All rights reserved © A Yates 2011
Online Therapy Information
What is online therapy?
Online
therapy
is
a
reference
to
online
counselling
and
psychotherapy
services,
including
chat
and
email
options,
was
once
considered
a
new
way
of
delivering
the
therapeutic
experience
when
talking
to
a
therapist,
now
it
is
commonly
used
by
millions
of
people
to
find
help
and
support
for
addressing
mental
health
problems
while
using
modern
technology
to
communicate over the internet.
It
started
many
years
ago
with
email
and
chat
programs,
customarily
known
as
chat-therapy
or
e-therapy,
often
using
platforms
like
yahoo
messenger MSN and using Skype to talk to psychologists and counsellors.
Skype
was
the
first
popular
VOIP
method
to
be
used,
but
it
was
heavily
slandered
by
many
therapists,
as
not
being
confidential
even
though
at
the
time
it
was
probably
more
secure
than
many
other
VOIP
options
and
landlines.
With
the
rise
of
modern
internet
enabled
devices
like
smartphones
computers
and
tablets,
having
therapy
delivered
over
the
internet
became
popular
by
demand,
also
commonly
known
as
e-counselling,
cyber
counselling,
online-counselling
and
in
the
US
usually
referred
to
as
teletherapy by some therapists.
No
longer
was
online
therapy
restricted
to
email
or
chat,
it
grew
to
include
video
and
voice
communications,
once
again
Skype
was
at
the
forefront
of
change.
However,
the
world
of
therapy
was
slow
to
catch
up,
often
dismissed by some therapists as not ethical or safe.
Although
online
therapy
has
its
issues,
it
was
never
the
less
pushed
into
existence
due
to
the
high
demand
for
change,
often
from
clients
who
wanted
to
experience
therapy
online
because
of
the
lower
cost
and
convenience.
Many
people
still
use
Skype
for
therapy,
and
it
is
still
considered
to
be
a
very
safe
and
secure
option,
but
now
there
are
a
number
of
choices
from
video
conferencing
software
like
Vsee,
Wire
and
many
others
that
claim
to
be more secure.
Therapy influenced by modern technology
As
a
therapist
who
has
been
working
online
for
almost
ten
years,
I
found
that
people
in
the
modern
technology-driven
world
like
the
freedom
to
choose
where they receive therapy.
Not
being
restricted
to
a
therapist’s
physical
office,
means
they
can
choose
to
have
the
help
and
support
that
they
need
at
home,
they
can
do
this
anywhere
that
feels
safe
and
comfortable
to
them.
That
could
mean
sitting
parked
in
the
car,
in
the
office
at
work
or
hotel,
as
long
as
they
can
find
a
good
connection,
they
can
have
therapy
online
where
ever
they
are
in
the
world.
By
giving
people
the
option
to
find
a
counselling
or
psychotherapy
service
over
the
Internet,
many
people
have
been
able
to
access
therapeutic
services
who
would
never
have
been
able
to
do
so
before
it
became
available
via
the
Internet.
Therapy
is
also
becoming
less
expensive,
by
using
encrypted
communication
programs
like
Skype,
wire,
Vsee,
and
other
communication
software,
therapists
working
online
can
provide
online
counselling
and
psychotherapy
to
a
much
broader
client
base,
all
this
without
having
to
pay
for
office
space
and
employ
someone
to
answer
the
phone and book appointments.
Websites
just
like
this
online
offering
a
counselling
and
psychotherapy
service
has
been
growing
in
popularity
for
some
time,
it
has
given
lots
of
people
the
freedom
to
find
what
they
need
when
they
need
it,
without
being
restricted to a physical locality
More choices with online therapy
The
access
to
online
therapeutic
services
over
the
Internet
is
not
limited
to
any
city
or
country
and
is
available
via
computer
or
smartphone
worldwide,
as long as the connection can support it.
There
usually
is
much
more
choice
regarding
the
available
times
and
the
number
of
days
that
the
service
is
available
to
you,
so
if
you
work
long
hours
a
Sunday
morning
is
maybe
better
for
you
than
a
Monday
night,
so
more flexibility and choice when using an online therapy service.
Having
a
video
therapy
session
can
help
some
people
connect
in
a
way
that
feels
almost
like
being
there
in
person,
the
visual
interaction
can
help
some
people
replicate
face
to
face
therapy
sessions,
and
although
it
may
be
similar,
it
is
not
the
same.
