Is Online Psychiatry Effective?

By Nadia Khan

Updated September 27, 2019

Reviewer Rachael Lee

It will be no secret to the reader that technology has had an immense effect on virtually every industry, but what about the mental health sphere? Online psychiatry has already made its appearance, and internet therapy may soon be pushing more traditional bricks and mortar practices to the sidelines.

What is Online Therapy?

Online therapy is known by a few different names, including e-therapy, e-counseling, teletherapy or cyber-counseling. It is a relatively new development in the mental health world and is essentially a therapist or a mental health provider that provides psychological advice and support over the internet. This can occur in a number of different ways: email, video conferencing, phone calls, online chats or messaging. Online therapy can be done in real-time with video conferencing, phone calls, or online chat rooms, or it can be done with a time delay, like with emails and messages.

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The History of Online Therapy:

You might think that online therapy is a new concept, but it has actually been around for a long time, it just looked a little bit different. Remember Sigmund Freud, the neurologist and the founder of psychoanalysis, who practiced mental health therapy between 1886 and 1938? He wrote letters to his clients frequently as a way to communicate and also encouraged his patients to write as well. That is just about the equivalent as modern-day emails. As early as 1982, self-help groups began immerging on the internet in the forms of group chats and forums. Today, their numbers of online support communities, chat rooms, bulletin boards and electronic mailing lists that provide convenient, around the clock access to peer support.

Today, there are much different online counseling and mental health services, so much so, that the International Society for Mental Health Online (ISMHO) was founded to explore and promote mental health in the digital age. Created in 1997, the ISMHA was formed to promote the understanding, use, and development of online communication, information, and technology for the international mental health community.

Benefits of Online Therapy:

Online counseling offers a number of potential advantages, reduced cost not being the least important. In a country where insurers still cover a percentage of psychological treatments at a lower rate, most mental health professionals will likely welcome any step that brings care within the reach of a larger number of people. A psychologist or counselor - and with some exceptions, most of these services do employ qualified and licensed practitioners. One benefit of internet therapy is that the provider does not need to rent office space in a respectable building or employ a receptionist, which results in lower overhead costs.

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Secondly, leaving the question of efficacy aside for the moment, internet therapy is just much more efficient. Instead of having to take an hour off work and travel to practice, the patient may type a quick email or make a phone call. This may be especially useful in terms of dealing with stressful situations as they arise. Their electronic therapist may be available at that given time, or they may respond later. In either case, the patient can rest assured that someone is indeed listening to them.

Internet therapy also breaks down barriers to accessing therapy. Maybe you live in a small town that doesn't have access to many in-person therapists, or maybe you live in a remote location with no access. Internet therapy allows you to have access to a number of mental health professionals that you would otherwise not be able to access because of location.

Another advantage of online therapy is the discomforts that might come with sitting in an office face-to-face with a therapist. The 'you can't see me' effect can help you feel more comfortable to open up about yourself, share information that might feel embarrassing or painful, and can help you to do so in a way that feels less uncomfortable than sitting in an office worrying about the tone of voice and body language.

Online therapy also holds many benefits for people whose first language isn't English. Not having to worry about pronouncing things the right way, or worrying if your therapist will understand you, online therapy can eliminate this added difficulty and allow you to have therapy in the form of an online chat or working with your therapist by sending emails or messages back and forth.

Most importantly, an electronic therapist is not a chatbot or other piece of software: it is simply the application of technology to place counselors and patients in touch with each other.

The Effectiveness of Online Psychiatry

The first point to consider is, something is always better than nothing. If a person suffering from addiction, depression, stress disorders or any other mental issue can get access to help they would have otherwise not received, it's a win for the psychiatric profession as a whole. However, a psychologist who charges $100 per fifty-minute to an hour and is only available between nine and five has no basis for complaint on this score.

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Online therapy has received support from many different sources, mostly being those who have been on the receiving end of online therapy. In a review of studies published by the World Journal of Psychiatry, the patient who has received mental health treatment through video conferencing reported high levels of satisfaction with their treatment. Their study also concluded that "videoconferencing-based telepsychiatric assessments are reliable, and clinically outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures".

As it turns out, research comparing the results of internet therapy to more conventional approaches is quite encouraging. While communicating in writing obviously obscures paralinguistic features and voice-only communication does not allow for visual cues, these are less than critical in some therapeutic modalities. It would certainly seem that online therapy is here to stay, whether as a stand-alone form of treatment or something to be used in conjunction with other means.

Limitations and Opportunities of Internet Counseling

Persons living in rural areas, in prison or in otherwise inaccessible locations can now receive quality care at any time of the day or night. Patients can also call upon a much wider range of expertise than a single therapist can offer, with specialists in anything from addiction to gender identity counseling, who work under the same umbrella organizations.

People who might not feel comfortable attending traditional face-to-face support groups also have the opportunity to receive services from online therapy.

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While online therapy can be very beneficial to a large number of people, it is also not appropriate for everyone. While has shown its effectiveness in many areas, there is a more serious mental illness that is not appropriate for online therapy. Online therapy is also not meant for individuals that feel like they are in crisis or are unable to stay or commit to being safe.

There are, however, certain things that electronic therapists just can't do. Making a firm diagnosis for, say, a court order is just not possible, nor is prescribing any form of medication. Effective regulation of these online services, including where confidentiality concerns arise, is also still an open issue. However, it's clear that this new horizon in treating mental health issues is here to stay, and we would be well advised to look for ways to improve it rather than simply dismissing online psychiatry as "an internet thing."