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By Caroline Fleck

Is Web Therapy a Good Idea?

Uploaded: Apr 17, 2015

Few topics are as popular or controversial in psychology today as web therapy (often called teletherapy). This intersection of technology, science, and therapy seems to have captivated consumers and providers alike (Showtime went so far as to base an entire TV show around this topic). Part of what makes web therapy so interesting, is that it raises a range of unique ethical and legal issues.

Now, full disclosure, I provide web therapy to a select number of my clients. Despite this fact I, like many therapists, remain conflicted about how popular web therapy has become and some of the ways in which it is being used. Having spent countless hours discussing, researching, and using this new form of therapy, I thought I'd share some of what I've encountered.

On the plus side, web therapy has some undeniable strengths and overcomes some of therapy's greatest limitations. For starters, it enables people to connect with a therapist even if they are homebound, in rural communities, or require a unique type of therapy that is not readily available.

When I was closing my practice in Seattle to come to California, I hated the idea of abandoning my clients. Many of them had spent months in therapy working to develop a strong therapeutic alliance that enabled us to tackle serious problems. Some of them expressed concern that their progress might be stymied by having to transition to a new therapist and "start over." I shared their concerns.

Because I was licensed in both Washington and California, I was legally able to provide web therapy to some of my clients. Conducting session online enabled me to keep working with my Washington clients without missing a beat. I continue to work with several of these clients and firmly believe that their treatment benefited from the continuity of care.

Web therapy also has the obvious advantage of being super convenient. You can avoid traffic to and from the doctor's office, talk within the comfort of your own home, and save on commuting and childcare expenses. These benefits may seem insignificant, but considering that many folks seeking therapy struggle with issues related to anxiety, depression, and stress management, these small comforts can go a long way to increasing the probability that someone will seek treatment and/or stick with it.

All of that sounds great, but as I stated, these benefits are not without their drawbacks. Some of the biggest issues surrounding web therapy are confidentiality (it is inarguably much more difficult to ensure the confidentiality of sessions conducted online rather than in a soundproof office), licensure (most states require that the provider be licensed in the state that the client resides), and reimbursement (many insurance companies will not pay for services provided online).

There are other clinical considerations to keep in mind as well. For instance, issues that require ongoing crisis management like suicidality and self-harm can be difficult to manage remotely. It can also be more challenging for clinicians to diagnose certain disorders based on online interactions alone where factors like eye contact, behavioral idiosyncrasies, and distractibility are harder to assess. Finally, although technology has come a long way, it still has a long way to go. I have had web sessions fail due to bad connections, interruptions in internet service, and malfunctions in software. If there is no alternative means of connecting, clients could go days or weeks without sessions while waiting for technological issues to resolve.

When it's all said and done, I think web therapy is a promising new direction for psychotherapy. If, however, your problems are severe, or you require a thorough diagnostic assessment, I might consider meeting with a clinician in person, at least initially to determine a diagnosis and treatment plan. Anyone pursuing teletherapy in California should confirm that their online therapist has a current and valid California state license and closely review the limits to confidentiality outlined by their web therapist.