The accessibility of online counseling has made it an easy available, relatively cheap and convenient form of treatment for mental health issues. But does this convenience come at a cost? When the relationship between therapist and client is mediated via a screen, can you still connect at the same level of depth as in in-person, face to face counselling? Let’s explore two studies that attempt to address this question.

Konstantina Tsalavouta attempted to explore the question of the nature of the online therapeutic relationship as part of her doctoral studies. Tsalavouta conducted an in-depth, qualitative study interviewing nine online therapists via Skype. The interview questions centered around: exploring how therapists experienced the online therapeutic relationship, and how they understood the process of developing and sustaining an online therapeutic relationship. Key findings indicated that while therapists did indeed appreciate the convenience of online counseling, they perceived a concomitant reduction in depth when working online. The lack of physical connection was viewed as having a negative impact on the quality of the therapeutic relationship and therapeutic alliance. The therapists reported that this required them to be more aware of how they structured the therapeutic relationship and made them more mindful of building an alliance with the client that offset the effects of working online. These finding seem to suggest challenges to the therapeutic alliance and relationship when working online which may make online therapy more appropriate for less complex mental health issues.

In her Master’s thesis, Kate Anthony also explored the nature of the therapeutic relationship in online counseling. She interviewed seven online therapists and explored questions regarding their perceptions of the therapeutic relationship, how they used text as part of their therapeutic process and how they countered the impact of reduced visual and auditory information. The therapists in her sample used more text-based forms of communication with their clients. She found that the online therapeutic relationship needs to pay close attention to the client’s written expressions and that the therapist needed to respond in a similar style in order to build rapport. She noted that therapists could establish a significant presence with the client through using text in a way which was perceived to be as real as face-to-face rapport. Her study also indicated that there was heightened openness from online clients who more freely expressed their feelings without shame or embarrassment. In addition, where client and therapist understood the use of text and communicated effectively via this medium, the online relationship is indeed therapeutic.

Both these studies provide some exploratory thoughts on the topic of the online therapeutic relationship. Given their qualitative nature, small sample size and other methodological limitations, it is hard to generalize these findings. With these limitations in mind, the first study seems to suggest that the quality of the therapeutic relationship is indeed restricted and limited when mediated through an online medium. In contrast, the second study indicates that if the nature of what online therapy has to offer is fully understood by both parties, then there are a range of compensatory strategies that can be used to ameliorate the lack of face-to face contact. The second study uses a more textual approach to the understanding of online therapy and as such is perhaps evaluating an entirely different experience as opposed to online counseling mediated via a webcam. Nevertheless, it points to opportunities inherent in working online, the importance of recognizing the availability of a more diverse and wider range of therapeutic tools, and the availability of compensatory strategies that can be maximized in order to maintain rapport and enhance the therapeutic relationship.

Author Bio:

Dr. Stacey Leibowitz-Levy is a highly-experienced psychologist with a Master’s Degree in Clinical Psychology and a PhD in the area of stress and its relation to goals and emotion. In addition to her private therapy practice, she currently runs – a mental health resource with self-help guides on stress, anxiety, depression, and many other areas. During her spare time, Stacey enjoys spending time with her husband and children, being outdoors and doing yoga.

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