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{{Infobox medical intervention|ICD10=|ICD9=|MeshID=D000068237|OPS301=|other_codes=|HCPCSlevel2=|Synonyms=online psychotherapy, internet-based therapy, internet-based counseling, internet-based psychotherapy, internet-based psychological therapies, internet-based mental health intervention, internet-delivered therapy, web-based therapy, e-therapy, e-counseling}}
'''Online counseling''' is the provision of professional ] counseling services concerns via the Internet. Services are typically offered via ], ], and ].<ref name=Mallen1 /> Some clients use online counseling in conjunction with traditional ], and a growing number of clients are using online counseling as a complete replacement to traditional office visits.<ref name=Mallen1>{{cite journal|last=Mallen|first=Michael J.|coauthors=David L. Vogel|title=Introduction to the Major Contribution Counseling Psychology and Online Counseling|journal=The Counseling Psychologist|year=2005|month=November|volume=33|issue=6|pages=761–775|doi=10.1177/0011000005278623|url=http://tcp.sagepub.com/content/33/6/761.abstract|accessdate=4 May 2011}}</ref> '''Online counseling''' or '''online therapy''' is a form of professional ] counseling that is generally performed through the internet. Computer aided technologies are used by the trained professional counselors and individuals seeking counseling services to communicate rather than conventional face-to-face interactions. Online counseling is also referred to as teletherapy, e-therapy, cyber therapy, or web counseling. Services are typically offered via ], ], and ].<ref name=Mallen1 /> Some clients use online counseling in conjunction with traditional ], or nutritional counseling. An increasing number of clients are using online counseling as a replacement for office visits.<ref name=Mallen1>{{cite journal|last=Mallen|first=Michael J.|author2=David L. Vogel|title=Introduction to the Major Contribution Counseling Psychology and Online Counseling|journal=]|date=November 2005|volume=33|issue=6|pages=761–775|doi=10.1177/0011000005278623|s2cid=145615146}}</ref>


While some form of ] has been going for over 35 years,<ref name=Mallen_Main>{{cite journal|last=Mallen|first=Michael J.|coauthors=Vogel, Rochlen and Day|title=Online Counseling Reviewing the Literature From a Counseling Psychology Framework|journal=The Counseling Psychologist|year=2005|month=November|volume=33|issue=6|pages=819–871|doi=10.1177/0011000005278624|url=http://tcp.sagepub.com/content/33/6/819.abstract|accessdate=4 May 2011}}</ref> the advent of internet video chat systems and the increasing penetration of ] has resulted in a growing movement towards online therapy. Clients are using videoconferencing, synchronous chat and asynchronous email with professional ] in place of or in addition to face-to-face meetings.<ref name=Mallen_Main /> While some forms of ] and ] have been available for over 35 years,<ref name=Mallen_Main>{{cite journal|last=Mallen|first=Michael J.|author2=Vogel|author3=Rochlen|author4=Day|title=Online Counseling: Reviewing the Literature From a Counseling Psychology Framework|journal=The Counseling Psychologist|date=November 2005|volume=33|issue=6|pages=819–871|doi=10.1177/0011000005278624|s2cid=145429569}}</ref> the development of internet video chat systems and the continued increase of the market penetration for the ] has resulted in the continuing growth of online therapy. Some clients are using videoconferencing, live chat and email services with a ] in place of or in addition to face-to-face meetings.<ref name=Mallen_Main />


==Benefits== == History ==
One of the first demonstrations of the Internet was a simulated psychotherapy session between computers at Stanford and UCLA during the International Conference on Computer Communication in October 1972.<ref>{{cite journal |last1=Lasar |first1=Matthew |title=ARPANET's coming-out party: when the Internet first took center stage |journal=Ars Technica |date=2011 |url=https://arstechnica.com/tech-policy/2011/10/arpanets-coming-out-party-when-the-internet-first-took-center-stage/ |access-date=19 June 2021}}</ref> Although this was a simulation and not actual counseling, the demonstration created an interest in the potential of online communication for counseling. As access to the internet, bulletin boards, and online services became more available in the 1980s, and online communication became more common, virtual ] naturally developed. These self-help groups may be considered a precursor to online counseling. When the ] became public in the early 1990s and mental health professionals began to create websites offering mental health information, some began to receive requests for personal help and started to respond to these requests, leading to the advent of online counseling.<ref>{{cite web |last1=Ainsworth |first1=Martha |title=E-Therapy: History and Survey |url=https://metanoia.org/imhs/history.htm |website=Metanoia |access-date=19 June 2021}}</ref>


