Friday, 11 May 2018

Online vs Face to Face Therapy

Technology has expanded to such extent that many of us now communicate and interact more through modes of technology than we do via traditional means of person to person contact.

The Smartphone and the wide availability of the internet allows us the freedom to not only talk over a phone line but also to video chat, instant text message, email and even have group meetings and company trainings wherever we are and at any time. These platforms allow people from across the globe to connect in real time and high definition for such low costs it feels free of charge and in many ways without limitations.

Is it any surprise then that we are seeing a shift in health care toward online services?
In the UK there has been a huge push toward online mental health care services. The IAPT (Improving Access to Psychological Therapies) is one clear example of this, where therapeutic services are being offered both in person as well as online to increase the number of patients that can be treated especially for low intensity conditions such as mild depression/anxiety.

In my current role as stop smoking adviser I treat patients face to face as well as through using phone clinics, text message and email services. In this format I have seen first-hand the benefits online services bring.
Many patients are unable to make a physical clinic appointment due to disability/illness or working/childcare commitments but are able to attend a telephone/text consultation. The other side of the coin is this also works for therapists in the same way, who can work from home at their convenience and can therefore offer more flexible clinic times perhaps outside regular working hours. If you live somewhere remote, or are stationed abroad and don’t speak the local language well enough – how else would you receive therapy but through online services?

Clients have reported to me that they feel very comfortable in their own home sat in their own armchair without the stress of traveling to an appointment and the awkward waiting room experience. Those with social anxiety can also readily be affected by such factors and prefer the experience of online communications.
Many of my patients openly admit to being ‘secret smokers’, and don’t like the thought of being caught out by being seen attending a smoking cessation session and therefore find online interactions more private and less intrusive. The anonymity of an online therapy may also produce more open interactions as inhibitions can be reduced, thus leading to more accurate and successful outcomes.     

I have also come across various individuals who are far more able to express themselves using the written word, where they have time and space to consider questions and responses, something that is not always possible in conversation during a given weekly time slot. With a text/email service information can be read and re-read an infinite number of times, for the patient to reply at their convenience without pressure.
Online services also opens the patient to a world of options and choices, including more affordable or even free services they would not be able to receive through attending traditional therapy.

To summarise telephone/online therapy is convenient, comfortable, unobtrusive and flexible while offering choice. It is economic also if you factor in the lack of travel costs and the logistics of a therapist potentially seeing a higher quantity of patients.
But do we lose any ingredients from traditional face to face therapy? The University of Wolverhampton UK lists some of the disadvantages.

For crisis situations where a patient is in emergency need of guidance then a physical presence is ideal, especially if a patient represents a risk to themselves or others. Severe mental health problems that require hospital staff and treatment also cannot be easily aided online. If a patient is already isolated from face to face interactions a traditional therapist is also preferential.
Online security is another factor to consider, particularly bearing in mind how often we read about identity fraud and online grooming etc. If we walk into a hospital we can feel a trust and confidence toward the professional we are speaking to; but is that the same in an online scenario? I would always encourage checks to be made and reviews to be read of any therapeutic service online or face to face. Make sure the service you are signing up to is credible.

Some individuals prefer face to face therapy. They like non-verbal, visual communication. Many, especially amongst the elder generation, do not have smart phones or the confidence in the internet and feel more comfortable using traditional means of therapy. A certain level of technological competency (and literacy when using text) is required, unless you have someone with you who might assist on your behalf.
As good as technology is, we still get bad reception at times, lines that crackle or batteries that run flat; which obviously can be frustrating and can lead to misunderstandings or even increase levels of stress that would not happen face to face.

If I currently see a patient in my clinic whose first language is not English I can use language line or visual cues to aid communication which perhaps would not be so easy over the phone/online.
I work with therapists who are adamant that traditional face to face therapies work better through the development of therapeutic rapport. Although I see their point of view, I don’t believe face to face interactions are the only way to build rapport and is more a case of personal preference. After all, don’t people make friends all over the world through communicating solely through instant messaging?

If you are someone at ease with communicating through technology and are open minded enough to try something new then I see no reason why you cannot interact exactly as effectively online as face to face, and if there is any negative difference in quality this is more than offset by all the advantages listed in this article.
All things considered I feel that if used in the right way the advantages of online therapy certainly outweigh the disadvantages. Looking to the future I believe it is a trend we are going to see a lot more of, not only in healthcare but in education, the work place and society in general. I am optimistic this can have a positive effect on global mental health trends, as the flexibility and convenience of modern techniques can enable a higher volume of patients to be treated both efficiently and effectively, with therapist and patient brought together without limitations.

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