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Monday, February 21, 2011

Tele-therapy? Is it really the wave of the 'therapy future'?

Im graduating with my Master in Social Work in August (let the countdown begin...) with my LMSW (once I pass the exam). What to do next is the a question that plaques me each day. My boyfriend, Rob, a computer junkie, asked me what I thought about the idea of being able to offer therapy through a face-to-face communication, computer-based program, such as Skype, enabling me to be much more mobile, since being with him will entail lots of moving around.

I first wrote the idea off. I just didn't think it would work. However, I found a couple of articles today that discussed the "wave of the future"- tele-therapy. It has mostly been done with individuals who are either unable to or have difficulty leaving their homes (elderly, individuals suffering from depression, anxiety) or people in rural areas that have little or no resources available to them.

Very few studies have been done to measure the effects of tele-therapy, especially in relation to in-the-flesh therapy.

A study published in the Journal of Consulting and Clinical Psychology, "Randomized Trial of Telephone Psychotherapy and Pharmacotherapy for Depression: Continuation and Durability of Effects", studied the effects of over-the-phone psychotherapy combined with antidepressant medications versus individuals that just receive antidepressants and found that they scored lower on the depression scales for 6 to 18 months compared to the group that only received medications.

This study was only comparing over-the-phone therapy, versus in-person, which only enables the therapist  to be able to hear the client's voice. I would assume that tele-therapy, which involves actual face-to-face interaction, would have much greater positive effect since it would allow the therapist to see the clients facial expressions, gestures, and other forms non-verbal communication.

Of course, there are some arguments against this type of therapy.

Some therapist would argue that although the therapist can still see their client, some of those non-verbal cues are too subtle to be able to pick up over the computer. I would agree with this. However, although we would surely miss out on some tell-tell clues, we would still be seeing clients that wouldn't have sought and/or received therapy at all. This form of therapy would definitely be opening up the doors of counseling to a whole new group of people.

David Lester wrote an article on the topic of E-therapy as he puts it, called "E-therapy: Caveats from experiences with telephone therapy" in which he argues that doing therapy through a medium, such as the internet, takes away from the formality of therapy, and that it is no longer considered therapy but  a conversation. He mentions that by taking away things from the session such as a waiting room, the therapist's chair, and whatever else the therapist would use to put  the therapist in a higher position of authority and power, would possibly "eliminate the therapeutic process" (Lester, D., 2006, p. 894).

This really depends on your school of thought and how you practice. As a therapist, I use a strengths-based, Solution-Focused framework, in which the client is the expert on their own lives and therapists are only there as facilitators of change.  Therefore, I find his argument to be irrelevant, since I would actually find this to be a pro of therapy. Studies have found that what is most beneficial for clients is relationship they build with their therapist, therefore, lessening the power gap between the client and therapist, would actually help to build and strengthen rapport.

The rest of Lester's arguments in his article do not really pertain to this topic, since he is basing it on the client only being able to communicate via typing, i.e. instant messaging. E-therapy obviously has come a long way since then, since we now have the capability to be able to have face-to-face communication.

So for now, I am definitely planning on doing more research into this new therapy. What was once just used for talking with grandma once a week, can become a new way of seeking out ways in which to improve yourself.

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