Information on sources related to online counseling was first created by Martha Ainsworth. In 1995, Martha Ainsworth began searching for a competent therapist because she had some psychological complaints. Her travel requirements made it difficult for her to consult a face-to-face therapist, and therefore, she needed an effective alternative online therapist. She only found a dozen web pages that offered online treatment for psychological complaints. Afterward, Martha Ainsworth wanted to reach the general public with her experiences and founded a clearinghouse for mental health websites, named Metanoia. By the year 2000, this clearinghouse contained over 250 websites of private practices and more than 700 online clinics where a therapist could be contacted.<ref>{{cite journal|last=Alleman|first=James R.|title=Online counseling: The Internet and mental health treatment|journal=Psychotherapy: Theory, Research, Practice, Training|volume=39|issue=2|pages=199–209|doi=10.1037/0033-3204.39.2.199|year=2002}}</ref>
The growing body of research into online counseling has established the efficacy of online therapy with treatment outcomes at least equal to traditional in-office settings.<ref name=Mallen_Main /> Online therapy has additional benefits unrealized by office-based treatments as it allows the patient to attend sessions at a higher rate than traditional sessions. The number of missed appointments is much less than with in-person therapy.<ref name=Glueckauf1>{{cite journal|last=Glueckauf|first=R.L.|coauthors=Fritz, Ecklund-Johnson, Liss, Dages, Carney|title=Videoconferencing-based family counseling for rural teenagers with epilepsy|journal=Rehabilitation Psychology|year=2002|volume=47|pages=49–72|doi=10.1037/0090-5550.47.1.49}}</ref> There is some research to suggest that online counseling is more effective because a client is at greater ease and feels less intimidated than they would in traditional settings. This makes clients more likely to be honest and thus allow the counselor to provide better treatment.<ref name=Spiro>{{cite journal|last=Spiro|first=R.H.|coauthors=Devenis|title=Telephone Therapy: Enhancement of the psychotherapeutic process|journal=Psychotherapy in Private Practice|year=1991|volume=9|pages=31–55}}</ref>


According to metanoia.org, the first service to offer online mental healthcare was "Ask Uncle Ezra", created by staff of Cornell University in 1986 for students.<ref>{{cite web |last1=Lang |first1=Susan |title=For two decades, Dear Uncle Ezra, world's first online advice column, has aided the perplexed, the shy and the confused |url=https://news.cornell.edu/stories/2007/02/any-person-any-question-ask-dear-uncle-ezra-advice |website=Cornell Chronicle |publisher=Cornell University |access-date=19 June 2021}}</ref> By mid-1995 several fee-based online services offering mental health advice had appeared.<ref name=matanoia>{{cite web|last=Ainsworth|first=M|title=E-therapy: History and survey|url=http://www.metanoia.org/imhs/history.htm|access-date=22 May 2014}}</ref> Between 1994 and 2002, a group of trained volunteer crisis counselors called "]", began providing suicide prevention services via email.<ref>{{cite book|editor-last=Kraus|editor-first=Ron|title=Online counseling: a handbook for mental health professionals|date=2004|publisher=Academic|location=Amsterdam|isbn=978-0124259553|author1=Zack, Jason |author2=Stricker, George }}</ref> There has been continuous increase in number of online counselling therapists and groups due to increase in web-based services and anonymity associated with virtual sessions.
Online counseling is also filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents and ] along with under-served ] often have an easier time finding a suitable therapist online than in their local communities.<ref name=Mallen_Main /> These access issues are solved with online counseling resources and result in clients receiving culturally or ] relevant treatment that they would not have otherwise been able to receive. African Americans tend to have an elevated rate of stress-related diseases and have lower access to traditional face-to-face treatments.<ref name=Sue_book>{{cite book|last=Sue|first=D.W.|title=Counseling the Culturally Different, theory and practice|year=1999|publisher=John Wiley}}</ref>


==Advantages and disadvantages of online counseling ==
Online counseling has also been shown to be effective for clients who may have difficulty reaching appointments during normal business hours.<ref name=Chang>{{cite journal|last=Change|first=T.|coauthors=Yeh, Krumboltz|title=Process and outcome evaluation of an on-line support group for Asian American male college students|journal=Journal of Counseling Psychology|year=2001|volume=48|pages=319–329|doi=10.1037/0022-0167.48.3.319|issue=3}}</ref> Additionally, research is demonstrating that online counseling may be useful for ] and rural people that traditionally under-utilize clinical services.<ref name=Mallen_Main />
===Advantages===
Online counseling offers several advantages. These include:


