Some people make appointments to see their therapist in person, others choose online counseling. As a counselor and therapist who offers both, my experience is that either is better or worse than the other, they are just different. Each approach to therapy has its own advantages and benefits.
When There is No 'Body Language', the Focus is on the Therapy
Some people have an idea that because online counselors will not see body language, they are at a disadvantage in their job and may not be as effective as face-to-face counselors. But how significant is 'body language' when considered against what is being said and heard? Online therapeutic conversations actually have the potential to be more focused than a discussion between therapist and client in the same room. The distractions of how someone is sitting, what they are wearing and what else is going on in the room are simply not present during online appointments.
'Body language' can of course give a counselor a better sense of a person, but it can also be influenced by the situation in itself. A person meeting with a therapist in an unfamiliar office may appear physically uncomfortable, more so despite than the consultation was taking place online.
There are obviously some differences between being in the same room as a therapist and meeting with them online. But such limitations need to be balanced against the extra attention that words and language receive when they are conveyed from a position of comfort and in a familiar environment like home.
Online Counseling: Different Choices for Different People
Online counseling is not just one approach. It encompasses a number of options which each has its own advantages.
- Webcam: Face to Face Counseling over the Internet
The most recognized approach to talk therapy over the Internet is probably webcam counseling. Webcam counseling means that you and the therapist see each other face to face, just like if you were together in the same room. So rather than talk about online counseling and 'face-to-face' counseling, I like to use the terms 'online counseling' and 'in-person counseling', because webcam counseling IS face to face.
There is no doubt many people enjoy the comfort and convenience of meeting a therapist over webcam. You do not need to think about transport, traffic or what you are wearing. You save time because you do not even need to leave home. All you need is a functioning computer with webcam, access to the internet and a quiet and private place. You can see and talk with your therapist in confidence and relaxed in your own space. If you do not want to be seen, you can choose to talk without the video, which is just like telephone counseling.
- Instant Messenger Counseling
Different people like the idea of therapy over the Internet for different reasons. The convenience of not having to leave home can be attractive but the privacy and confidentiality of online conversations are also a drawcard for many.
Instant message software such as Skype and Windows Messenger makes it possible to participate in therapy without being seen or heard. Typing out your problems and having your therapist respond with questions or reflections on what you have written can be a refreshing alternative to having to give voice to difficult experiences. This might be quite important for someone who experiences shyness or struggles to speak to a stranger. An additional feature of the software is that it automatically keeps a transcript of the conversation on your computer that you can choose to delete at any time. The advantage here is you can read over the transcript to refresh your memory of what was said at any time after the session has finished and refer to the dialogue at your next appointment if you have any questions. Research has shown that documentation of what transpired can make therapy sessions much more effective.
- Email Counseling
Email counseling has been around for some time now. It offers the convenience of not having to leave home, the privacy of not being seen or heard and the added advantage that you can choose to write in your own time.
Some people feel under time pressure when they are in a room with a therapist. This pressure disappears with email counseling. Exchanging emails with your therapist means you can think through what you want to say, take your time to write it and then, when you receive a reply from the practitioner, you can read it over in your own time. Email counseling takes the rush out of therapy. And everything the therapist says is documented, which is another safeguard for you.
The Benefit of Options in Therapy
I have heard some critics answer that online counseling is a poor substitute for in-person counseling, too risky or even that it should not be legal to practice it.
We have already covered how the different approaches to online therapy have their own advantages that may outweigh 'body language' and other specific disadvantages in some situations. In terms of the risks or other concerns, I think it is important to point out that internet based therapy makes counseling and therapeutic support possible for many people who would not otherwise be prepared to engage with a therapist.
A lot of people who have consulted me through online appointments may not have even tried counseling if the online options were not available. Should these people be denied access to counseling just because they are not prepared to sit down in an unfamiliar space with a stranger they have never met?
Online counseling and therapy are inevitably the direction that much therapeutic practice will take in the future. Internet based talk therapy has the potential to help many people because it is comfortable, private and actually does not put the consumer back in control.
Risk, Safety and Effectiveness in Internet Based Counseling
Despite the best attempts to try to regulate counseling practice and therapy, paying for any service will always be, to some extent, a matter of 'let the buyer beware'.
Choose a counselor or therapist who is a member of a reputable professional association and insured to practice. Membership of a professional body means the practitioner has some degree of accountability for their work. You can also check with the association to ensure they are who they say they are.
If you have any particular concerns, write them down and send them to the therapist or ask for a preliminary conversation to discuss these issues. These may include matters like qualifications, privacy and confidentiality, technical problems and payment. I encourage people to shop around for a counselor or therapist that feels comfortable with, just as you would if you needed to choose a new doctor, or mechanic or decorator.
In terms of who an online counsel should and should not see, there are no hard and fast rules for this. In my own practice, I do not make myself available to people who are at any significant risk or personal danger or if there is extreme urgency to the situation. I am working with people from all around the world so I am not in a position to easily engage local emergency services. If the situation is one of domestic violence or recent sexual assault for example, I direct people to contact a GP or their nearest public hospital. Medical professionals and institutions are usually much better resourced to find the most appropriate help for anyone in such a situation.
Who Are the Most Suitable Clients for Online Counseling?
You do not need to be isolated or disabled or even short of time to choose an online therapist. Meeting with a therapist or counselor over the Internet can be just as effective as consulting a practitioner who is in the same room. Online counseling is suitable for those with problems like anxiety or depression, relationship issues, sexuality concerns, confidence, shyness, addiction, career problems or burnout or difficulties with life direction and purpose. In fact anything you might talk about with a therapist in person can be explored with a competent and professional online therapist.
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