The computer will see you now - the rise of online therapy
Nowadays you can talk to a counsellor, psychotherapist or psychologist without leaving the house. Online therapy is on the rise, but it is not without its limitations
Ask someone to envisage a therapy session and they'll invariably conjure up an image of a patient reclining on a leather Chesterfield chaise longue, while a bespectacled doctor asks them questions about their childhood.
The modern alternative is significantly different. Nowadays, clients with a good Wi-Fi connection can access all manner of mental health services without ever leaving the house.
Distance therapy is on the rise, with one study suggesting that 20pc of psychotherapists now offer some form of online, email or telephone service. The new generation are especially receptive. Millennials, or digital natives as they are known, are generally the biggest users, while the therapists offering the service tend to be younger and more digitally savvy.
The instant messaging platform Talkspace, which connects people with licensed therapists, has over 100,000 users in the US and recently raised $9.5 million in funding. Elsewhere, 7 Cups of Tea, a free, anonymous community of 'active listeners' encouraged 17,000 people to volunteer their services in year one. Closer to home, MyMind, which employs 75 therapists and has locations in Dublin, Cork and Limerick, is one of the largest providers of affordable distant therapy services in Ireland.
Communications officer Carmen Bryce concurs that their largest demographic is young students. However, the service is also popular with clients who have mobility issues and "new mothers who can't leave the house".
"Accessibility is at the core of our mission," says Bryce. "We believe mental health services should be in everyone's reach so we couple our face-to-face counselling with the online option to extend the reach of our services."
Online therapy is largely an additional service in Ireland. Therapists are simply offering an alternative to patients who require accessibility, flexibility and anonymity.
Psychotherapist and counsellor Carmel Farnan started offering distant therapy three years ago. She now treats 80pc of her patients face-to-face and 20pc remotely.
"I was reluctant to do it at first," she admits, "but the results have been very positive. Some people just didn't want to be seen in the waiting room," she adds.
Psychotherapist, relationship counseller and sex addiction therapist David Kavanagh also observed a spike in clients wishing to remain relatively anonymous.
"If you've been sexually abused, say, and you want to talk but you find it too challenging, then you have the option of going online," he says. "Online is a 'safe space' for people who are shy or uncomfortable."
"Still, it's not a sensible option for people with social phobia," adds Farnan. "If someone has social phobia, the last thing you would want to do is give them the opportunity not to interact as part of their therapy."
Studies around the effectiveness of distant therapy have been largely promising. One found that it may promote more client-openness, while another concluded that online therapy reduced suicidal thoughts among young doctors who were working 80-hour weeks and overnight shifts.
Still, it has its limitations - and not just because medication can't be prescribed and some health insurers don't provide cover for sessions that take place online.
Psychotherapist Gillian Isaacs Russell was moved to write Screen Relations: The Limits Of Computer-Mediated Psychoanalysis And Psychotherapy, following her experience of offering distant therapy to clients when she moved to a rural area of South Dakota.
Russell observed a distinct difference between working on the screen and working 'co-presently' in the room. "If you have to pay attention to the implicit non-verbal part of a relationship, then it doesn't come across in the same way," she says.
"On the screen, it's usually from the shoulders up so we're not able to see a lot of the intimate things that are going on with our patients," she says.
For instance, therapy via a screen makes it difficult for a therapist to see if a client with an eating disorder has lost weight - and impossible for a therapist to smell alcohol on the breath of a client with a drinking problem.
Farnan agrees. There are a number of issues, including severe depression and psychosis, which she doesn't treat online. And while she is confident that she can pick up a lot from the tone of a client's voice, she generally prefers to do face-to-face.
"You're going to pick up on a lot of non-verbal cues in your therapy room," she says. "When you think about it, 55pc of our communication is non-verbal, so by not being able to see the client, the therapist has a huge disadvantage," adds Kavanagh. "If you have a therapist five miles from you, and you can afford it, then you need to go and see that person. That's the best opportunity to progress your healing," he concludes.
Business performance coach Terri Morrissey is of a similar opinion. She says she prefers to meet clients face-to-face before following it up with telephone or online coaching.
"[Online therapy] has a role," she says, "but there are obviously a lot of caveats with things like this. If it's a serious issue, I'm not sure how much can be dealt with online."
Most of the experts agree that the success of online therapy has as much to do with the problem being treated as it does with the mode of therapy employed.
While Russell is dubious of many aspects of online therapy, she believes it's the perfect medium for cognitive behavioural therapy (CBT), positive psychology and self-help courses, which she describes as "dictatorial and not based on a relationship".
This is backed up by a number of studies which found that online cognitive behavioural therapy is as effective - and in some cases more effective - than face-to-face.
These studies inspired clinical hypnotherapist Fiona Brennan, who is launching a digital self-help/self-hypnosis programme The Positive Habit today. "The main idea behind The Positive Habit is that most of our thinking, our behaviours and our feelings are habit-based," she says. "Our thoughts create our present and our future and negative thoughts shape how we feel about ourselves and the world so it is vital to look at shifting these thoughts into a positive gear."
Therapists engaging in distance therapy also need to be aware of security issues. Hacking is an omnipresent threat on the internet and most of the Irish therapists offering online services don't have sophisticated platform encryption that gives clients complete peace of mind. This is slowly changing, however. MyMind currently uses Citrix but they are moving over to Twilio.
"It's a very user-friendly and secure platform and it's very much in line with data protection," explains Bryce. "The client is sent a link. They click on the link and the therapist is right in front of them on the screen."
Still, the vague safety threat cannot be compared to the risk of not receiving any help at all. "Sometimes taking that first step into therapy can be difficult, especially because there is still that stigma attached," adds Bryce.
This is particularly true for men, who are twice as likely to be suspicious of therapy when compared to the opposite sex. "It can very helpful for somebody who is a little apprehensive about the first step," continues Bryce. "But once they get into the process and develop a relationship with the therapist, they begin to feel more comfortable about coming to the centre. Online therapy challenges the stigma. The more accessible it becomes, the less stigma is attached."
* Terri Morrissey is also the CEO of the Psychological Society of Ireland. Her comments above are in an individual capacity, not an organisational one.
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