* ''Increased accessibility'': Online counseling fills an unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents, people with disabilities and ], along with under-served ], often have an easier time finding a suitable therapist online than in their local communities.<ref name="Mallen_Main" /> It also makes counseling accessible to clients who face difficulties in keeping appointments during normal business hours,<ref name=Chang>{{cite journal|last=Change|first=T.|author2=Yeh, Krumboltz|title=Process and outcome evaluation of an on-line support group for Asian American male college students|journal=]|year=2001|volume=48|pages=319–329|doi=10.1037/0022-0167.48.3.319|issue=3}}</ref> while decreasing the number of missed appointments for in-person therapy.<ref name=Glueckauf1>{{cite journal|last=Glueckauf|first=R.L.|author2=Fritz|author3= Ecklund-Johnson|author4=Liss|author5=Dages|author6=Carney|title=Videoconferencing-based family counseling for rural teenagers with epilepsy|journal=]|year=2002|volume=47|pages=49–72|doi=10.1037/0090-5550.47.1.49}}</ref> Along with accessibility of therapists, online counseling also enables accessibility of information to the clients. In face-to-face counseling, information is stored only with the therapists. In online counseling, the transcripts of communications between the therapist and clients may be available to therapists as well as clients. This allows people seeking therapy to monitor changes in their own conditions.<ref>{{Cite journal|last1=Amichai-Hamburger|first1=Yair|last2=Klomek|first2=Anat Brunstein|last3=Friedman|first3=Doron|last4=Zuckerman|first4=Oren|last5=Shani-Sherman|first5=Tal|date=2014-12-01|title=The future of online therapy|url=https://www.sciencedirect.com/science/article/pii/S0747563214004683|journal=Computers in Human Behavior|language=en|volume=41|pages=288–294|doi=10.1016/j.chb.2014.09.016|issn=0747-5632}}</ref>
==Effectiveness==
* ''Increased comfort and convenience'': Online counseling can offer higher comfort and convenience for clients and therapists alike.<ref>{{Cite thesis|last=Thompson|first=Ryan|date=2016|title=Psychology at a Distance: Examining the Efficacy of Online Therapy|type=Honors thesis |publisher=Portland State University |url=http://archives.pdx.edu/ds/psu/17399|language=en|doi=10.15760/honors.292|doi-access=free}}</ref> Therapists or clients may not need to travel for their sessions, which may be less expensive and more comfortable for all involved. In addition to the convenience, many people also enjoy the perceived confidentiality that comes with online counseling. They tend to feel more comfortable sharing information with their mental health professional and may feel less ashamed and powerless due to the removed environment.<ref name="Situmorang 166–174">{{Cite journal|last=Situmorang|first=Dominikus David Biondi|date=2020-10-01|title=Online/Cyber Counseling Services in the COVID-19 Outbreak: Are They Really New?|url=https://doi.org/10.1177/1542305020948170|journal=Journal of Pastoral Care & Counseling|language=en|volume=74|issue=3|pages=166–174|doi=10.1177/1542305020948170|issn=1542-3050|pmc=7528539|pmid=32967547}}</ref>
* ''Less expensive'': Although most therapists charge the same fees for teleconsultations as they would for direct counseling, teletherapy can be relatively less expensive as it does not involve travel costs if both parties have internet access from where there are.
* ''Approachable treatments'': Online access to therapy may help remove the stigma around mental health and can help individuals feel more comfortable with discussing mental health issues.<ref>{{cite journal |last1=Andersson |first1=Gerhard |last2=Titov |first2=Nickolai |title=Advantages and limitations of Internet-based interventions for common mental disorders |journal=World Psychiatry |date=February 2014 |volume=13 |issue=1 |pages=4–11 |doi=10.1002/wps.20083|pmid=24497236 |pmc=3918007 }}</ref>


===Disadvantages===
⚫ Some in the psychology community have argued that online therapy can never replace traditional face-to-face therapy.<ref>{{cite web|last=Cherry|first=Kendra|title=Online Counseling|url=http://psychology.about.com/od/psychotherapy/a/onlinepsych.htm|publisher=About.com|accessdate=4 May 2011}}</ref> Research from G.S. Stofle and J. suggests that online counseling would benefit people functioning at a moderately high level.<ref name=Stofle_book>{{cite book|last=Stofle|first=G.S.|title=Choosing an online therapist|year=2001|publisher=White Hat Communications}}</ref><ref name=Suler>{{cite journal|last=Suler|first=J|title=Psychotherapy in cyberspace: A 5 dimensional model of online and computer-mediated psychotherapy|journal=CyberPsychology & Behavior|year=2000|volume=3|pages=151–160|doi=10.1089/109493100315996|issue=2}}</ref> Severe situations such as ] or a ] might be better served by traditional face-to-face methods.<ref name=Zelvin_book>{{cite book|last=Zelvin|first=E.|title=Online Counseling Skills Part I: Treatment Strategies and Skills for Conducting Counseling Online|year=2004|publisher=Academic Press}}</ref> Although further research may prove otherwise.<ref name=Mallen_Main />
Some of the disadvantages of online counseling include:


