Online Therapy

Online Therapy

Online therapy, also known as e-therapy, is defined by Cook and Doyle (2002), as the provision of mental health services through the internet. A recent development in mental health, online therapy is a movement from face-to-face therapy, which has sparked a lot of interest as well as controversy. Most online therapy takes place via emails, full-service websites, and chat-based interfaces. According to Griffiths and Cooper (2003), the field of psychology cannot afford to ignore the internet, implying that this recent development was bound to happen. Some psychologists even argue that for such problems as addiction to internet pornography and addiction to internet gambling are best tackled through online therapy (Chester & Glass, 2006). This is because recent information and technological advancements have made virtual worlds even more accessible to individuals than the ‘real’ world. This makes online therapy one of the forefront current issues facing the world of psychology.

As mentioned earlier, online therapy has sparked controversy due to certain issues relating to it. In their article, Cook and Doyle (2002) state that one of the primary concerns in online therapy is caused by geographical separation, which may not nurture the establishment of a working alliance – a central component of successful therapy. Working alliance, or the quality of the therapeutic relationship, is important as it predicts the outcome of psychotherapy (Knaevelsrud & Maercker, 2006). However, it has been found, through working alliance scores, that it is possible to establish a high alliance in online therapy even though the figures are slightly lower than those of face-to-face therapy (Griffiths & Cooper, 2003).

Another controversial issue facing online therapy is misreading of cues. Because auditory and visual cues are missing, a client is left to get his cues from text-based communication. Therapists who are not well trained in this may give wrong cues that the client gets when he ‘reads between the lines.’ This increases the room for error between the client and the therapist. The reverse may also happen where the therapist reads the wrong cues from the client. This results in a situation where real issues evade assessment (Chester & Glass, 2006). Additionally, lack of access to important non-verbal behaviors that are crucial in the counseling process is a challenge facing online therapy.

Ethical issues also surround online therapy. According to Childress (2000), clients of online therapy are at a greater risk for breaches in confidentiality, posing a potential risk to online consumers. This risk occurs at both the client and therapist’s end as well as in the transmission of information. Clients also need to be aware that email correspondence may be subject to subpoena. Additionally, because of the globalism associated with online communication, the standards for recognition of legal protection may vary from one jurisdiction to another (Childress, 2000). Another ethical issue associated with online therapy is the heightened possibility of emotional injury and re-traumatization (Childress, 2000). This may happen through the earlier mentioned misreading of cues. Additionally, problems may surface when a client becomes suicidal or homicidal, as online therapy does not offer ideal crisis intervention practices (Rochlen, Zack & Speyer, 2004).

Because of all these issues and more related to online therapy, as well the redefinition of counseling necessitated by this contemporary phenomenon, additional research is required to determine whether it is a viable counseling practice. It is important to note however, that with all the issues surrounding online therapy, largely positive effects have been shown to exist. Indeed, preliminary controlled trials indicate that online therapy might indeed be effective (Knaevelsrud & Maercker, 2006). What therefore remains is to determine whether the pros of online therapy significantly outweigh the cons.


Chester, A., & Glass, C. A. (2006). Online counseling: a descriptive analysis of therapy services on the internet. British Journal of Guidance & Counseling, 34(2), 145-160.

Childress, C. A. (2000). Ethical issues in providing online psychotherapy interventions. Journal of Medical Internet Research, 2(1), 67-82.

Cook, J., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. CyberPsychology & Behavior, 5(2), 95-105.

Griffiths, M., & Cooper, G. (2003). Online therapy: Implications for problem gamblers and clinicians. British Journal of Guidance & Counseling, 31(1), 113-135.

Knaevelsrud, C., & Maercker, A. (2006). Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients? Journal of Medical Internet Research, 8(4), 102-117.

Rochlen, A., Zack, J. S., & Speyer, C. (2004). Online therapy: Review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60(3), 269-283.










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