The global telehealth market is projected to expand at a compound annual growth rate (CAGR) of 13 percent from 2017 to 2025, according to a report from market intelligence company Transparency Market Research[1].

Affordable, convenient and discrete, E-Therapy as a form of treatment is seeing a growing number of providers appearing on the market every year. Today one can find ratings for these platforms through professional and commercial publications, test-drive them for free to see how they work and compare them to traditional therapy to learn about their advantages and limitations.

E-Therapy, unlike the broader term of teletherapy which applies to all forms of therapy, more often than not refers to the use of digital technologies in the provision of psychotherapy and counseling. E-Therapy is a relatively new development in how mental health problems are being treated and has quickly gained popularity with patients and therapists alike.

What Is E-Therapy?

E-Therapy is essentially a form of delivery of mental health care through different telecommunication channels, be it video conferencing, internet platforms, instant chat, texting, internet phone, email, and mobile apps. It may also be referred to as online therapy, distance therapy, virtual or web therapy, but it’s essentially the same thing.

As long as the client and the therapist have an internet connection and can agree on a channel of communication, the methodology that can be applied through e-therapy often doesn’t differ much from conventional therapy. Of course, while telepsychiatry offers some promise, the treatment of more serious mental conditions and usage of some very specialized approaches will almost always need physical proximity to succeed.[2][3]

Nevertheless, for many clients, the experience of e-therapy is not much different from conventional therapy, and many practitioners are comfortable building client relationships despite the distance.

Advantages of E-Therapy Over Conventional Therapy

E-therapy offers many advantages over traditional face-to-face psychotherapy. Many of today’s patients, who often have busy lives, limited free time and fewer resources appreciate the ease of access, flexibility and cost savings of e-therapy.

Many of today’s patients, who often have busy lives, limited free time and fewer resources appreciate the ease of access, flexibility and cost savings of e-therapy.

There are a number of ways in which e-therapy contributes to the expansion of mental health provision, particularly for those who otherwise may not have been able to access care due to their circumstances. Some of the most commonly cited advantages are listed below.

  1. E-Therapy Is as Effective as Conventional Therapy:

Despite skeptical attitudes from patients and practitioners alike, many conditions can be effectively treated by e-therapy and studies are mounting the evidence that these modalities are far from inferior to conventional therapy.

One Candian study done in response to Canadian Psychiatric Association’s recommendation for telehealth and e-health services to be developed found that: “Telehealth may be a viable option for patient assessment and delivery of psychotherapy to patients who are processing trauma as part of their mental health problems as well as dealing with depression, anxiety, and post-traumatic stress disorder (PTSD)“.[4]

  1. E-Therapy Is Cost-Effective

The use of the internet to bring patients and healthcare providers together has the potential to cut the cost for everyone involved. Patients can save on expenses associated with transportation, babysitting fees, lost hours at work, etc. working hours for people with non-standard schedules, etc.[5]

 3. E-Therapy Makes  Psychotherapy Available for People in Remote Areas

E-therapy and telemedicine in general help people in remote areas get to a therapist and be treated for their mental conditions. In many rural areas, patients have to wait to get the help they need, or even cancel it altogether because of complicated logistics.[6]

  1. It Allows the Patient to Choose from a Wider Range of Therapists and Methods

Pairing up with the right therapist is crucial for patients. Many areas have a limited number of therapists who provide conventional therapy, so patients there are often forced to choose from a shortlist of providers. If a patient doesn’t click with any of the local therapists, he can turn to e-therapy for more options.

  1. It Has Better Turnaround Rates

One of the biggest issues in conventional therapy is patients not showing up for their appointments. E-therapy has constantly shown better return rates from the patients because it allows more flexibility and doesn’t require them to leave their homes or area.[7][8]

  1. It Has More Sessions Covered by Insurance

 A very practical advantage over conventional therapy is simply a matter of how the insurance company sees the two branches of psychotherapy. In many cases, insurance companies only cover a limited amount of face-to-face therapy sessions but put no limit on how many e-therapy sessions you can get.

  1. Easy to Use As Support in the Treatment of Other Conditions

Many people who struggle with chronic diseases like diabetes, cancer, multiple sclerosis, paralysis, Crohn’s disease or Parkinson’s have a hard time dealing with their condition and cope with the pain and suffering. Many of these patients are also physically impaired and each medical appointment can be a complicated event. For these people, e-therapy can provide comfort, support, and emotional aid without forcing them to over complicate their lives.[9]

Limitations of E-Therapy

As with any new technology or innovation, e-therapy has its limitations. Knowing them and assessing one’s situation correctly will avoid a negative outcome, so here are some of the areas in which e-therapy can lack.