* ''Anonymity and privacy'': Online counseling uses technology-aided devices and internet as the main medium for communication between the therapist and the client. All the personal and sensitive information of patients is stored on internet sites or devices. This increases the risk of data theft.<ref name="Khelifa 2007"/> While online counseling can feel more private than face-to-face interactions, there is potential for breaches of privacy in online counseling.<ref name="Situmorang 166–174"/> For example, non-encrypted electronic Internet communications might be intercepted, and records could be accessed by family members or hackers.<ref name="Khelifa 2007">{{cite journal |last1=Khelifa |first1=M |title=Online counseling: Competing ethically and safely in a global environment. |journal=American Association of Behavioral and Social Sciences |date=2007 |volume=10}}</ref> In online counseling, there may be a lower risk of discrimination based on race, ethnicity, age or gender, because these factors can be more difficult for the therapist to perceive in an online context.<ref name="Situmorang 166–174"/> It is important to establish the safety of the site and verification of therapist or client before beginning an online counseling session.<ref>{{Cite journal |title=Family Separation in Court: What You Need to Know |url=http://dx.doi.org/10.1163/2210-7975_hrd-9970-20180101 |access-date=2022-03-14 |website=Human Rights Documents Online|doi=10.1163/2210-7975_hrd-9970-20180101 }}</ref>
⚫ Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of ] in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.<ref name=Cohen>{{cite journal|last=Cohen|first=G.E.|coauthors=Kerr, B.A.|title=Computer-mediated counseling: An empirical study of a new mental health treatment|journal=Computers in Human Services|year=1998|volume=15|pages=13–26|doi=10.1300/J407v15n04_02|issue=4}}</ref>
* ''Finding the right match for therapeutic needs of clients'': Online counseling does not guarantee the right match for the therapeutic needs of the clients. Emotional and visual contact can be absent during online counseling sessions.<ref>{{Cite journal|last1=Baker|first1=Kurt D.|last2=Ray|first2=Mike|date=December 2011|title=Online counseling: The good, the bad, and the possibilities|url=http://www.tandfonline.com/doi/abs/10.1080/09515070.2011.632875|journal=Counselling Psychology Quarterly|language=en|volume=24|issue=4|pages=341–346|doi=10.1080/09515070.2011.632875|s2cid=145160203 |issn=0951-5070}}</ref> This absence may prevent therapists from sensing negative feelings like anger, terseness, or irritation in clients. It can also cause the sessions to be more straight to the point and less emotionally gradual, which can be beneficial or not depending on the client's need.<ref>{{Cite journal|last1=Rochlen|first1=Aaron B.|last2=Zack|first2=Jason S.|last3=Speyer|first3=Cedric|date=March 2004|title=Online therapy: Review of relevant definitions, debates, and current empirical support|url=https://onlinelibrary.wiley.com/doi/10.1002/jclp.10263|journal=Journal of Clinical Psychology|language=en|volume=60|issue=3|pages=269–283|doi=10.1002/jclp.10263|pmid=14981791 |issn=0021-9762}}</ref>
* ''Establishing authenticity of therapists or counselors'': Counselors and therapists are professional health care providers and hence require licenses to undertake clients for counseling as a part of their mandatory professional requirements.<ref>{{Cite web |title=Overview of State Licensing of Professional Counselors |url=https://www.counseling.org/knowledge-center/licensure-requirements/overview-of-state-licensing-of-professional-counselors#:~:text=Professional%20counselors%20are%20required%20by,education,%20examination,%20and%20experience. |access-date=2022-03-18 |website=www.counseling.org}}</ref> Psychologists and professional health care providers also require licensing in the state or other governmental subdivision where they practice in order to take clients. As the internet allows clients to choose therapists all across the world, establishing legitimacy and authenticity of the therapists or counselors may be difficult.<ref>DeAngelis, T. (2012, March). Practicing distance therapy, legally and ethically. ''Monitor on Psychology'', ''43''(3). http://www.apa.org/monitor/2012/03/virtual</ref>
* ''Unreliable technology'': Slow internet, power outages are some of the challenges that can arise from using technology for counseling.
* ''Requirement for digital literacy:'' The digital literacy of elderly adults is increasing substantially as six in ten seniors use the internet and 77% own a cell phone.<ref>{{Cite web |last=Smith |first=Aaron |date=2014-04-03 |title=Older Adults and Technology Use |url=https://www.pewresearch.org/internet/2014/04/03/older-adults-and-technology-use/ |access-date=2023-03-20 |website=Pew Research Center: Internet, Science & Tech |language=en-US}}</ref> However, the elderly population continues to lag in their own adaptation to newer technological developments. International studies from 2009 to 2020 have come to show that older adults have lower measures of online communication and collaboration, digital safety, and positive attitudes on technology usage.<ref>{{Cite journal |last1=Oh |first1=Sarah Soyeon |last2=Kim |first2=Kyoung-A. |last3=Kim |first3=Minsu |last4=Oh |first4=Jaeuk |last5=Chu |first5=Sang Hui |last6=Choi |first6=JiYeon |date=2021-02-03 |title=Measurement of Digital Literacy Among Older Adults: Systematic Review |journal=Journal of Medical Internet Research |language=EN |volume=23 |issue=2 |pages=e26145 |doi=10.2196/26145 |pmc=7889415 |pmid=33533727 |doi-access=free }}</ref>


