The Advent of Online Counseling For Mental Health

Almost all human beings, as they move towards growth and development, experience external stressors/hindrances and mood/thought/physiological disturbances at some point. Psychotherapy/counseling has been stereotypically imagined as sitting on a couch in a clinic with a mental health professional at these adversity points. While adversities and maladaptive coping remain hindrances, the stereotypical image of mental health services has been rapidly changing ever since the pandemic and has been received with varying views. The shift from in-person counseling to online therapy has been the need of the hour during the pandemic and comes with its own set of pros and cons to look into. Any change/shift brings along a certain amount of uncertainty/curiosity. Thus, this article aims to help you get more familiar with online counseling which is gaining the utmost popularity in mental health.

What is Online Counselling?

Online counseling is interchangeably used with teletherapy, e-counseling, and virtual psychotherapy. They all have a similar core concept of mental health professionals delivering their services via chat, audio, or video therapy sessions. The prominent difference between online versus in-person counseling comes in the mediums and pace of communication. Many other essential components of providing mental health services remain the same. Just like in-person counseling, online counseling too can only be provided by certified psychologists and counselors who have completed rigorous and long years of education, training, and supervision; it involves the use of multiple therapeutic approaches as well as a mental health professional actively working in a continuous professional alliance with clients. There are a specific set of ethics and regulations which need to be followed in both.

Having looked at some of the similarities and differences between in-person and online counseling, let's look into what advantages and disadvantages online counseling has in store for us.

Advantages - Why Should You Try Online Counselling?

1. It has been shown that online therapy is similar and, in some cases, even more, effective than clinic therapy for assisting with various mental health concerns like mood-related disorders like anxiety and depression, confidence and self-esteem issues, dealing with family/relationship/attachment stressors, lifestyle-related concerns as well as self-actualization related growth. (Andrews et al.,2018)

2. Teletherapy has opened avenues by increasing accessibility for both clients and mental health professionals. Teletherapy makes it possible for therapeutic assistance for so many people who are restricted to their homes due to severe anxiety-related concerns like agoraphobia and physical movement limitations or people who don’t have in-person access to mental health services in their areas to reach them.

3. It offers greater flexibility by ethically bending many of the time, place, and monetary restrictions while not compromising the quality of the services. In fact, flexible and preference-based scheduling of sessions enhances a therapist’s availability and satisfaction. The same goes for clients who can access sessions while managing their day-to-day routines. Online mental health websites provide one single platform with multiple options for the client's preferred mode of communication, finding and matching with different kinds of counselors/therapists best suited for the client’s personal needs, concerns, and goals, thereby making the process of seeking help much more convenient and smoother for clients.

4. The taboo, social stigma and fear of judgment associated with seeking help for mental health concerns have always acted as a huge barrier. Teletherapy reduces the interference of this obstacle by letting people seek help in the comfort, familiarity, and safety of their homes with a certain level of anonymity and the absence of the worry to be seen by someone they know. This has been shown to enhance vulnerability, disclosure, openness to the experience, and a more authentic self-projection.

5. It eliminates many barriers and normalizes mental health care for many young generations who are so accustomed to the comfort of interacting and sharing with people using technology. Once clients feel accustomed to these initial digital intervention experiences, they are more open to seeking help. Thus, online digital interventions in the form of counseling through audio/email/video conferencing, digital symptom forms, thought and mood reflection worksheets and various videos providing psychoeducation about mental health concerns form a good framework for providing mental health services. In adjunct with in-person therapy, thus serves as a great first step or smooth entry point for even seeking in-person psychotherapy in the future.

Disadvantages - Things That Concerns The Clients And Therapist In Online Therapy

1. The most prominent concern about online counseling has been the perceived feeling of the process, feeling impersonal/ disconnected /not intimate enough to foster the kind of therapeutic alliances formed during in-person therapy. Building a therapeutic alliance/connection and therapist-client fits are really crucial to the process. People who prefer face-to-face communication/being around people while conveying or listening might have a harder time connecting over screens. Technical glitches, disconnection due to network issues, presence of only technology-based conversations, especially through just texts/emails, can make it more difficult to foster secure alliances.

2. Inference from non-verbal signs, facial and tone clues, and physical conduct are important sources of indicators in the therapeutic process of assessment, diagnosis, and treatment. While this inference is still somewhat possible via audio/video conferencing, it is completely absent through texting/emailing which makes the process more complex for the therapist.

