therapy.

technology glitches
These can disrupt the flow of a session which can then be difficult to settle back in to. However, you and your therapist will always have a contingency in place and will attempt to minimise any disruption.

suitability
Currently, online therapy may be your only choice of therapy, but it is not suitable for everyone. Discuss any concerns with the therapist so they can best advise how to support you. As with face-to-face therapy, your therapist should have your GPs details as well as an emergency contact, together with your consent to waive confidentiality if they consider you to be at risk.

security and confidentiality
You may be aware of the discussion in the media recently around which video platforms are safe. However, platforms are ensuring that they provide secure connections and as soon as a weakness is discovered they are doing their best to increase security. The Information Commissioner’s Office gives up to date information on acceptable platforms and therapists take advice directly from them as well as their professional organisation. Generally speaking, online therapy is safe; therapists are subject to GDPR guidelines and take client confidentiality and privacy very seriously. Your therapist will discuss the risks and any concerns you may have.

Is online therapy effective?
Yes! Deeply meaningful therapeutic relationships do develop online and can support change and healing. A number of recent studies indicate that that online therapy can be as effective as face-to-face. NICE, the National Institute for Health and Care Excellence, provide a list of research studies if you are interested in reading about this further.

One person’s experience is unique to them, so as in face-to-face therapy, what works well for one individual may not work for another. If you are not sure, find a therapist that works with a variety of different platforms and options. Always bear in mind that that the therapist needs to be right for you too. Although therapists abide by the same or similar guidelines and may have similar training and approaches, they are unique individuals too. If you think they are not for you, try another. Some clients like to try a session with a few different therapists before they decide. Give it a try, and think about what might work best for you.


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