In person or online therapy?

In last month’s column I wrote about how to find a therapist and a therapy method that is the right fit. Quite a significant part of the decision to attend therapy can also be around time and schedules. How and when to fit the therapy sessions into a busy and/or challenging lifestyle can be something that might pose a barrier to accessing therapy. Maybe children, jobs, caring for someone or not having transport are issues that present what might seem like insurmountable hurdles when trying to get the support one needs. 

Many sectors across our society, locally and globally, have experienced a digital revolution in recent years. This is particularly observable in the area of mental health, with the move to online therapy initially met with scepticism both by clients and practitioners. People wondered how could online sessions work? Practitioners said online sessions might be missing the same “energy” as in person! There was much doubt and many naysayers. Since the rapid move to online everything due to the COVID-19 pandemic, online therapy has been proven to be accessible, effective and suitable.

Technology has been used in therapy for many years, with Sigmund Freud and Carl Jung’s psychotherapeutic relationship by paper letter being a famous example. They exchanged 359 letters between 1906 and 1913, in which they shared a mutually important and beneficial relationship that was psychologically supportive. Moving forward in time to the appearance of computer technology, another famous example of the early use of technology was the development of a computer programme named Eliza, in 1966. Eliza mimicked an interaction with a therapist, the programme was used to show both the potential and the limitations of technology in therapy. Today, with the emergence of Chat GPT and AI, the tech industry has begun to suggest this may replace therapy. Eliza never truly made an impact and I am uncertain that chat bots could ever replace human connection either, whether online or in person.

Technology has become quite prolific in therapy as time has passed due to its availability and ease of use as it has developed. In recent research, it was found that the yearly publication rate of research on this topic increased from one paper in 1981 to 1,902 by October 2020, with the growth rate across decades consistently tripling in size. As internet speeds have increased significantly, along with access in more rural areas across the world, and in Ireland itself, so too have ways to access therapy. It can be a reliable and trustworthy alternative to face to face sessions regardless of the method of therapy offered by a therapist. The use of technology in therapy can pose both advantages and risks for a therapist and a client. Technology can overcome borders, time zones, costs, inconveniences and present unique ways of working through screen sharing and media. Yet, certain aspects of working with technology in therapy pose a challenge such as safety, suicidal risk, session privacy, a loss of some useful information such as body language, technology failures and security of personal data.

Most psychotherapists and counsellors now offer multiple ways of attending sessions, in person, online and telephone being the most common. When searching for a therapist providing such a service, it is wise to ask the potential therapist about their online sessions. What platform do they use and is it secure? Such as Zoom or Google Meets. How do they use GDPR and data security? Where will the sessions take place for both the client and the therapist? Is the therapist insured to have online sessions with clients regardless of location? These ethical, insurance and legal considerations must be taken into account to ensure the experience is built on transparency and trust. A therapist’s professional representative body should also have regulations on how to work online ethically. Such as the Irish Association for Counselling and Psychotherapy (IACP) who launched their Working Therapeutically Online: Practice Guidelines and Competencies in February 2024.

A study of 27,500 people undertaken by the NHS in the UK in 2023 found that online therapy is just as helpful as in person. Online therapy increases availability and choice for anyone searching for a therapist, suddenly unburdened by geography a person can search for a therapist that fits them. Maybe it is for a therapist who is trained in a specific approach or specialises in working with a specific issue that is not available locally. Furthermore, accessing therapy online also introduces the element of convenience. One can find a therapist who works at a time that suits their schedule. Also, it is noteworthy to not forget perceived stigma, shame or taboo around therapy in Ireland. It might suit a person in an area such as West Cork to see their therapist online from the privacy of their own home as opposed to being seen entering a therapist’s place of practice! It is unfortunate that this is a part of our culture currently but hopefully this will change as time continues to pass and progress is made around the normality and importance of mental health care.

I work with clients both in person and online, with some clients that I see in person sometimes deciding to have a session online. This is a hybrid approach and I offer this as life can present unforeseeable events that might prevent someone attending their session in person such as a car issue or last-minute changes in child care. Lastly, some clients can be experiencing challenges that might feel too big to surmount on any given day preventing them from travelling or getting out of bed for in person therapy. Yet, they may still want to have a session and online can be just the answer. I have found clients appreciate the option and flexibility as it suits their life in the moment. Online sessions with me are via Zoom, with the Zoom link sent when a client makes a booking on my website. I have written before that the main factor that leads to effective and useful therapy is a trusting and safe relationship that is built between the therapist and client. This is still paramount when attending sessions online, research has found that online sessions pose no challenge in this regard. Living in an area that can be considered rural, and very remote in some parts, online therapy might well be the solution for some! 

For more information on Leo’s services, p: 085 1300573 

email: info@leomuckley.com 

web: www.leomuckley.com 

@leomuckleypsychotherapy

Leo Muckley

Leo Muckley, MSc in Counselling and Psychotherapy, offers psychotherapy and counselling sessions in person in Glengarriff and Skibbereen, online and also by walk and talk. He is a member of the Irish Association for Counselling and Psychotherapy (IACP). www.leomuckley.com

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