  1. Privacy and Security Concerns

One of the biggest issues with e-therapy and telemedicine, in general, is that the patient’s private information can be at risk.[10] Many online therapists provide their services via Skype, Facechat or other video chat services that are not designed for this purpose. These sessions can be compromised and the patient’s data can easily be leaked. Hackers are targeting medical data because it is very valuable, so the risk is there.

  1. Unlicensed Therapists

Since the Internet offers so many business opportunities for people all around the world, patients may come across the services of unlicensed therapists. Even when these mental health providers have the best intentions, they might do more harm than good if they don’t know the object of their work so well.

Unlicensed therapists often lack experience and expertise and might offer their services at lower prices. For some mental patients, getting unregulated therapy might make their condition worse.

  1. Some Professionals Are Reluctant to Use E-Therapy

Many therapists who prefer traditional face-to-face methods will not accept offering their services via the internet – often, this stems from concerns around difficulties in building patient health engagement and rapport.[11] In some cases, in-person therapy is objectively the only solution, in other cases, the therapist’s own skepticism keeps them from extending their reach.

Some Patients Are Reluctant to Try Online Services

People are still used to get free stuff on the internet, so they might pass on mental health services that are offered online. Not trusting the therapist’s credentials is also one of the reasons some people trust in-person therapy more.

  1. E-therapy Isn’t for Everyone

As mentioned above, some patients require in-person therapy, and internet services are not an option for them. Suicidal or schizophrenic patients are such examples because the therapist needs to observe certain signs in-person to correctly assess them.

  1. Technical Problems May Disrupt the Therapy Process

E-therapy doesn’t need much, but a good internet connection and proper auxiliaries are needed to establish a clear line of communication.[12] Any interruption in the line of communication can affect the quality of the mental health therapy session and can even cause a regression. If the tools which are used are not performing right, the therapist can misinterpret the patient’s message and provide the wrong feedback.

  1. Online Therapists Cannot Respond to Crisis Situations

One of the disadvantages of working with patients from a distance is that the therapist cannot respond in case of a crisis like suicide threat or psychotic episode.[13]

Interestingly, some mobile therapy apps are designed specifically with this shortcoming in mind, although research into their efficacy is still in its early stages.[14]

Ethical Guidelines to E-Therapy

Being a relatively new field, e-therapy has gone some time without being regulated, and people started worrying about this. Not long after the era of the internet started, in the ‘90s, the American Association of Telemedicine was founded and started drafting a guideline book for online doctors and therapists.

Another way of regulating online therapy is to only allow certified therapists to present themselves as such. This is the reason you sometimes may find people who advertise as “life coaches”, providing similar services without having a therapist certification.

No matter what a certain state’s laws are, online therapists must align with the same principles and ethics as any other therapist would.

In the United States, you might find some geographical limitations that apply to online therapy as well. For example, some states don’t allow out-of-state psychotherapists to practice inside their borders unless they are certified in that state too. This could mean that a patient can’t really benefit from distance therapy if the therapist they choose is not certified in the state of the patient.

No matter what a certain state’s laws are, online therapists must align with the same principles and ethics as any other therapist would. Let’s go through some of them:

  • Online therapists should receive proper training, both formal and informal: college courses, university courses, workshops, conferences, clinical supervision. They must be transparent about their training and only offer the services they are qualified to deliver.
  • Therapists who offer e-therapy should be able to understand and handle the technology they work with to use it properly. The patient must be informed about the technological limitations the therapy has, and know what to do in case the system goes down.
  • Therapists, both online and in-person, have to obey the laws of their geographical area. This means certain certifications, rights to practice, legal licenses, etc.[10]
  • The therapist must obtain informed consent from the patient, after informing them about the risks and costs involved.
  • Just as conventional therapists, online therapists have the duty to warn the authorities if a client poses a threat to themselves or others.

How to Choose the Right e-Therapy Service

Because the internet is connecting so many people around the world, it opens a world of opportunities for good people and bad people alike. Sometimes, it’s not that black and white, but good intentions are not enough if therapy is unfit for the problem it addresses.

Patients must have a selection system when browsing for an online therapist to protect their privacy, their mental health, and their finances.

When you choose an online therapist, you must have a basic knowledge about what you need and how to get the right professional to help you.

  1. Know What Problem You Are Addressing.

 Before you start the selection, it’s important to know what problems you want to address during therapy. Even if you don’t have a trained opinion on mental health, your introspection will provide an important starting point for the therapists you will contact.

