Online therapy shrinks the world

It’s ideal if you’re agoraphobic or housebound, it’s often cheaper than face-to-face therapy, and there’s no fixating on the unfortunate shoes your therapist wears or the colour of her carpet

July 16, 2012 | By:

Time and distance are no longer obstacles to getting help for your issues. As Markie Robson-Scott explains, now your laptop can be a virtual consulting room

Health_Online therapy sitesWhen Ellie moved to Hong Kong with her husband and three-month-old baby, she knew she’d miss her London psychotherapist, and was prepared to do without her. But six months later, her marriage began to fall apart and she was desperate. A friend recommended someone in Hong Kong but they didn’t click. So she ended up having three Skype video sessions a week for a year with her previous therapist.

“It was a godsend. I thought there’d be technical problems but apart from a few occasions when the screen would freeze if there was a storm – and then we reverted to Skype chat – it was fine.”

Ellie already had a bond with her therapist, but others say online therapy can work well from the word go. “In face-to-face counselling I took much longer to get down to brass tacks,” says Kim, 51, a family literacy co-ordinator in California who has worked with an online therapist for two years. She emails and the therapist responds within 48 hours.

“In online therapy, I don’t feel a need to chit-chat. I can dive right in. There is a back-and-forth email thread of many sessions, so I don’t need to recap. But you have to be motivated and willing to be open, which I am.”

Other obvious advantages are flexibility, choice – your therapist can be anywhere – and lack of time-wasting travel to and from consulting rooms. It’s ideal if you’re agoraphobic or housebound, it’s often cheaper than face-to-face therapy, and there’s no fixating on the unfortunate shoes your therapist wears or the colour of her carpet.


Sarah Luczaj, a psychotherapist and poet based in rural Poland with (mainly ex-pat Brit) clients in India, the US, Vietnam and Switzerland, works on email, Skype chat and occasionally video. She says people think online therapy is a sanitised version of ‘real, messy therapy’ but in fact it’s just as intense and emotional.

Both parties have to work harder to avoid misunderstandings. “You have to say more, spell things out, and signal the tentativeness of my responses and suggestions, as I have no idea how they are being received. I think this extra-explicitness is good.”

She finds writing is often more successful because, with a webcam, “you feel as if you’re both near and not near at the same time, which can be hard”.

But isn’t writing about your problems alienating, a step removed?

“It depends on the person. A writing persona can be truer than a face-to-face one. And in ordinary therapy a lot of people throw up a mask which stops them addressing the real problems, so in a way it’s no different.”

Also, she says, the lack of a physical presence can be a plus to people on the autistic spectrum who may find it less stressful to write things down than interact with someone in the same room.

Not everyone is keen. Psychotherapist Kitty Hagenbach’s list of Skype clients is building up, but she feels that online work is “not as healing or healthy as person to person. The energetic messages between two people in the same room are tremendously important. I’m afraid this distance is going to mean further isolation – and we’re already isolated enough.”

Role play without embarassment

But distance can lead to a new level of insight, says Dr Kate Anthony, who is a fellow of the BACP (British Association for Counselling and Psychotherapy), co-founder of the OTI (Online Therapy Institute) and co-editor of Tilt (Therapeutic Innovations in Light of Technology) magazine. If you want your experience to be even more virtual, you can use an avatar, as people in the therapy rooms of Second Life are doing.

Studies show that using avatars works a treat for social anxiety and role-playing. Anthony says: “You can change your avatar mid-session in order to show your therapist – who’s also using an avatar – how you’re feeling.”

Anthony is open-minded about any new technology that can help even in minor ways, such as the self-help apps for depression, anxiety and anger now available for iPhone and iPad.

Ian Toman is a person-centred therapist with BWW (Big White Wall), an online early intervention service for people in psychological distress that operates in partnership with the Tavistock and Portman NHS Trust.

BWW uses the Buzzumi platform – similar to Skype and often used for video conferencing – for one-on-one counselling with video, text and whiteboard support. All the BWW therapists have at least five years’ experience as well as specialised online training with the ‘Tavi’.

Toman says online practice allows therapist and client to work together on a more equal footing. People feel more confident in their own homes and open up more quickly. And time flexibility is a huge advantage. “Many people are embarrassed to ask their employers for time off work for mental health reasons. On Big White Wall you can go out of hours. I’m working from 6pm to 9pm on Mondays to Thursdays, and a colleague is offering times on Saturdays and Sundays.”

Finding the right therapist, let alone checking their qualifications, can be difficult at the best of times in the real world. But surely unregulated cyberspace is even more of a minefield?

Kate Anthony says things are improving. She vets all therapists affiliated to the OTI and has developed training courses and a ‘Get Verified’ ethical framework, endorsed by various professional bodies, to which they must adhere.

Meanwhile, the therapists on Mootu are all members of professional organisations, as are those on BWW and Mytherapist.com. Mootu is a national network of about 130 UK-based counsellors and psychotherapists who work on Skype video. You can search via a keyword like ‘anxiety’ for someone suitable and book a free 15-minute trial consultation.

And the beauty of it is that you don’t even need to leave your own couch.

Four therapy websites

Big White Wall: 50-minute video and/or chat sessions cost £75 plus VAT (compared with £150 for a non-virtual session at the Tavistock Institute). Free on the NHS in some areas, and free for serving personnel, veterans and their families.

Mootu: Skype video sessions from £30 to £50 for 50 minutes.

Sarah Luczaj (through My Therapist): £45 for a week of reading a client’s emails and a reply that takes her 50 minutes to write.

Online Therapy Institute: information about online therapy and links to practitioners.