It
is
a
much
better
option
than
just
using
sound
for
people
who
need
to
have
visual
feedback
when
they
are
experiencing
online psychotherapy and counselling.
Not
using
the
video
for
therapy,
and
Just
using
sound
only
is
a
bit
like
closing
your
eyes,
for
some,
it
is
a
better
way
to
connect
with
their
thoughts.
Fewer
distractions
from
visual
stimuli
and
a
better
connection
to
their
inner
world,
if
you
close
your
eyes
and
shut
out
the
external
visual
world,
are
you
then
paying
more
quality
attention
to
your
inner
world,
try
it
and
see.
That
is
why
I
offer
sound
only
as
well
as
video,
using
video
when
experiencing
therapy
helps
some
people
feel
comfortable
and
connected,
but
it
can
feel
intrusive
to
some.
With
only
using
sound
to
talk
in
therapy
it
can
help
some
people
feel
more
at
ease,
there
is
no
need
to
dress
up
and
impress
or
project
the
image
you
think
I
want
to
see.
Instead,
you
can
feel
less judged and more in tune with what is important to you.
Many
people
find,
that
using
the
sound
only
option
when
talking
online
very
helpful,
the
main
advantage
that
remaining
hidden
from
the
online
therapist
gives
you,
is
that,
it
can
allow
you
to
feel
more
secure
within
yourself,
it
can
help
make
the
therapy
experience
feel
less
stressful
and
will
enable
you
to
talk
openly
about
personal
issues.
It
then
becomes
more
about
you
and
your
needs;
it
is
not
about
how
embarrassed
or
anxious
you
feel
in
front
of
a
camera
talking
about
your
thought’s
feelings
and
life
experiences.
Feeling
more
relaxed
by
not
using
a
webcam
may
help
you
deal
with
painful
thoughts
and
feelings.
The
benefits
of
feeling
less
stressed
and
anxious
when
having
therapy,
are
often
experienced
immediately
and
eventually
could help you to make the changes you need in your life on your terms.
Using Chat and Email to have therapy
There
are
many
ways
to
talk
to
a
therapist
online,
chat
or
Email
programs
can
provide
a
real-time
interactive
experience
using
a
computer
or
a
mobile
device
using
text to talk to a counsellor directly in real time.
Chat
programs
tend
to
have
more
complex
confidentiality
concerns,
and
there
are
some
issues
with
knowing
whom
you
are
talking
to
without
any
visual
or
voice
interaction,
but
people
still
request
it,
and
some
therapists
still
provide
online
counselling
with
this
method.
This
service
only
provides
limited
chat
via
secure
apps,
for
reconciling
questions,
contact
requests
and
communicating
changes
to
appointment
times.
Online therapy with flexible appointments
A
therapist
working
online
or
off-line
will
offer
similar
options
in
regards
to
the number of sessions per week and the length of the therapy session.
In
general,
a
number
of
sessions
are
usually
provided
at
seven-day
intervals;
therapists
primarily
accept
this
as
an
appropriate
time
interval
allowing an excellent working balance for both the therapist and the client.
Sometimes
more
sessions
are
needed
for
more
acute
short-term
support,
at
the
other
end
of
the
spectrum,
some
people
may
only
need
one
session
every two weeks or even one or two per month.
Each
session
will
typically
last
between
fifty
or
sixty
minutes,
but
some
sessions
can
last
for
up
to
ninety
minutes.
The
longer
time
frame
is
very
dependent
on
the
situation
and
is
not
generally
used
as
a
standard,
but
the
extra-long
session
can
be
beneficial
with
complex
cases
where
the
client
feels
they
need
more
time
to
express
or
think
over
the
emotions
and
beliefs
involved.
Hiding your identity when having therapy online.
You can now hide your Identity when having online therapy.
The
suggestions
below
may
give
you
some
help
in
keeping
your
identity
hidden
when
using
this
therapy
service.
I
do
not
use
encrypted
email
as
it
has
created
too
many
problems
in
the
past
trying
to
explain
to
clients
how
to
use
it,
encrypting
email
is
not
very
user-friendly
and
until
that
has
changed email is only used for setting appointments and general enquiries.
