Shrink back into your sofa and forget the consulting room

Online therapy
Online therapy
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If you need to talk things through but can’t face the therapist’s couch, there’s a newer alternative – online. Grace Hammond reports.

Martha hurries along the hall, keen not to be late for her appointment with her therapist. But she hasn’t had any of the usual delays on the way, such as getting stuck in traffic or failing to find a place to park. She’s also not bothered by the fact that she lives in Kent and her therapist is in Manchester. In fact, she hasn’t actually left her flat. She’s just overslept.

Martha is one of the pioneers of a radical new approach to counselling and therapy.

Rather than travelling to an appointment, sitting or lying on a couch and talking to a therapist, both sides stay at home and connect over the internet.

Settling down on her own sofa, Martha has a sip of coffee, curls up, picks up her laptop and logs on to Skype. Her therapist’s face appears. “How are you feeling?” he asks.

The therapist’s consulting room has long been a staple of books and films and the clichés are well known: the interesting bits start emerging just when time’s up; wanting to leave is a sign that uncomfortable progress is being made. But as more and more patients get off the couch and into the cloud, the practice and image of therapy are going to change drastically.

“It’s surprising it hasn’t happened sooner,” says 
Joanna Bawa, a psychologist 
who studies internet-therapy links. “There have always been other ways of offering psychological help, such as phone helplines, and Skype has been around for a number of years. But the whole move to the web has only taken off recently.”

It could soon be available on the NHS through your GP, thanks to the campaigning of clinical psychologist Nadine Field, who set up several years ago to speed up access to therapists, a service that can still be painfully slow.

“We’ve now got the evidence to show what we offer is actually more effective than face to face, and we can get someone an appointment within 36 hours,” she says.

The magic of the internet abolishes the constraints of geography. “You may be in Bradford, but your therapist could be in Bognor or Brisbane,” Field continues.

What’s more, by tapping into global demand, therapists 
will be able to narrowly 
specialise and become really skilled at treating very specific problems such as claustrophobia or obsessive compulsive 

Surprisingly, the site doesn’t
use anything more sophisticated than a web version of text messaging.

You sign up to the site, give your doctor’s details, and then a window comes up where the therapist types a greeting such as, “Hello, what’s happening?” and you can hit the keyboard and tell them.

“The fact that you can’t see the other person can be very liberating – people become very focused and can get to the heart of their problem quickly,” says Field. “A trial (of 300 people published in The Lancet) found that people with serious depression were much better after seven or eight sessions. These patients would normally need 15 to 20 face-to-face sessions on the NHS to reach that point.”

While PsychologyOnline is currently limited to certain 
areas, new sites are springing up all the time. Mootu, which was set up by successful entrepreneur John Witney, who made his money with the recruitment website JobServe, has a database of more than 70 therapists and counsellors who will see clients through Skype for between £40 and £60.

While increased ease of access undoubtedly has its benefits, it has also led to fears of unqualified therapists preying on vulnerable individuals as well as a potential lack of comeback if things go wrong.

Here in the UK, therapists aren’t licensed – anyone can put up a sign and start seeing clients.

“What happens if a client who’s talking to me on Skype suddenly starts becoming really distressed or suicidal, and he’s on the other side of the country or even in a different country?” asks psychotherapist Martin Pollecoff.

He says he appreciates Skype as a valuable tool, but insists on a face-to-face meeting first to gather basic information.

“I have a lot of City clients who are cash-rich and time-poor. They can’t come in regularly and are often away travelling. Skype is a marvellous way of letting us stay in touch.”

Any new technology generates new opportunities and new fears. Perhaps the fears are greater in therapy because its basic structure – two people in a room seeking understanding – has not changed in a century.

What’s certain is that its transformation by the web has only just begun.