3. The advent of online counseling has brought a whole new set of possible ethical and legal hindrances that are being worked on. Teletherapy has made it possible for mental health professionals to provide services to clients who live in completely different states or even countries where the code of ethics and laws regarding qualifications to become a psychologist, licensure, and practice of mental health might be completely different. In such a situation, differing codes of ethics and lack of awareness about it have the scope for many malpractices and fraud professionals practicing under fake credentials. Plus, there are significant concerns about possible misuse of technology that impacts confidentiality/anonymity, leading to apprehension and fear regarding opening up.

4. Just like there is a different key for each lock, online therapy is not a key appropriate for all people. It is not considered a good fit for people suffering from severe mental health disorders, experiencing active psychosis, or intense suicidal ideations or self-harm. These people might need immediate face-to-face intervention, and online counseling won’t suffice to manage the symptoms' severity. It might also reduce access for technologically challenged people or don’t have the economic resources to invest in technology. The mode of teletherapy is still developing, and there is a lack of consistent and standard guidelines to deal with crises or ambiguous situations through online counseling.

5. While there are a ton of research in regard to the efficacy of in-person interventions for various mental health concerns, the research gaps in online counseling are far more. There are very few courses that assist a mental health professional in delivering/shifting to online modes of counseling.

What Can You Do?

Having covered the gaps/concerns associated with online therapy, let's look at what clients and therapists can do to address these concerns and be more mindful of making this choice for themselves.

For people wanting to seek help

1. Gradually put in efforts to be more verbally communicative or take advantage of multiple methods of communication/methods to converse till you feel comfortable enough for a video session. This might help reduce the therapist's lack of physical and nonverbal clues to understand you.

2. Just like you would do before investing in any self-care product/ service, do your research. Starting by asking yourself questions like what mode of communication would you prefer, how much are you open to paying, would you want to try out portals which offer a trial session beforehand, would you prefer choosing your own therapist or are they chosen for you, what kind of concerns are you seeking assistance for? The beauty of online counseling is the scope for customization suited to your unique preferences and needs; use it to your benefit.

3. You have every right to check and know the qualifications of the mental health professional you decide to work with and the platform being used even on mediums of online counseling; use that access to make a more informed decision. It’s a key point to remember that the process of online counseling or therapy is not just about posting mental health content-related posts/blogs/ live chats/ engaging in mental health advocacy. It is a continuous and active process of therapist-client bonding and structured interventions meant to assist the client’s concerns on a personal level, just like in-person therapy.

For Therapists or Counsellors

Filtering candidates who might benefit from online counseling from candidates who need psychiatric/in-person interventions is a crucial step in this process.

1. Work within your scope of qualifications, and if there is an inter-jurisdictional therapeutic process involved, accustom yourself to the ethical laws and regulations of practice in that state.

2. Online counseling, especially structured psychotherapy via video sessions, is a relatively new area. If you have made that shift from in-person to online counseling or even choose to start with it, educate yourself about technology-related usage, up-to-date research, and minor nuances in telehealth practices in the field of mental health through certified courses, training, and seeking supervision. This will help reduce ambiguity and sustain the quality of work you are engaging in regardless of the medium.

3. Many online mental health portals have opened up, but before joining any such organization as a mental health professional, familiarize yourself with the company guidelines and regulations for mental health services, the safety and security of the portal they use for the same as well as the presence of a mental health professional in the founders or at least in the team of people making the policies/creating the portal. This will ensure that the code of ethics for mental health professionals will be followed throughout the services delivered by the organization.

Online counseling has truly helped, so many mental health professionals and clients need to connect during the pandemic when distress and isolation were at maximum, and accessibility to mental health care had tanked down. This has led to many clients and psychologists positively looking at this shift. If you are one of them, check out the Reevin Mental Health Website, which provides customized, affordable, and accessible online counseling and mental healthcare services while abiding by the ethical conduct of providing virtual therapy.  If this form is mindfully developed with gradual research and application strengthening the quality of online services being provided, the dream of achieving access to quality mental health care for every Indian will become a very realistic and near-future possibility. I would love to know and understand your preferences and perspectives about this shift; feel free to share the same in the comments!