The world of online psychotherapy continues to develop rapidly. There are now dozens of videoconference platforms designed or marketed specifically to therapists. The research base is steadily growing. States and provinces are working feverishly to provide clarity in law for therapists working online.
In such a rapidly-changing environment, it can be difficult for therapists to reasonably assess the current state of online therapy. Here’s what we can safely say we know as of April 2017. Unless otherwise noted, “online therapy” here refers to interactive, video-based work. Other forms of technology, including phone, text, and chat, are often used in therapy, but less is known about them.
We know lots of therapists are working online
In a 2014 study of MFTs’ uses of technology, more than 20% had engaged in videoconferencing with clients. If the sample was truly representative of the MFT field, this would mean that thousands of MFTs around the country have already engaged in online therapy. While many were uncomfortable with the idea of using online therapy as the sole form of treatment (particularly if the client was a family), previous history suggests that many more of us will use the technology as it becomes more comfortable and familiar in other parts of life. In the same study, more than 80% of MFTs had emailed clients (Hertlein, Blumer, & Smith, 2014).
Even those therapists who do not provide therapy online are gradually moving elements of their in-person practice online. Several companies now offer secure platforms for electronic records, calendaring, and billing.
We know online therapy works -- with some caveats
Online therapy has now been shown to be effective on a level comparable to in-person therapy for a variety of specific individual problems, including anxiety, depression, eating disorders, obsessive-compulsive disorder, panic, and more. Online therapy has also been shown to be useful for specific behavioral change, like quitting smoking or losing weight.
The studies supporting these conclusions have typically utilized manualized forms of cognitive-behavioral therapy. Some have examined therapy delivered via video-conference, while others have reviewed therapy delivered by text exchange (messaging or email). Together, these findings show great promise for online work.
We know clients like online therapy
One of the expected advantages of online therapy is the convenience it offers to clients. Sure enough, clients report liking that they don’t have to travel to a therapist’s office to do therapy, saving them time and money. The online environment may also be less threatening to clients than meeting a therapist in person.
Of course, some clients still prefer in-person treatment. However, this may be a function of simple unfamiliarity with the online therapy process. One recent study found that negative attitudes toward online therapy can often be easily changed.
We know online therapy improves access to care
Another expected advantage of online therapy is that it allows clients to access mental health care who otherwise would not. That seems to be happening. Richard Bischoff and colleagues from the University of Nebraska-Lincoln gave a workshop at the 2016 AAMFT Annual Conference where they described their use of grant funding to provide online services to three rural counties. In that project, they were able to provide services to many clients who otherwise simply would not have been likely to access in-person care.
While text-based therapy remains controversial and has less research support, I’ve previously argued that the clients who are accessing text-based therapy are often those who would not or could not receive in-person therapy. As such, the ability to have at least some access to a therapist, even if by text, may be preferable to no access at all.
We know online therapy can be done legally and ethically
Therapists clearly worry about their ability to practice online in a manner that is both compliant and effective. Multiple studies have shown therapists’ discomfort with adopting new technology for their clinical work, especially in the context of a rapidly changing regulatory environment. Despite these concerns, actual complaints against therapy providers working online appear to be rare. And inexpensive resources for professionals continue to proliferate, including AAMFT’s new best practice guidelines for MFTs working online, books to guide therapists on HIPAA compliance, and additional platforms seeking to appeal to therapists and their clients.
We know that there is a lot more to learn about online therapy
We know a lot -- even a lot more than we knew just a few years ago -- about online therapy. We also know that there is a lot we don’t yet know. I’ll address several of those issues in next week’s post: What we don’t know about online therapy.
Benjamin E. Caldwell, PsyD is a Los Angeles-based Clinical Fellow of AAMFT. He chaired the workgroup that developed Best Practices in the Online Practice of Couple and Family Therapy. The Best Practices document is now available from AAMFT. Have questions about online therapy? Join Dr. Caldwell on May 5, 2017 for a webinar on online therapy hosted by AAMFT. More information can be found here.