Understanding the Brain

Online counseling

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Online counseling is the provision of professional mental health counseling services concerns via the Internet. Services are typically offered via email, real-time chat, and video conferencing.[1] Some clients use online counseling in conjunction with traditional psychotherapy, and a growing number of clients are using online counseling as a complete replacement to traditional office visits.[1]

While some form of tele-psychology has been going for over 35 years[2] , the advent of internet video chat systems and the increasing penetration of broadband has resulted in a growing movement towards online therapy. Clients are using videoconferencing, synchronous chat and asynchronous email with professional psychologists in place of or in addition to face-to-face meetings.[2]


The growing body of research into online counseling has established the efficacy of online therapy with treatment outcomes at least equal to traditional in-office settings.[2] Online therapy has additional benefits unrealized by office-based treatments as it allows the patient to attend sessions at a a higher rate than traditional sessions. The number of missed appointments is much less than with in-person therapy.[3] There is some research to suggest that online counseling is more effective because a client is at greater ease and feels less intimidated than they would in traditional settings. This makes clients more likely to be honest and thus allow the counselor to provide better treatment.[4]

Online counseling is also filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents and expats along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities.[2] These access issues are solved with online counseling resources and result in clients receiving culturally or linguistically relevant treatment that they would not have otherwise been able to receive. African Americans tend to have an elevated rate of stress-related diseases and have lower access to traditional face-to-face treatments.[5]

Online counseling has also been shown to be effective for clients who may have difficulty reaching appointments during normal business hours. [6] Additionally, research is demonstrating that online counseling may be useful for disabled and rural people that traditionally under-utilize clinical services. [2]


Some in the psychology community have argued that online therapy can never replace traditional face-to-face therapy.[7] Research from G.S. Stofle and J. suggests that online counseling would benefit people functioning at a moderatly high level.[8][9] Severe situations such as suicidal ideation or a psychotic episode might be better served by traditional face-to-face methods. [10] Although further research may prove otherwise.[2]

Cohen and Kerr conducted a study on the effictiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.[11]

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition.[2] Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.[12] Researchers have suggested that counseling professionals themselves are more critical of newer technologies than their clients.[citation needed]


There is a split between within the counseling field on the validity of online counseling. Some practitioners have suggested that online counseling cannot be considered psychotherapy,[13] while scientific journals such as The Lancet have published studies that demonstrate that online cognitive behavioral therapy is as effective as traditional "in-person" therapy for the treatment of depression.[14] Over 30 years ago, when distance technology first made an appearance in the research literature, similar complaints were lodged against telephone therapy.[15] However a 2000 study established that over 98% of psychologists who were members of the American Psychological Association used the telephone as a regular means of therapy, including 69% who conducted psychotherapy on the telephone and 79% who used it for emergency consultations.[16] A 2003 study concluded that telephone therapy outcomes were not significantly different from face-to-face therapy.[17]


  1. 1.0 1.1 Mallen, Michael J.; David L. Vogel (November 2005). "Introduction to the Major Contribution Counseling Psychology and Online Counseling". The Counseling Psychologist 33 (6): 761–775. doi:10.1177/0011000005278623. http://tcp.sagepub.com/content/33/6/761.abstract. Retrieved 4 May 2011. 
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Mallen, Michael J.; Vogel, Rochlen and Day (November 2005). "Online Counseling Reviewing the Literature From a Counseling Psychology Framework". The Counseling Psychologist 33 (6): 819–871. doi:10.1177/0011000005278624. http://tcp.sagepub.com/content/33/6/819.abstract. Retrieved 4 May 2011. 
  3. Glueckauf, R.L.; Fritz, Ecklund-Johnson, Liss, Dages, Carney (2002). "Videoconferencing-based family counseling for rural teenagers with epilepsy". Rehabilitation Psychology 47: 49–72. doi:10.1037/0090-5550.47.1.49. 
  4. Spiro, R.H.; Devenis (1991). "Telephone Therapy: Enhancement of the psychotherapeutic process". Psychotherapy in Private Practice 9: 31–55. 
  5. Sue, D.W. (1999). Counseling the Culturally Different, theory and practice. John Wiley. 
  6. Change, T.; Yeh, Krumboltz (2001). "Process and outcome evaluation of an on-line support group for Asian American male college students". Journal of Counseling Psychology 48 (3): 319–329. doi:10.1037/0022-0167.48.3.319. 
  7. Cherry, Kendra. "Online Counseling". About.com. http://psychology.about.com/od/psychotherapy/a/onlinepsych.htm. Retrieved 4 May 2011. 
  8. Stofle, G.S. (2001). Choosing an online therapist. White Hat Communications. 
  9. Suler, J (2000). "Psychotherapy in cyberspace: A 5 dimensional model of online and computer-mediated psychotherapy". CyberPsychology & Behavior 3 (2): 151–160. doi:10.1089/109493100315996. 
  10. Zelvin, E. (2004). Online Counseling Skills Part I: Treatment Strategies and Skills for Conducting Counseling Online. Academic Press. 
  11. Cohen, G.E.; Kerr, B.A. (1998). "Computer-mediated counseling: An empirical study of a new mental health treatment". Computers in Human Services 15: 13–26. 
  12. Dongier, M.; Templer, R., Lalinec-Michaud, M., Meuneir, D.. "Telepsychiatry: Psychiatric consultation through two-way television: A controlled study". Canadian Journal of Psychiatry 31: 32–34. 
  13. Cherry, Kendra. "Online Therapy". About.com. http://psychology.about.com/od/psychotherapy/a/onlinepsych.htm. Retrieved 4 May 2011. 
  14. Kessler, David; Lewis, Kaur et al (August 2009). "Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial". The Lancet 374 (9690): 628–634. doi:10.1016/S0140-6736(09)61257-5. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61257-5/abstract. Retrieved 4 May 2011. 
  15. Lamb, C.W. (1969). "Telephone therapy: some common errors and falacies". Voices: the Art & Science of Psychotherapy 5: 42–46. 
  16. VandenBos, G.R.; Williams, S. (2000). "The internet versus the telephone: What is telehealth anyway?". Professional Psychology: Research and Practice 31 (5): 490–492. doi:10.1037/0735-7028.31.5.490. 
  17. Sangha, K.K.; Dircks, A., Langlois, S. (2003). "Assessment of the effectiveness of genetic counseling by telephone compared to a clinic visit". Journal of Genetic Counseling 12 (2): 171–184. doi:10.1023/A:1022663324006.