Use a temporary email address
Temporary
email
or
throw
away
email
address
is
anonymous
and
temporary
and
will
help
you
hide
who
you
are,
or
allow
you
to
keep
control
of
your
identity,
and
people
use
them
all
the
time
to
help
avoid
spammers
when
singing
into
online
shops
or
forums
and
any
other
online
services.
Some example of temporary email services.
The
example
websites
show
on
this
page
are
not
recommend
by
me
in
any
way,
all
website
services
and
links
below
are
just
examples
and
should
not
be seen as recommendations.
https://www.mailinator.com/
https://maildrop.cc/
https://www.abine.com/index.html
https://www.guerrillamail.com/
Use a virtual private network (VPN)
A
VPN
is
a
secure
way
to
hide
your
information
that
is
usually
traceable
such
as
your
IP
address
and
country
of
origin;
a
VPN
allows
you
to
pretend
to
the
world
wide
web
that
you
are
online
in
another
country
so
hiding
your
information from every website or service you use.
You
can
use
a
free
VPN
service,
but
in
my
opinion,
the
speed
can
be
restrictive
especially
when
using
a
program
like
Skype
or
wire
to
converse
over
the
Internet,
you
get
a
better
and
faster
service
by
paying
a
small
monthly fee.
You can find many VPN’s here is a few examples
https://www.ipvanish.com
/
https://www.goldenfrog.com/vyprvpn
https://www.expressvpn.com/
https://nordvpn.com/
https://cyberghostvpn.com/
Anonymous online payments
If
you
want
or
need
to
hide
your
identity
legally
when
making
a
payment
online
try
using
a
prepaid
card,
you
can
use
a
prepaid
card
anywhere
you
can
use
a
credit
card.
When
you
buy
a
prepaid
card
with
cash
and
you
also
top
up
the
card
with
money,
you
remain
almost
untraceable
when
using
the
card.
Prepaid
cards
are
great
for
concealment.
They
are
just
like
throwaway
cards
not traceable to you in any way.
If
you
buy
one,
you
will
then
have
an
anonymous
and
disposable
payment
card
to
help
keep
your
identity
safe
whenever
you
make
any
payments
online.
Please
be
aware
that
most
prepayment
cards
have
fees
associated
with
them
such
as
monthly
administration
charges
or
load
fees,
so
shop
around
and check the cost before using.
Advantages and disadvantages of online therapy
Some of the advantages
•
You can stay hidden from view while in therapy.
•
There
is
no
need
to
travel
to
see
the
therapist
when
you
can
use
the
Internet for counselling.
•
Flexible appointment times, including evenings and weekends.
•
Talk from home and feel more relaxed in your home environment.
•
Physical
disability
is
not
an
issue
finding
therapy.
(No
steps
or
lifts
or
travelling to and from)
•
There is more choice regarding what online therapist you can use.
•
It can be less embarrassing talking about some personal issues.
•
You can keep your privacy by staying anonymous.
•
You can talk via phone or PC with Skype to talk to a counsellor.
•
Connect from work or any place you have a connection.
•
No one need know you are seeing a therapist with Skype.
•
It’s physically safer for you.
Some of the disadvantages
•
Online
therapy
is
not
always
suitable
for
serious
mental
health
issues
such as bipolar and schizophrenia without local clinical support.
•
You need to feel confident using a computer.
•
You need to understand how to keep your computer secure.
•
As
with
any
technology,
it
is
possible
that
hardware
can
fail
or
go
wrong
leaving you unable to communicate.
•
If
you
make
recordings
of
the
session
you
“must”
encrypt
it
if
your
PC
is
stolen
all
data
on
your
hard
drive
can
be
looked
at
and
used
unless
it’s
encrypted.
•
It
is
not
safe
for
people
who
are
feeling
suicidal
or
in
crisis
without
more
information and backup available.
•
Qualifications
do
not
mean
that
much
online
as
different
countries
have
different requirements, so you need to ask more questions.
•
There
can
be
issues
with
some
slow
connections
in
some
parts
of
the
world,
and
it
is
not
always
possible
to
use
video
if
the
connection
is
slow.
•
Having therapy online may be against the law in your state or country.
Not everyone agrees
Regarding
therapists
working
online,
it
is
worth
mentioning
that
some
therapists
to
this
day
do
not
like
this
way
of
providing
help
and
support
over
the
internet,
they
think
it
is
not
beneficial
to
the
client
and
carries
too
many
unknown
risks,
or
that
it
is
not
classed
as
actual
therapy
and
not
confidential
or
secure.
