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Psychotherapy has long prided itself on being a very powerful, but inherently slow, process. Traditionally, this has worked well in cementing relationships between practitioners and patients, who spend many hours together within the course of treatment. These qualities, however, have collided awkwardly with the modern world.

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Today, when it’s easy to go shopping, do your banking, and finish a full day’s work without once speaking to another person, it’s easy to see why, cutting more than fifty minutes out of a day to talk about your personal problems might seem not only wildly impractical, but unnatural.

The rise of internet-based therapy offers a happy middle ground. Services like BetterHelp and Talkspace allow users to find therapists online, and conduct sessions through a mix of texts, e-mails, and video calls. Users can access their mental health providers whenever it’s convenient; on their phone or on their desktops, during lunch break or after work.

But does it work?

A study involving patients who sought therapy for work stress, marriage trouble, anxiety, depression, or parenting found that patients were as happy with the outcomes of online therapy sessions as those who saw a counsellor face-to-face. Patients who underwent treatment online were just as happy with the skills and experience their counsellor possessed as those who went in person, and reported that their counsellor made them comfortable enough to be open. Online therapy may even be better for certain patients. Men seemed to prefer it, given its degree of anonymity and the stigma around men seeking help for mental or emotional issues.

Still, there are questions about the efficacy of online therapy. There is a burgeoning worry that the connections we make online are poor substitutes for the ones we make in the real world. The relationship between therapist and patient is known to be a key factor in a treatment’s success. It isn’t just discussing the problems a patient may have, but the interaction between client and therapist, how the patient feels they’re being perceived by the therapist, or if their problems are being taken seriously, all of which can be communicated through eye contact, body language and gestures as much as through speech.

Given the importance of this in the field, it raises the question: what happens when that relationship is entirely virtual? And the lack of offline connection calls into question its appropriateness when treating the severely mentally ill, patients struggling with addiction, or patients who may be suicidal.

These initial studies suggest that online therapy shouldn’t be discounted simply because of its modality. It might not be perfect, but at least those too time-strapped to see a therapist in an office (but too stressed not to) have an appealing, and immediately accessible alternative.


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The British Journal of Social Work, Vol. 39, No. 4 (2009), pp. 627-640
Oxford University Press