A young man and woman doing their video therapy sessions by smart phone, and a young man using his computer for it

When is online help the best choice?

By Beth Mares RP (Ontario)

Beth’s website

Advantages of distance counselling

Often therapy works better remotely even when there are other options. Probably the commonest reason for psychotherapy failure is not sticking with it. For many people the greater convenience of web-based counselling makes it more likely they will complete their therapy. Regular attendance is also important for most people, and this is often easier with distance therapy. With cyber therapy you also have more choice of providers, so that if you live in an under serviced area such as Northern Ontario you have a better chance of finding a psychotherapist with the expertise and approach you want. Some people feel they have more space and find it easier to think clearly when the therapist is not in the same room; instant messaging (chat) may work even better than video therapy for people who tend to feel off-balance or judged when talking about their personal problems. Distance therapy can also offer greater privacy.

Why is privacy important for successful psychotherapy?

If you are a public figure, or live in a small centre where many people know you, you might prefer not to be seen at the counsellor’s office–especially in the company of your husband or wife; this concern might cause discomfort that would make it hard to relax and focus on your therapy. It really is a good idea to keep your personal business private, too. Also, it is best practice to avoid a dual relationship between a mental health provider and client whenever possible. It is both easier and less problematical to talk freely when you know you’re not going to run into your confidant at the PTA. Of course, internet therapy only improves confidentiality when you have a private place where will not be disturbed. If you have a private space at work but are concerned about possibly being overheard, a chat session could be the answer; your communications on a web-conferencing platform that complies with privacy legislation are encrypted, so although your IT department might have access to the file, they should not be able to read it.

Confidentiality issues

With various governments, commercial data miners and hackers prowling the internet these days, governments processing the general public’s phone calls, and technology that can overhear conversations in offices from a remote location, privacy is not absolute. However a little knowledge and care can make communications reasonably secure. Gmail, Hushmail and some others are encrypted in transit, and rather than use Skype, your counsellor should use a PIPEDA compliant platform such as Vsee, which is specially designed to transmit confidential medical information and would be very difficult to crack.

Is distance therapy right for me?

Any qualified psychotherapist, psychologist or addiction counsellor who offers services online will ask about you, your situation and the problem in an initial session so as to offer guidance.

The number one consideration is safety: if there is any danger of self-harm or of violence to you or by you, if you are or have recently been addicted to a substance, if your long term health is endangered by anorexia, etc.–a psychotherapist in private practice is not likely to have the resources to give you the best care.

There are other reasons you might decide to travel to an office if you live in a large centre and have plenty of options. For example, for some people it may be more difficult to do trauma work or other in-depth emotional work if the guide and support-person is not physically present. Marital therapy can be more difficult remotely, at least if the partners are both using the same device and can’t see each other’s faces; however, these disadvantages can be outweighed by considerations of practicality or privacy. There are some psychotherapy methods which cannot be used in internet therapy, though the main methods can. In general, distance is rarely an obstacle when the client mainly requires practical help, and for many people it also works just as well for in-depth healing.