Covid 19 pandemic changed and accelerated many processes related to our work and daily existence. Suddenly, working online from home, which wasn’t a common practice before, became normal in some sectors, and many employers are not planning to bring staff to working fully at the office, switching to a hybrid of online and office work. The same happened to counselling and psychotherapy. Counsellors had concerns about purely online work as in some ways it was going against the advice of major counselling and psychotherapy theories. However, counselling was forced to move online and stay this way for months. Conscious and concerned at the beginning, many counsellors and psychotherapists soon realised that… it works. It definitely happened in our professional circles.
At Talking Therapy, we bring together relational counsellors and psychotherapists. The relational approach teaches that therapy works if the client can relate to their counsellor – namely, establish a trusting relationship. This seems quite logical: it’s naturally difficult to open up to a stranger, and the same applies to your counsellor. An important factor of building a relationship is the ability to interact with another person in a way that allows you to ‘read’ maximum information about them but also about how they respond to you. When we interact with one another, we receive such information about them and our relationship in verbal and non-verbal ways, with the latter providing the most – about 80% - of information. Now, when two humans sit in the same room, they can ‘read’ more compared to when they look at each other online. It is because they can observe the whole body of another human and catch more subtleties – such as intonation, breathing, eye contact, micro-facial expressions. They can also talk without interruptions, which may happen when talking via online means. It makes communication flow more naturally, allows the counsellor to better attune to the client’s feelings, making the therapeutic relationship develop more harmoniously and potentially faster. In summary, the main concern of counsellors and psychotherapists was that with online work, they would see more obstacles to building therapeutic relationships with their clients. And it’s the therapeutic relationship that is the main contributor to the success of counselling.
Having worked online for months, many counselling professionals noticed that they could achieve similar results not only with existing clients, with whom they had a chance to work face-to-face but also with new ones. Establishing a new client relationship is particularly difficult, so this was reasonable proof that online counselling worked. Note, here we are talking about weekly counselling sessions moving to video calls, and not emails or any other text message means. Like in the other sectors, some counsellors are not planning to go back to working face-to-face or only do a small number of offline sessions.
In short – not much yet. A search of one of the largest databases of research articles reveals only a few recent studies on the efficacy of online counselling and psychotherapy. One qualitative study from 2021 says that “findings indicate that therapists have a positive attitude towards online counselling” (1). It means that counsellors and psychotherapists adapted to new ways of working and were happy with the progress. But it’s important to keep in mind that this is a small qualitative study.
A few other research articles mainly focused on behavioural counselling, such as CBT, and conclude that it works online and via email.
Email or text message counselling is a slightly different story. Such services exist, but the research on their outcomes is limited. Two studies showed positive impact of email counselling on problems with gambling and when working with students (2,3).
As we mentioned above, the effectiveness of counselling depends on whether you can relate to your counsellor. In email and any other forms of text therapy, you can not see the person, speak to them, and hear their voice or intonation. It removes a very substantial amount of non-verbal information that helps in establishing a trusting relationship as well as a few other therapeutic effects that are present in the video or face-to-face session and aid counselling work. Email and texts are asynchronous by nature - i.e. the response is delayed.
Writing can have a therapeutic effect, and clients are sometimes advised to keep a journal where they write about their feelings. However, neuroscience says that talking through and building a verbal narrative of one’s struggles and history is far more powerful. It helps our brain to process and integrate various events and emotions. It is essential in working with particular issues such as trauma when one needs to build and then retell their story multiple times to process and integrate the experience.
Interestingly, one research focused on establishing the portrait of a good counsellor or psychotherapist and interviewed the public about it. The findings outlined that the key characteristics of such counsellor were “work‐related principles, professionalism, personality characteristics, caring communication, empathy, and understanding were important categories of competence” (3). It largely resonates with the theory of what works in relational counselling – online or offline. If we apply these to any counselling that comes in the text form – email or text, we can see the difficulties. How would a counsellor show care, empathy, and understanding by written means? It is possible to do but to a limited extent and will potentially require a longer time.
Another pattern missing in text or email counselling is a pre-set time and immediacy of communication of online or face-to-face weekly sessions. For counselling to progress, the emotions must be captured and discussed here and now, as later the client’s state of mind and emotions may change. It also helps counselling process when the responses from both sides are spontaneous and not thought through, as would mostly be the case in written forms. Weekly appointment pattern is important for creating a space free of other disturbances, for yourself to reflect and listen to your feelings and emotions.
At Talking Therapy, we brought together counsellors and psychotherapists who work online. Looking at the first encouraging results of online counselling, we believe that the world of therapy is transforming, and we would like to lead this change. While doing so, we are also making it easier for clients to find therapists that are not necessarily based in the area they live in but have free spaces and specialise in particular struggles they face.
References:
1. Smith, J. and Gillon, E. (2021) ‘Therapists’ experiences of providing online counselling: A qualitative study’, Counselling & Psychotherapy Research, 21(3), pp. 545–554. doi: 10.1002/capr.12408
2. Jonas, B. et al. (2020) ‘Web-based intervention and email-counseling for problem gamblers: Results of a randomized controlled trial’, Journal of Gambling Studies, 36(4), pp. 1341–1358. doi: 10.1007/s10899-019-09883-8.
3. Dunn, K. (2012) ‘A qualitative investigation into the online counselling relationship: To meet or not to meet, that is the question’, Counselling & Psychotherapy Research, 12(4), pp. 316–326. doi: 10.1080/14733145.2012.669772.
4. Kühne, F., Heinze, P. E. and Weck, F. (2021) ‘What do laypersons believe characterises a competent psychotherapist?’, Counselling & Psychotherapy Research, 21(3), pp. 660–671. doi: 10.1002/capr.12343
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