Ask simple questions:

  • What seems to trouble you most in your life?
  • What do you want to change about yourself?
  • What is your biggest weakness of defect?
  1. Learn a Bit about Therapy

Knowing what to expect from therapy is going to prevent disappointment or other negative experiences. If you don’t have time to research by yourself or you don’t know where to begin, make sure you talk to your potential therapist about how the sessions will go and what the goal of therapy is.

  1. Get Information about the Therapists You Are Considering

As said before, an online therapist needs just as many qualifications as an in-person therapist. Providing therapy to people who are struggling with mental issues is a very big responsibility and cannot be done by anyone, no matter how well-intentioned and empathetic they are.

Collect information about the professional training of the therapist you’re about to work with and make sure it is official. Most reputable teletherapy providers will provide access to credentialed, licensed practitioners – they in turn may also have profiles that you can browse to look at experience and specialization.

  1. Don’t Be Afraid to Change Therapists If Something Doesn’t Feel Right

Even if you got your therapist after a selection process that was integrated into the online platform you are using, it doesn’t mean that he or she is the only one who fits your needs. A very important thing in therapy is the alliance between patient and therapist, and that can only be tested after being in contact.[15]

If you and your therapist don’t click, let them know that you would like to try a different person.

Conclusion

E-therapy is a relatively new industry with the huge potential of reaching patients in need. Although it has its limitations and disadvantages, an informed and educated patient can benefit hugely from web-based services.

General practitioners, ER doctors, counselors, and other specialists should have an interest in knowing more about e-therapy and recommending it to the patients in need. At the same time, the patients themselves should have access to more information on e-therapy, and learn how to recognize the right platform and therapist for them.

Luckily, the internet breaks boundaries and offers instant access to information and services, and certified online specialists are gaining more recognition from the public and institutions, and more resources to do their job. We can only expect things to change and evolve in the future and give more and more people access to quality healthcare.

References

  1. ^ Landi, H. (2018). Report: Telehealth Market Estimated to Reach $19.5B by 2025. Retrieved from https://www.hcinnovationgroup.com/clinical-it/news/13030029/report-telehealth-market-estimated-to-reach-195b-by-2025
  2. ^ Chakrabarti, S. (2015). Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World Journal of Psychiatry, 5(3), 286.
  3. ^ American Psychiatric Association. (2020). What is Telepsychiatry? Retrieved from https://www.psychiatry.org/patients-families/what-is-telepsychiatry.
  4. ^ Palylyk-Colwell, E., & Argáez, C. (2018). Telehealth for the Assessment and Treatment of Depression, Post-Traumatic Stress Disorder, and Anxiety: Clinical Evidence. Ottawa: Canadian Agency for Drugs and Technologies in Health.
  5. ^ Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2016). Therapist‐supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews, (3), CD011565.
  6. ^ Ashwick, R., Turgoose, D., & Murphy, D. (2019). Exploring the acceptability of delivering Cognitive Processing Therapy (CPT) to UK veterans with PTSD over Skype: a qualitative study. European Journal of Psychotraumatology, 10(1), 1573128.
  7. ^ Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G. & Christensen, H. (2015). Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘individual patient data’meta-analysis. Psychological Medicine, 45(13), 2717.
  8. ^ Watson, H. J., Levine, M. D., Zerwas, S. C., Hamer, R. M., Crosby, R. D., Sprecher, C. S. & Moessner, M. (2017). Predictors of dropout in face‐to‐face and internet‐based cognitive‐behavioral therapy for bulimia nervosa in a randomized controlled trial. International Journal of Eating Disorders, 50(5), 569.
  9. ^ Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P. (2019). Internet‐delivered psychological treatments: from innovation to implementation. World Psychiatry, 18(1), 28.
  10. ^ APA. (2020). Guidelines for the Practice of Telepsychology. Retrieved from https://www.apa.org/practice/guidelines/telepsychology
  11. ^ Graffigna, G., Barello, S., Bonanomi, A., & Lozza, E. (2015). Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) scale. Frontiers in Psychology, 6, 274.
  12. ^ Oravec, J. A. (2000). Online counselling and the Internet: Perspectives for mental health care supervision and education. Journal of Mental Health, 9(2), 121.
  13. ^ Brooks, E., Turvey, C., & Augusterfer, E. F. (2013). Provider barriers to telemental health: obstacles overcome, obstacles remaining. Telemedicine and e-Health, 19(6), 433.
  14. ^ Castillo-Sánchez, G., Camargo-Henríquez, I., Muñoz-Sánchez, J. L., Franco-Martín, M., & de la Torre-Díez, I. (2019). Suicide prevention mobile apps: descriptive analysis of apps from the most popular virtual stores. JMIR mHealth and uHealth, 7(8), e13885.
  15. ^ Barak, A., Klein, B., and Proudfoot, J. G. (2009). Defining internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38(1), 4.

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