It
has
been
argued
that
treating
internet
addiction
online,
for
instance,
is
enhancing
the
problem
not
providing
a
good
way
of
challenging the dependency.
In
my
opinion
as
a
therapist,
there
are
obviously
some
concerns
providing
therapy
online,
but
I
believe
the
advantages
for
the
clients
by
far
out
way
the
possible
problems.
I
do
know
from
my
own
experience
of
running
a
private
therapy
practice
online
for
several
years,
that
providing
an
internet-
based
therapy
service
has
its
issues,
I
also
understand
that
online
therapy
is
not
the
same
as
working
with
face
to
face
clients,
there
are
some
subtle
but
significant differences.
I
had
to
learn
all
this
from
my
own
experience
with
trial
and
error,
working
as
a
therapist
providing
therapy
services
over
the
internet,
because
when
I
started
providing
therapy
online,
there
was
no
one
to
ask
or
gain
information from at that time.
The problems with online therapy
Being
one
of
the
first
therapists
to
provide
online
therapy
I
had
to
discover
the
good
and
the
bad
all
on
my
own,
I
found
that
in
my
experience
there
are
aspects
of
a
service
like
this
that
are
indispensable.
By
providing
therapy
over
the
internet
I
have
enabled
people
to
seek
the
support
they
cannot
find
in
any
other
way,
this
has
allowed
people
to
find
the
help
they
need
in
a
way that works for them.
However,
you
cannot
escape
from
the
facts
that
online
therapy
services
are
prone
to
possible
technical
problems
from
a
number
of
inherent
weaknesses.
There
are
possible
problems
associated
with
the
quality
of
the
connection,
although
it
has
improved
substantially
compared
to
a
few
years
ago,
there
can
occasionally
be
issues
with
the
functionality
of
software
or
hardware that could disrupt the online therapy interaction.
This
means
that
at
any
moment
a
problem
could
disrupt
an
online
therapy
session,
and
in
some
cases
create
a
situation
where
the
client
feels
helpless
and
anxious.
This
is
obviously
not
helpful
to
either
the
client
or
therapist,
especially if the client is in crisis or experiencing other personal difficulties.
Confidentiality and security problems
Problems
with
confidentiality
always
need
careful
consideration;
there
is
always
a
risk
that
clients
will
not
be
using
the
best
practices
regarding
their
security
requirements.
I
have
had
prospective
clients,
wanting
therapy
via
their
computer,
but
had
no
working
anti-virus
or
firewall.
So
I
was
unable
to
take
them
on
as
a
client
until
they
had
fixed
the
issues,
and
then
listened
to
and
understood
the
information
I
provided
about
using
best
practice
to
keep
their
device
secure
as
possible.
Only
if
I
was
satisfied
would
we
continue.
After
any
security
improvements
or
recommendations,
I
have
to
trust
that
my
clients
will
implement
or
continue
to
use
reasonable
security
practices
when
opening
emails
and
keep
their
security
systems
up
to
date
to
protect
their confidentiality.
Not suitable for everyone
Not
everyone
should
have
therapy
online;
this
is
my
personal
opinion,
but
I
would
not
recommend
that
people
with
a
severe
psychotic
mental
illness,
reach
out
to
any
therapist
seeing
clients
on
the
internet.
I
have
no
objection
with
psychiatrists
or
clinical
psychologists
talking
to
their
patents
online,
as
they
would
in
all
probability
have
the
experience
and
knowledge
as
well
as
all
the
necessary
information
available
to
be
able
to
respond
appropriately
in a time of crises.
Any
therapist
who
wants
to
work
online
has
to
be
aware
of
the
risks
involved, from what I have seen, some are not fully aware.
As
I
am
only
dealing
with
neurosis
and
do
not
usually
deal
with
psychosis
(unless
working
in
conjunction
with
a
psychiatrist),
I
have
to
be
as
careful
as
I
am
able
to
be,
to
screen
out
high-risk
factor
clients
that
would
not
be
suitable
for
online
therapy
services.
Unfortunately,
no
screening
will
completely
remove
that
risk,
and
that
is
always
a
problem
to
be
aware
of
when
working
with
clients
online,
especially
those
who
are
hidden
or
anonymous.