Online Therapy: Innovation or Compromise?

A while ago, when I was a graduate student studying counselling psychology, I wrote a paper with a similar title, in which I discussed the key ethical principles, values, and standards relevant to the practice of providing psychotherapy and counselling over the Internet. At that time, online therapy was a subject of intense debates as it was still a relatively new practice. In my paper, I considered three options for my future practice:

1. To refrain from any form of online contact with clients.

2. To work with clients in whatever environment they prefer, even if they choose to communicate with me exclusively online.

3. To offer online contact as an adjunct to face-to-face counselling.

After carefully weighing the risks and benefits of each option, I decided that I would provide online support only in addition to face-to-face counselling. In other words, the third option seemed the least risky to me. Why? Primarily because online therapy at that time was mostly about exchanging emails and texting. I was afraid that without nonverbal cues, I could miss out on important information about my clients, including thoughts and emotions of which even they might be unaware. With respect to videoconferencing, which was just emerging, I was afraid that the interruptions and abrupt terminations of therapy sessions caused by technical issues might be confusing and distressing to my clients, and even cause damage to our therapeutic relationship. Alternatively, I could be left wondering if the client has disconnected because of something I said or because he or she is in crisis. Despite my reservations, I ended my paper with a more optimistic conclusion: “I believe online counselling can be beneficial for clients, if it is practiced carefully and ethically.”

That was then. Fast forward to the spring of 2020, and online therapy has become the only available option. Since the beginning of the pandemic, I’ve been providing my services exclusively online. Given this experience, there is no longer any doubt in my mind that online therapy (or virtual therapy as some prefer to call it) is an innovation; it is not a compromise. Recent research seems to confirm my conclusion:

· Online therapy effective at treating depression and anxiety

· Virtual treatment for depression is better than in-person sessions: McMaster study

Apart from the most obvious benefit of convenience, I’ve noticed a number of other less obvious benefits. For instance, I’ve noticed that the online format seems to enable my clients to be more open and to talk about things that they wouldn’t readily talk about face-to-face. For some reason, my clients seem to talk about more sensitive and personal issues online than they did in person. They also appear more assertive online. I wonder if participating in psychotherapy or counselling from the comfort of their homes disinhibits clients and makes it easier for them to communicate complex and emotionally charged issues. The online format may also equalize the power balance between the therapist and the client. Whatever the reasons, I haven’t heard any complaints about the online format from any of my clients.

Moreover, I can now reach geographically remote or isolated clients, as well as clients who have limited mobility. In addition to seeing local clients, I am now offering online therapy via secure video to individuals who live anywhere in Ontario, Prince Edward Island, Newfoundland and Labrador, Manitoba, Saskatchewan, British Columbia, Northwest Territories, Nunavut, and Yukon. My clients seem to appreciate the convenience of accessing psychotherapy and counselling services at a click of a button. They are no longer waiting for the opportunity to resume our sessions in person. I believe that, regardless of the situation with the pandemic, online therapy is here to stay.