Therapy over the phone and in more recent years on video has been around for a long time, but since the recent pandemic it has become normalised with lots of online therapy platforms emerging and an abundance of “mental health” apps.
At Brighton and Hove Psychotherapy we offer both face-to-face and online therapy, and whilst many people can benefit from the latter, this option is certainly not advisable for everyone. I would like to share some of what I have observed about psychotherapy conducted online from my own clinical experience, from supervising clinicians who work with clients online and from many exchanges with colleagues in the field, especially since the beginning of the Covid-19 pandemic. Here are some considerations:
Doing therapy from the comfort of your own home x travelling to see your therapist
The journey to a therapist’s office is a part of the work itself, as long as it isn’t so arduous and exhausting that it becomes unsustainable. The intention and commitment to make the journey each week, the space to reflect, the checking in with self before entering the therapist’s office, arriving at a physical room and being greeted in, or waiting for your appointment, all are rituals that are a part of the process itself. There is also the journey after the appointment, which hopefully is long enough to allow some space to be with yourself before engaging in any other activity. Time poor people will argue that they can fit therapy into their day more easily if it’s done online, however one of the goals of therapy for some individuals could be to look at difficulties in prioritising personal needs, including making time for therapy appointments.
Choosing from a larger pool of therapists x choosing someone locally
Depending on where you live it may be easy or difficult to choose someone to work with. However, the very process of choosing is an important one. I compare some online directories or platforms to fast food. We live in a consumer-led culture where convenience is highly sought after. We want quick results because many of us are time poor, but consider that this is probably on of the most important choices you will make. Therefore, it is worth spending some time and effort choosing a therapist as it might determine the future state of your mental health and even your life.
People who are socially anxious can access help at home
Unless someone has a debilitating condition that keeps them housebound, in which case psychiatric care would be advised, colluding with or perpetuating the existing issue might be counter productive. Encouraging someone with social anxiety to venture out and travel to see a clinician face to face is a small step towards creating a relationship that is safe and manageable for the client, before they risk other forms of social engagements that go beyond the therapy room.
“ The therapist’s office is intimidating ”
Here is another great reason to explore why it is more difficult or intimidating to talk about yourself when faced with a therapist – a real person in the real world. Psychotherapy should enable and encourage people to have better relationships that are real. If the ease of talking more about yourself when you’re meeting someone online could be linked to difficulties forming and sustaining real relationships. Just as we see brilliant poets and writers who can barely utter a word when faced with a social situation, someone who is seemingly confident and capable of relating on the screen, can be very different in person.
Having said all the above, I remain an advocate of virtual sessions depending on the person and type of work. For instance, more cognitive and solution-focused approaches can work well online. Whereas in-depth psychotherapy which draws on unconscious processes is undoubtedly much better done in person. I would not recommend online therapy to those who struggle to maintain clear boundaries, feel easily emotionally overwhelmed, or are dealing with a range of complex psychological issues. People leading chaotic lives usually find it more containing to have the predictability of their therapist’s office environment. I also would not advise anyone training to become a psychotherapist to have their therapy online, and couples work can be difficult virtually, especially if the couple is in the middle of a lot of conflict.
This is not to say that good work can’t take place virtually, but we have to accept that there will always be a missing component and that the therapy will probably not achieve it’s full potential.
On our website you can find more information about our counselling and psychotherapy services and how to contact our team.
Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.
Further reading –
The Psychology of Mindful Eating
What are the benefits of counselling and psychotherapy?
Why is mental health important?