==Medical uses and effectiveness==
As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition.<ref name=Mallen_Main /> Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.<ref name=Dongier>{{cite journal|last=Dongier|first=M.|coauthors=Templer, R., Lalinec-Michaud, M., Meuneir, D.|title=Telepsychiatry: Psychiatric consultation through two-way television: A controlled study|journal=Canadian Journal of Psychiatry|volume=31|pages=32–34}}</ref> Researchers have suggested that counseling professionals themselves are more critical of newer technologies than their clients.{{citation needed|date=May 2011}}
Although there is some preliminary support for the possibility that online counseling may help populations that otherwise underutilize traditional in-office counseling, the question of the effectiveness and appropriateness of online counseling has not been resolved.<ref name=Mallen_Main /><ref>{{Cite journal |title=What it digital health technology and what can it do for me? |url=https://evidence.nihr.ac.uk/collection/what-is-digital-health-technology/ |website=NIHR Evidence|year=2022 |doi=10.3310/nihrevidence_53447 |s2cid=252584020 }}</ref>


⚫ ===Mental health ===
==Controversy==
⚫ Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level.<ref name=Stofle_book>{{cite book|last=Stofle|first=G.S.|title=Choosing an online therapist|year=2001|publisher=White Hat Communications}}</ref> J. Suler suggests that people functioning at a particularly high level, and who are well-educated and are artistically inclined, may benefit the most from using text-based online counseling to as a complement to ongoing psychotherapy.<ref name=Suler>{{cite journal|last=Suler|first=J|title=Psychotherapy in cyberspace: A 5 dimensional model of online and computer-mediated psychotherapy|journal=CyberPsychology & Behavior|year=2000|volume=3|pages=151–160|doi=10.1089/109493100315996|issue=2}}</ref> Severe situations, such as ] or a ], might be better served by traditional face-to-face methods,<ref name=Zelvin_book>{{cite book|last=Zelvin|first=E.|title=Online Counseling Skills Part I: Treatment Strategies and Skills for Conducting Counseling Online|year=2004|publisher=Academic Press}}</ref> although further research may prove otherwise.<ref name=Mallen_Main />


⚫ Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of ] in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.<ref name=Cohen>{{cite journal|last=Cohen|first=G.E.|author2=Kerr, B.A.|title=Computer-mediated counseling: An empirical study of a new mental health treatment|journal=Computers in Human Services|year=1998|volume=15|pages=13–26|doi=10.1300/J407v15n04_02|issue=4}}</ref>
There is a split between within the counseling field on the validity of online counseling. Some ] have suggested that online counseling cannot be considered psychotherapy,<ref name=about_psych>{{cite web|last=Cherry|first=Kendra|title=Online Therapy|url=http://www.livecounselling.ca|publisher=About.com|accessdate=4 May 2011}}</ref> while scientific journals such as ''The Lancet'' have published studies that demonstrate that online ] is as effective as traditional "in-person" therapy for the treatment of depression.<ref name=Lancet>{{cite journal|last=Kessler|first=David|coauthors=Lewis, Kaur et al|title=Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial|journal=The Lancet|year=2009|month=August|volume=374|issue=9690|pages=628–634|doi=10.1016/S0140-6736(09)61257-5|url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61257-5/abstract|accessdate=4 May 2011}}</ref> Over 30 years ago, when distance technology first made an appearance in the research literature, similar complaints were lodged against telephone therapy.<ref name=Lamb>{{cite journal|last=Lamb|first=C.W.|title=Telephone therapy: some common errors and falacies|journal=Voices: the Art & Science of Psychotherapy|year=1969|volume=5|pages=42–46}}</ref> However a 2000 study established that over 98% of psychologists who were members of the ] used the telephone as a regular means of therapy, including 69% who conducted psychotherapy on the telephone and 79% who used it for emergency consultations.<ref name=VandenBos>{{cite journal|last=VandenBos|first=G.R.|coauthors=Williams, S.|title=The internet versus the telephone: What is telehealth anyway?|journal=Professional Psychology: Research and Practice|year=2000|volume=31|pages=490–492|doi=10.1037/0735-7028.31.5.490|issue=5}}</ref> A 2003 study concluded that telephone therapy outcomes were not significantly different from face-to-face therapy.<ref name=Sangha>{{cite journal|last=Sangha|first=K.K.|coauthors=Dircks, A., Langlois, S.|title=Assessment of the effectiveness of genetic counseling by telephone compared to a clinic visit|journal=Journal of Genetic Counseling|year=2003|volume=12|pages=171–184|doi=10.1023/A:1022663324006|issue=2}}</ref>

