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What is online therapy?

This piece was a long time coming because questions about teletherapy (online therapy – video sessions – telehealth) are on many people’s minds.

Since I use my IG account and Facebook to talk about my work – every now and then, I get some questions about how it works. I thought that instead of replying to private messages, I should write proper text here. So here it is – a short article about teletherapy = psychotherapy online.

I’ve been doing video sessions with most of my clients for years now.

It is a new concept – that’s for sure, but it actually works great. Especially that for some people, it’s the only way to get the support they need.

What is online therapy?

Online psychotherapy (otherwise known as e-therapy, distance therapy, web therapy, or teletherapy) is still considered uncharted territory in this digital era of ours. Those who go through the process can easily tell all the pros and cons. Those, on the other hand, who’ve never been to ‘teletherapy’ couldn’t know where to start and if it’s even worth it. So let me tell you about it a little more.

First of all, we use the term ‘teletherapy’ to describe the form of therapy that will be conducted over the video call. I prefer Zoom over the other systems since it’s very secure, but there are others like that too.

You will experience the same setting, the same techniques, and processes as in a session you’d have in an office. There are some differences, and I’ll get to them in a moment.

Let’s talk about therapy in general.

It’s safe to say that psychotherapy, in general, might still be somewhat of a mystery for some. It can be thought of differently in different countries and cultures. All in all – psychotherapy – be it online or in an office – is all about taking care of your mental health and your personal growth. Some people are more accustomed to this idea, while others might still not see much point in talking to a stranger about what’s bothering them.

How to find a good therapist?

The first thing to think of when you look for psychotherapy online – is to make sure your therapist is well-educated in the area of mental health. They should hold a valid certificate or a license – depending on the country they received their credentials. Different countries have different rules and regulations; sometimes, this profession is not regulated at all. The rule of thumb is to seek the help of those who are certified/licensed to provide such help.

If anything goes wrong, you then have access to further steps concerning any misconduct or wrongdoing. Not that it would often happen with a mental health profession – but it’s crucial to have this option available.

So when you browse through the therapists’ websites, you should be able to find links to all the institutions that have granted them their credentials. Sometimes, there will be online lists of certified psychotherapists where you can look up the person you consider working with.

Some countries, despite not having this profession fully regulated, will recognize certified psychotherapists, and your mandatory/premium insurance might cover all or part of the cost of your sessions.

Make sure your psychotherapist is undergoing supervision– which is a process all therapists should be engaged in. It’s talking their work through with other experienced colleagues.

What is modality?

Aside from that – there is also a matter of modality. In other words – the theory/school of thought the therapist was educated in. When we say modality – we mean the set of theories, techniques, and tools used to understand, describe, and work with specific disorders and conditions people experience.

Of course, this is not something specific for online therapy (teletherapy), but when you’re browsing through the therapists’ websites, you might as well check this one thing. You can make sure whether this approach is something you feel comfortable with. Not all modalities work with understanding the past and your childhood. For some, it’s necessary to only focus on the present. Some therapists will then work mostly with symptoms – and some – will try and uncover the underlying cause.

Some therapists will give you ‘homework’, some will want you to be ‘here and now’ in understanding what’s going on and how what you think impacts what you feel, and so on.

Do your research, ask people who know more, and decide what modality feels right for you.

Modalities influence what happens throughout therapy, and how the therapy is conducted. The whole range of methods and techniques used in the process, as well as interpretation, setting, length of the session, or the number of them. All that originates in the school of thought the therapist is educated in. They can also work in an integrative way – using two or more modalities.

An online meeting. What, where, how?

When you’ve found a certified, well-educated mental health professional – an online formula should then be a full-quality therapeutic process. Because of the medium used (internet), some specifics make it a slightly different experience than you’d get in a regular office-based session.

All in all, I’d say the whole process is very comparable. I’ve had clients who transferred to an online process from an office setting where they would come once or twice a week and see me in person. I’ve also had those whom I already consulted online. Let me tell you a bit about how the whole process looks from beginning to end.

The logistics of online consultation.

