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.

Hypnotherapy Online Via Skype Vs Traditional Appointment

For better or worse we now live as a part of one globalised community. You do not need to live in the same street, the same town or even the same country to be in face-to-face contact with someone any more, and thanks to computer programs like 'Skype' or ‘Oovoo’ this wonderful technology is available to each of us absolutely free. To use Skype you simply need a computer (or Smartphone) with a web cam and a microphone, and from there you can connect with anyone across the globe LIVE, their video and sound streamed to your computer, and yours streamed to them vice-versa, mimicking almost exactly an interaction with someone in the same room as you.

This futuristic technology not only allows friends and family to be in real contact no matter the distance they are apart, it also allows business meetings to function and lectures to be given when colleagues, students and teachers are thousands of miles away from one another. In recent years online therapy (E-therapy) has started to take place across the globe, with online hypnotherapy not far behind the innovation. Many hypnotherapists worldwide are now utilising the World Wide Web and its modern functionality to expand their businesses, allowing themselves to connect with a far broader spectrum of clients. But not everyone agrees to this new phenomenon, with traditionalists claiming real time face-to-face therapy can never be replaced.  

So what are the benefits of having an online hypnotherapy session as oppose to a traditional walk in appointment?

• The session can be done from the comfort and convenience of your own home
• Feel secure and relaxed in a place you are familiar with, if you want to do the session in your favourite chair with your favourite incense burning next to you – you can!
• Usually after hypnosis you feel very relaxed, ordinarily you would have to walk back out onto the street or get into your car – whereas at home you could take a long bath or lie down for as long as you want to
• Time effective – no time wasted in waiting rooms/travel to and from
• No travel expenses/parking fees
• Accessibility – no matter where you live in the world access is the same, or for that matter if you have mobility difficulties or constraints leaving your home for any reason.
• Flexible service and hours, easy to make appointments outside office hours or unsociable hours.
• Online sessions are often cheaper than ordinary appointments
• Encoded video links mean the sessions stay confidential
• A wider choice of hypnotherapists available at a touch of a button

The journal Psychiatric Services, conducted a 2000 study that revealed patients receiving treatment through video conferencing reported ‘high levels of satisfaction’. Another article in Newsweek in 2006 stated that some people might actually benefit from online therapy, especially those who do not feel comfortable with traditional person-to-person contact. Alleman’s (2002) study claimed that the anonymity of online therapy allows the client to express themselves more freely and securely than they would ‘in person’ therefore allowing the session to be more effective.

So why the negative toward online therapies from some quarters?

• Some people will tell you there is nothing like having a ‘real life’ interaction with their therapist/client that cannot be replaced online (many of the arguments read in this category concern therapy without the use of live video stream).
• Hypnosis online, and therapy online in general, is not suitable for people with serious psychological conditions mainly because the therapist is not on hand to deal with a crisis situation, for example suicide or self-harm.  
• Unfortunately online there is always the heightened risk of unlicensed practitioners offering their services.
• Online there is less legal protection for the client due to the various different laws that govern individual countries that could cause problems with a global grievance.
• The laws regarding therapy are clear in one country, or state, to the next. But online laws are far less clear and this can cause confusion on the global circuit.
• Equipment Failure. Even the best computers can break down for a host of reasons, and the same goes for internet connection or power cuts.

It is up to the reader to decide whether the pros outweigh the cons. I believe that the criticisms stated above should be taken seriously before proceeding in making contact with an online therapist, as well as basic common sense being taken into consideration.

If your problem is something that is putting you or others in direct danger you should seek the in person guidance of a mental health practitioner near to where you live immediately. Check the credentials of the online therapist. Even if they display their certification, if you are worried about the validity of those certificates go ahead and double check with their University or their regulatory body to ensure they have been trained where they say they have been trained. If you are seeing a certified expert in the field then there is a far smaller chance of problems being caused by their therapy sessions. If you are worried about breaking the law in your region, do some research and see what the literature says – but the chances are you will find that there is nothing illegal in taking an online hypnotherapy session.

Technical failure is a possibility, but as technology advances there are less problems with computers or power cuts and I for one can’t remember my current computer breaking down once in the two years I have been using it. A good hypnotherapist will advise what to do in the event of a technical issue, so if one does occur there will be no adverse effects from the session, you would simple stir out of hypnosis until the technical issue is resolved, and then go back into hypnosis once it starts up again.

I think that the way society is headed hand in hand with technology, online therapy is the future of the practice. The internet is playing a bigger and bigger role in people’s everyday life from shopping, keeping in contact with friends and family, work, school, entertainment – why should health matters be any different? The better computers and Smartphones get the greater the quality of video and sound will become meaning this ‘virtual’ interaction will be even more realistic and commonplace. Traditionalists in every field do not like change because it upsets the environment they know so well, and who can blame them for that, but looking at the list of advantages it is hard to dismiss online hypnotherapy. The online platform makes it accessible to far more people worldwide in a format that more and more people are most comfortable with, while in the same breath being more time and cost effective. Hypnotherapy has existed successfully for quite some time in the form of audio recordings, so I see no reason why it's effectiveness should be exclusive to in-person appointments. Perhaps the main drawback would be a persons reluctance to engage in computer based interaction, but once those barriers are knocked down through trial and experience I feel certain the individual will appreciate the ease and convenience of the online format.