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition.<ref name=Mallen_Main /> Research has come to show that the effects and benefits online counseling has to offer is equivalent or comparable to in-person counseling.<ref>{{Cite journal |last1=Murphy |first1=L. |last2=Parnass |first2=P. |last3=Mitchell |first3=D. L. |last4=Hallett |first4=R. |last5=Cayley |first5=P. |last6=Seagram |first6=S. |date=2009-04-15 |title=Client Satisfaction and Outcome Comparisons of Online and Face-to-Face Counselling Methods |url=http://dx.doi.org/10.1093/bjsw/bcp041 |journal=British Journal of Social Work |volume=39 |issue=4 |pages=627–640 |doi=10.1093/bjsw/bcp041 |issn=0045-3102|hdl=10214/2497 |hdl-access=free }}</ref> This suggests that therapeutic effects can be available to patients without having to go into the office, wait in a waiting room, or even leave the home. Client satisfaction surveys have demonstrated a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.<ref name=Dongier>{{cite journal|last=Dongier|first=M.|author2=Templer, R. |author3=Lalinec-Michaud, M. |author4=Meuneir, D. |title=Telepsychiatry: Psychiatric consultation through two-way television: A controlled study|journal=]|volume=31|pages=32–34|doi=10.1177/070674378603100107|year=1986|issue=1|pmid=3512068|s2cid=27055160}}</ref>

===Nutrition counseling===
Nutrition counseling specific to conditions is available by many consultants online using Skype or another face-to-face program. This is especially effective for people with a busy work schedule, and others who cannot make it to an office regularly. Online consulting for imbalances in ] levels, ], and other health conditions make it easier to manage when using nutritional approaches.<ref>{{cite journal|title=Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study|first1=Anne M.|last1=Mittnacht|first2=Cynthia M.|last2=Bulik|date=1 January 2015|journal=International Journal of Eating Disorders|volume=48|issue=1|pages=111–122|doi=10.1002/eat.22319|pmid = 24976176|url=https://cdr.lib.unc.edu/downloads/7h149r78x }}</ref><ref>Mittnacht, A. M. and Bulik, C. M. (2015), Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study. Int. J. Eat. Disord., 48: 111–122. {{doi|10.1002/eat.22319}}</ref>

===Smoking cessation===
The effectiveness of real-time video counseling for helping people to stop smoking is unclear.<ref name="TzelepisPaul2019">{{cite journal|last1=Tzelepis|first1=Flora|last2=Paul|first2=Christine L|last3=Williams|first3=Christopher M|last4=Gilligan|first4=Conor|last5=Regan|first5=Tim|last6=Daly|first6=Justine|last7=Hodder|first7=Rebecca K|last8=Byrnes|first8=Emma|last9=Byaruhanga|first9=Judith|last10=McFadyen|first10=Tameka|last11=Wiggers|first11=John|title=Real-time video counselling for smoking cessation|journal=Cochrane Database of Systematic Reviews|year=2019|volume=2019|issue=10|issn=1465-1858|doi=10.1002/14651858.CD012659.pub2|pmid=31684699|pmc=6818086}}</ref> Few studies compare the effects of video and telephone counseling on smoking cessation.<ref name="TzelepisPaul2019"/>

== New technological applications in online counseling ==
Online counseling has evolved with the newer developments of technology and therapeutic programs. There are now apps and programs being developed to make the complex processes of therapy and planning manageable for the patient through their smartphone. This makes certain resources more readily available to the patient in the form of self-monitoring, self-improvement courses, treatment and care management, and data collection of personal trends and symptoms.<ref>{{Cite journal |last=Teachman |first=Bethany A. |date=2014 |title=No Appointment Necessary: Treating Mental Illness Outside the Therapist's Office |url=https://www.jstor.org/stable/44290160 |journal=Perspectives on Psychological Science |volume=9 |issue=1 |pages=85–87 |doi=10.1177/1745691613512659 |jstor=44290160 |pmid=26173245 |s2cid=32191466 |issn=1745-6916}}</ref>

"MyCompass" is a specific self-help program that many online counselors use for their patients. This tool helps track factors associated with treatment plans including, mood, personal log data, and diary entries. These collections allow the program to examine therapeutic factors and present the individual and their practitioner with how these different factors influence and impact one another.<ref>{{Cite journal |last=Harrison |first=Virginia |date=December 2011 |title=Mobile mental health: Review of the emerging field and proof of concept study |url=https://www.researchgate.net/publication/51711243 |journal=Journal of Mental Health |volume=20 |issue=6 |pages=509–524 |doi=10.3109/09638237.2011.608746 |pmid=21988230 |s2cid=36656087 |via=ResearchGate}}</ref>

== Online counseling and COVID-19 ==
Online counseling increased dramatically in 2020 during the ] as many countries issued lockdowns to control the spread of the virus.<ref>{{Cite journal|last=Atalan|first=Abdulkadir|date=August 2020|title=Is the lockdown important to prevent the COVID-19 pandemic? Effects on psychology, environment and economy-perspective|journal=Annals of Medicine and Surgery|language=en|volume=56|pages=38–42|doi=10.1016/j.amsu.2020.06.010|pmc=7293850|pmid=32562476}}</ref> Consequently, mental health professionals were unable to meet with their clients in person, so continued treatment online.<ref name="Situmorang 166–174"/> In addition to this transition, the pandemic and associated quarantine caused many people to become anxious and depressed, which resulted in an increased demand for mental health services. Because online counseling became so prominent during this time, the overall use of online counseling increased even as social distancing eased.<ref>{{Cite journal|last1=Markowitz|first1=John C.|last2=Milrod|first2=Barbara|last3=Heckman|first3=Timothy G.|last4=Bergman|first4=Maja|last5=Amsalem|first5=Doron|last6=Zalman|first6=Hemrie|last7=Ballas|first7=Thomas|last8=Neria|first8=Yuval|date=2021-03-01|title=Psychotherapy at a Distance|journal=American Journal of Psychiatry|volume=178|issue=3|pages=240–246|doi=10.1176/appi.ajp.2020.20050557|pmid=32972202|s2cid=221917121|issn=0002-953X|doi-access=free}}</ref>