When you want to set up your first appointment, you will usually use an online form or call the person you’d like to work with. There will be information on the site. That first meeting is called a consultation. Consultation, in general, may last somewhere between 1 and 3 meetings and is necessary to assess what the matter is, what kind of help the person needs and if the therapist and the client are compatible.

It’s a time for the therapist to be able to diagnose if the problem the patient/client is experiencing is within the scope of their expertise. I, for example, don’t work with heavy substance abuse. If a person reveals they have severe problems in this area, I will refer them to some other specialist.

The consultation also helps to clarify the problem the client is sometimes not aware of him/herself.  

It is also a time for the patient to see if they feel they can trust the therapist and if they feel comfortable talking about conflicting, often intimate issues with them. This whole process takes place online – using a video call. As mentioned before, I use Zoom as I find it one of the best in the category.

By the end of the consultation, the therapist and the client agree on the scope of the help and the length of the therapy, as well as details of payments, the cancellation policy, insurance details – if needed – and so on. We call it - the contract.

As you can see so far – the whole process is the same as with the appointment you would have in an office.

What’s different is if you go to a physical office – you’d be there a couple of minutes before your scheduled time, and the therapist would invite you in when the time came.

With online therapy, you, as a patient, call the therapist at the scheduled time. If you use Zoom – you go to your virtual waiting room, and at the scheduled time, your therapist lets you into the virtual office.

The session.

The most significant difference is the session itself. In an office, you get to see each other in person – the whole person – which is pretty obvious. In an online meeting, it’s usually the waist-up frame. Otherwise, you’d get a tiny person on the screen, and you don’t want that.

You will also need a stable wifi connection to be able to have a high-quality audio and video image. All so that the mimics, the moments of silence, the tears, the sighs – can be noticed, interpreted, and understood better.

The default camera and microphone you have on your computer or tablet are enough.

And that’s it – you’re all set.

The things to pay attention to.

One thing from the logistics spectrum is, for sure, the wifi problems. Rarely, but it happens that the connection is so slow that it’s virtually impossible to hold a real conversation. Once or twice, my internet provider had some technical issues, and I had to reschedule a couple of sessions.

Something I had to touch on a couple of times with my clients/ patients was the rules and boundaries that otherwise don’t often need much explaining. There was a time, for example, when a patient called me wearing her pajamas, with wet hair – straight out of the shower. This would never happen in an office, but somehow it seemed appropriate to her – given the flexibility of the setting. Some other time another patient thought she’d use the time for the session to have lunch.

Of course, these are just examples that we still use and integrate within the material of the therapy – to understand and work with it.

Who is online therapy for?

This is the question that is as frequent as the question about what depression is. “Who can benefit from an online therapy process?”.

My answer is – pretty much everyone who needs this kind of flexibility.

I’ve worked with clients/patients who:

  • are ‘digital nomads’,

  • expats – not finding local psychotherapists speaking their language,

  • very (VERY) frequent travelers,

  • living in a city/country with psychotherapy services not available easily,

  • people with a hectic schedule,

  • people with intense cases of anxiety or other mental disorders that make it difficult for them to leave the house.

Some circumstances would call for a regular in-the-office or rather in-patient treatment. Those would be:

  • severe psychiatric condition (for example – psychotic episodes, severe clinic depression),

  • high suicidal risk.

Is online therapy effective?

More and more research shows that the essential aspect of the therapy and its effectiveness are the patient/client’s motivation and the relationship (rapport) – between the client and the therapist.

Taking that into account – it feels less important whether you see each other in person or on the screen. The connection – no pun intended – is the most impactful factor.

I do find it refreshing to see my online clients – OFFLINE. In an ideal world, I would prefer to see them in person more often. It’s still a matter of personal preference more than it is a matter of effectiveness.

Here you can find an article on how to prepare for an online psychotherapy session, and below I’ll attach some links if you feel you want to read more about the effectiveness of online psychotherapy:

As you can see – there are differences between an office and an online setting. All in all, it is pretty comparable when it comes to results.

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