By Sally McGregor, MC, NCC, LPCC
COPAGS Programming Chair
Online therapy is not just a fleeting fad, but rather a paradigm shift in our profession, and it should be treated as such. Life is increasingly automated, and numerous services and transactions exist entirely online. The same is true of psychotherapy. Some consumers are determining that it is more practical to utilize our services from the privacy and comfort of their living rooms. Rather than resist this change, perhaps we should embrace it.
Did I just call therapy patients “consumers”? Let me explain. I am extremely uncomfortable with regarding clients as consumers in the context of the actual therapy. Words are important, and we should watch how we use them. We stop doing our job the minute we begin to relate to our clients more as paying customers than as people seeking an overall more satisfying and meaningful life. However, as professionals seeking to provide a service, we also need to consider that our clients are demanding that we become more tech savvy, in some of the same ways that non-medical service providers are. On a macro level, considering our patients as consumers allows us to think about how to make psychotherapy accessible to as many people as possible. Truthfully, I also think resistance to change is futile. In any profession, if you do not adapt to the demands of a changing world, and modernize as the technology does, you are bound to be left behind. So, it is time to take this whole distance therapy phenomenon a lot more seriously.
Telepsychology is the umbrella term for any interaction with a psychologist through a website, phone, or mobile app. It can be attractive to people who otherwise may not interested or able to attend in-person appointments. For example, people who are housebound with mobility issues can find virtual therapy extremely useful. That being said, the use of technology places a pretty tangible barrier between the client and their psychologist. For relational therapies, which place an emphasis on the interpersonal, moment-to-moment process as a healing factor, I can understand the trepidation on the part of professionals. How much do we lose when the complexity of human connection is reduced to an exchange of text messages? Ideally, you would be able to use a HIPPA compliant video conferencing app to avoid sacrificing face-to-face contact, and a real-time conversation. But, even then, technology can still feel like a barrier.
On the other hand, it is interesting to consider whether treatment entirely via text message could be therapeutic. More than one of my clients (particularly my adolescent clients) spend a portion of their session with me reviewing text message exchanges they have had with their romantic interests and friends. This is clearly an opportunity for them to illuminate and process the interpersonal issues they are experiencing. I realized the amount of emotional investment they place in these forms of communication. Entire arguments are initiated and resolved via iMessages. If text messages are one of the most significant and meaningful ways in which they communicate with other people, who is to say text-therapy cannot be beneficial as well?
I do not want to end this blog post without acknowledging that there are important issues with online therapy, and that this post is a very small part of a much larger conversation. At this juncture, it can be difficult to secure insurance coverage for such services. Technology frequently fails to work correctly and concerns about confidentiality are an entirely new beast when your communication is over the internet. Most importantly, considering how you will respond to a crisis situation becomes very important when your client has never stepped foot into your office, in real life. However, for those clients who live in remote areas, or who otherwise experience barriers to attending therapy in person, we have an obligation as professionals to consider the options. When our clients have transformed how they communicate with others, why should we be so determined to sticking to our old forms of communication?