==See also==
* ]
* ]
* ]


== References == == References ==
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Latest revision as of 07:12, 26 November 2024

Medical intervention
Online counseling
Other namesonline psychotherapy, internet-based therapy, internet-based counseling, internet-based psychotherapy, internet-based psychological therapies, internet-based mental health intervention, internet-delivered therapy, web-based therapy, e-therapy, e-counseling
MeSHD000068237
[edit on Wikidata]

Online counseling or online therapy is a form of professional mental health counseling that is generally performed through the internet. Computer aided technologies are used by the trained professional counselors and individuals seeking counseling services to communicate rather than conventional face-to-face interactions. Online counseling is also referred to as teletherapy, e-therapy, cyber therapy, or web counseling. Services are typically offered via email, real-time chat, and video conferencing. Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling. An increasing number of clients are using online counseling as a replacement for office visits.

While some forms of telepsychology and telepsychiatry have been available for over 35 years, the development of internet video chat systems and the continued increase of the market penetration for the broadband has resulted in the continuing growth of online therapy. Some clients are using videoconferencing, live chat and email services with a mental health professional in place of or in addition to face-to-face meetings.

History

One of the first demonstrations of the Internet was a simulated psychotherapy session between computers at Stanford and UCLA during the International Conference on Computer Communication in October 1972. Although this was a simulation and not actual counseling, the demonstration created an interest in the potential of online communication for counseling. As access to the internet, bulletin boards, and online services became more available in the 1980s, and online communication became more common, virtual self-help groups naturally developed. These self-help groups may be considered a precursor to online counseling. When the World Wide Web became public in the early 1990s and mental health professionals began to create websites offering mental health information, some began to receive requests for personal help and started to respond to these requests, leading to the advent of online counseling.

Information on sources related to online counseling was first created by Martha Ainsworth. In 1995, Martha Ainsworth began searching for a competent therapist because she had some psychological complaints. Her travel requirements made it difficult for her to consult a face-to-face therapist, and therefore, she needed an effective alternative online therapist. She only found a dozen web pages that offered online treatment for psychological complaints. Afterward, Martha Ainsworth wanted to reach the general public with her experiences and founded a clearinghouse for mental health websites, named Metanoia. By the year 2000, this clearinghouse contained over 250 websites of private practices and more than 700 online clinics where a therapist could be contacted.

According to metanoia.org, the first service to offer online mental healthcare was "Ask Uncle Ezra", created by staff of Cornell University in 1986 for students. By mid-1995 several fee-based online services offering mental health advice had appeared. Between 1994 and 2002, a group of trained volunteer crisis counselors called "Samaritans", began providing suicide prevention services via email. There has been continuous increase in number of online counselling therapists and groups due to increase in web-based services and anonymity associated with virtual sessions.

Advantages and disadvantages of online counseling

Advantages

Online counseling offers several advantages. These include:

  • Increased accessibility: Online counseling fills an unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents, people with disabilities and expatriates, along with under-served minorities, often have an easier time finding a suitable therapist online than in their local communities. It also makes counseling accessible to clients who face difficulties in keeping appointments during normal business hours, while decreasing the number of missed appointments for in-person therapy. Along with accessibility of therapists, online counseling also enables accessibility of information to the clients. In face-to-face counseling, information is stored only with the therapists. In online counseling, the transcripts of communications between the therapist and clients may be available to therapists as well as clients. This allows people seeking therapy to monitor changes in their own conditions.
  • Increased comfort and convenience: Online counseling can offer higher comfort and convenience for clients and therapists alike. Therapists or clients may not need to travel for their sessions, which may be less expensive and more comfortable for all involved. In addition to the convenience, many people also enjoy the perceived confidentiality that comes with online counseling. They tend to feel more comfortable sharing information with their mental health professional and may feel less ashamed and powerless due to the removed environment.
  • Less expensive: Although most therapists charge the same fees for teleconsultations as they would for direct counseling, teletherapy can be relatively less expensive as it does not involve travel costs if both parties have internet access from where there are.
  • Approachable treatments: Online access to therapy may help remove the stigma around mental health and can help individuals feel more comfortable with discussing mental health issues.

