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Online Therapy: Friend or Foe? V1.1

Updated: Apr 24, 2022

Hypnotherapist Bill Frost explores the role of online therapy and some of the reasons why therapists have avoided using technologies such as Zoom in the past… For many years I have accepted the common view that online therapy is somehow dangerous, unsafe and something to be feared. Then a tea-spoonful of viral material effectively closed our physical therapy rooms and changed the world we live in forever. From the outset Covid generated widespread feelings of panic and anxiety. Even in our household we amassed a sizable stock of canned food and toilet paper on a ‘just in case’ basis. In many cases the effect of social isolation on our patients was rapid and substantial, giving rise to a lot of distress and an increased demand for therapy. This forced us to reconsider the role of online therapy and overcome our own techno-phobias. So, what exactly were we so afraid of? For some therapists the concern was in terms of security. However, Zoom has offered a HIPAA compliant service branded as “Zoom for Telehealth” since 2017 and Skype offers HIPAA compliance with some of its business packages. HIPAA stands for the US Health Insurance Portability and Accountability Act which sets the standard for the protection of sensitive patient data. So, if you have the right package, and configure your system properly, confidentiality can be sufficiently assured.

For other therapists, the concern was that the dissociated nature of online therapy would destroy the “healing environment”. This is based on the thinking of Carl Rogers, the founder of the Person-Centred therapy movement. Rogers believed that the close therapeutic relationship was a core part of what generates change. Anecdotally however, what tends to happen is that the sense of therapeutic closeness can be increased, especially if the client uses headphones. Clearly both therapist and client need to be in non-public environments!

More formally, the impact of the impact of online therapy on the therapeutic relationship has been researched in the past. At least one systematic review (Sucala et al 2012) has concluded that online therapy is at least equivalent to in person therapy. Another concern was what happens when the connection breaks. This is inevitable with all platforms and is something that can never be entirely avoided. There are certainly a lot of things that all parties can do to reduce the likelihood of a dropped connection, but the risk will always be there. To counter this, we simply ensure that we have alternative means of making contact and reassure clients that they will awaken naturally should the line go down. Now we are permitted to welcome clients back into our therapy rooms, I wonder how many of them will prefer to stay online? Given the choice will clients opt for online therapy even if in-person therapy is arguably more convenient? Only time will tell… At this year’s International Hypnosis Conference I will highlight some of the lessons we have learnt from transferring our therapy online! In a light-hearted way I will explore some of the common mistakes we all tend to make along the path to Zoom enlightenment. This will include room setup issues such as lighting, background audio and camera positioning; as well as technical challenges, dealing with interruptions, confidentiality concerns, virtual backgrounds, filters and more besides. The role of online therapy in the future will also be considered. Based on: Sucala et al, (2012), ‘The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review’, Journal of Medical Internet Research, Vol. 14, No. 4

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