Disadvantages

Some of the disadvantages of online counseling include:

  • Anonymity and privacy: Online counseling uses technology-aided devices and internet as the main medium for communication between the therapist and the client. All the personal and sensitive information of patients is stored on internet sites or devices. This increases the risk of data theft. While online counseling can feel more private than face-to-face interactions, there is potential for breaches of privacy in online counseling. For example, non-encrypted electronic Internet communications might be intercepted, and records could be accessed by family members or hackers. In online counseling, there may be a lower risk of discrimination based on race, ethnicity, age or gender, because these factors can be more difficult for the therapist to perceive in an online context. It is important to establish the safety of the site and verification of therapist or client before beginning an online counseling session.
  • Finding the right match for therapeutic needs of clients: Online counseling does not guarantee the right match for the therapeutic needs of the clients. Emotional and visual contact can be absent during online counseling sessions. This absence may prevent therapists from sensing negative feelings like anger, terseness, or irritation in clients. It can also cause the sessions to be more straight to the point and less emotionally gradual, which can be beneficial or not depending on the client's need.
  • Establishing authenticity of therapists or counselors: Counselors and therapists are professional health care providers and hence require licenses to undertake clients for counseling as a part of their mandatory professional requirements. Psychologists and professional health care providers also require licensing in the state or other governmental subdivision where they practice in order to take clients. As the internet allows clients to choose therapists all across the world, establishing legitimacy and authenticity of the therapists or counselors may be difficult.
  • Unreliable technology: Slow internet, power outages are some of the challenges that can arise from using technology for counseling.
  • Requirement for digital literacy: The digital literacy of elderly adults is increasing substantially as six in ten seniors use the internet and 77% own a cell phone. However, the elderly population continues to lag in their own adaptation to newer technological developments. International studies from 2009 to 2020 have come to show that older adults have lower measures of online communication and collaboration, digital safety, and positive attitudes on technology usage.

Medical uses and effectiveness

Although there is some preliminary support for the possibility that online counseling may help populations that otherwise underutilize traditional in-office counseling, the question of the effectiveness and appropriateness of online counseling has not been resolved.

Mental health

Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level. J. Suler suggests that people functioning at a particularly high level, and who are well-educated and are artistically inclined, may benefit the most from using text-based online counseling to as a complement to ongoing psychotherapy. Severe situations, such as suicidal ideation or a psychotic episode, might be better served by traditional face-to-face methods, although further research may prove otherwise.

Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition. Research has come to show that the effects and benefits online counseling has to offer is equivalent or comparable to in-person counseling. This suggests that therapeutic effects can be available to patients without having to go into the office, wait in a waiting room, or even leave the home. Client satisfaction surveys have demonstrated a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.

Nutrition counseling

Nutrition counseling specific to conditions is available by many consultants online using Skype or another face-to-face program. This is especially effective for people with a busy work schedule, and others who cannot make it to an office regularly. Online consulting for imbalances in blood lipid levels, blood sugar regulation, and other health conditions make it easier to manage when using nutritional approaches.

Smoking cessation

The effectiveness of real-time video counseling for helping people to stop smoking is unclear. Few studies compare the effects of video and telephone counseling on smoking cessation.

New technological applications in online counseling

Online counseling has evolved with the newer developments of technology and therapeutic programs. There are now apps and programs being developed to make the complex processes of therapy and planning manageable for the patient through their smartphone. This makes certain resources more readily available to the patient in the form of self-monitoring, self-improvement courses, treatment and care management, and data collection of personal trends and symptoms.

"MyCompass" is a specific self-help program that many online counselors use for their patients. This tool helps track factors associated with treatment plans including, mood, personal log data, and diary entries. These collections allow the program to examine therapeutic factors and present the individual and their practitioner with how these different factors influence and impact one another.

Online counseling and COVID-19

Online counseling increased dramatically in 2020 during the COVID-19 pandemic as many countries issued lockdowns to control the spread of the virus. Consequently, mental health professionals were unable to meet with their clients in person, so continued treatment online. In addition to this transition, the pandemic and associated quarantine caused many people to become anxious and depressed, which resulted in an increased demand for mental health services. Because online counseling became so prominent during this time, the overall use of online counseling increased even as social distancing eased.

See also

References

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  35. Atalan, Abdulkadir (August 2020). "Is the lockdown important to prevent the COVID-19 pandemic? Effects on psychology, environment and economy-perspective". Annals of Medicine and Surgery. 56: 38–42. doi:10.1016/j.amsu.2020.06.010. PMC 7293850. PMID 32562476.
  36. Markowitz, John C.; Milrod, Barbara; Heckman, Timothy G.; Bergman, Maja; Amsalem, Doron; Zalman, Hemrie; Ballas, Thomas; Neria, Yuval (2021-03-01). "Psychotherapy at a Distance". American Journal of Psychiatry. 178 (3): 240–246. doi:10.1176/appi.ajp.2020.20050557. ISSN 0002-953X. PMID 32972202. S2CID 221917121.
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