In the current world, the internet is a space that builds, connects, and develops various spheres of human life. We can use the knowledge and services it offers without limitations, and reach an unlimited number of people who may be interested in a product, service, or form of treatment. Therefore, the question arises why psychotherapy cannot take advantage of this space and its possibilities? Questions regarding whether to conduct online psychotherapy via Skype and whether it is an effective method are secondary compared to what type of psychotherapy it is, what techniques the psychotherapist uses, and the difficulties experienced by the patient.
In the psychotherapeutic community, there has been a long-standing debate about whether online psychotherapy is possible and to what extent it is effective in treating patients. Various studies have been conducted to confirm the effectiveness of this form of treatment, mainly focusing on Cognitive-Behavioral Therapy (CBT) and crisis intervention, as they are time-limited forms of treatment. Moreover, these studies concern specific disorders and a particular method of CBT-based treatment. An example of an article containing descriptions of various studies is “Delivery of Evidence-Based Psychotherapy via Video Telehealth” by Daniel F. Gros & Leslie A. Morland & Carolyn J. Greene & Ron Acierno & Martha Strachan & Leonard E. Egede & Peter W. Tuerk & Hugh Myrick & B. Christopher Frueh, July 7, 2013. In summary, the effectiveness of online behavioral therapy has been confirmed in the treatment of panic attacks, tic disorders in children, depression in children, alcohol, tobacco, and drug abuse, post-traumatic stress disorder, social phobia, and bulimia, as well as in the treatment of anxiety and depressive symptoms. It is worth emphasizing that in these studies, online psychotherapy was only a part of the treatment – it preceded or continued the previous individual or group contact, and that the focus was on reducing the severity of symptoms and maintaining such a state of improvement for a specified time. There is no evidence here confirming a permanent cure of the above-mentioned disorders, but only the maintenance of improvement, abstinence, or a reduction in the severity of symptoms for a specific time after therapy, as shown in the study. The content presented above concerns one research project on the effectiveness of online psychotherapy.
Psychodynamic Online Psychotherapy
Recently, the concept of Augmented Reality has emerged. It is a system that combines the real world with computer-generated content and overlays it in real-time, for example, through multimedia glasses. This allows us to obtain necessary information practically instantly, as we have continuous access to an unlimited source of knowledge. However, with online psychotherapy, it is quite the opposite. As psychodynamic psychotherapists in online sessions, we do not see and feel everything that may be essential in treatment. The patient, like the therapist, has limited access to nonverbal communication, and does not encounter difficulties during therapy that could be overcome as part of treatment. In other words, an essential part of psychodynamic psychotherapy is the inclusion in the process of diagnosis and treatment of all content and messages that will only be available in direct meetings. Content that includes how the patient enters or exits, how they pay for sessions, and how they relate to the therapist’s space is essential in diagnosis and treatment. It is also impossible to use techniques such as mirroring and containing the patient’s emotions. The properties of online communication and direct communication differ so significantly that they cannot be treated as equal.
Another aspect is the risk of exacerbating the patient’s psychopathology. Not every patient is suitable for psychodynamic therapy, just as not everyone could benefit from online psychotherapy. Self-harm, suicide attempts, other forms of self-injury, intentional forms of venting such as disconnecting during a session, and many others cannot take place in the therapist’s office, but they can occur online. Shortly after the end of an online session, difficult emotions may be vented in various ways, whereas during an in-person session, the patient has the opportunity to experience and endure the most difficult time before and after the session. There are many such dangers across the entire spectrum of disorders. Treating internet addiction or social withdrawal through Skype sets a precedent. The patient’s home environment may only appear to be safe. It is not neutral, but is associated with emotions and memories that can significantly affect the treatment process. Unexpected visits from friends or noises from family members behind closed doors also do not facilitate treatment. All of this is only part of the dangers that must be acknowledged in order for psychodynamic therapy to be effective and, in accordance with the Hippocratic Oath, not harmful to patients.
Drawing conclusions from years of consideration of this issue, the Main Board of the Polish Society for Psychodynamic Psychotherapy included a provision in the Code of Ethics for Psychodynamic Psychotherapists stating that: “The foundation of the framework for psychodynamic therapy is the principle that the therapeutic process can only take place in direct contact between the therapist and the patient, which excludes the use of electronic forms of communication.”
mgr Michał Kozaczuk
mgr Michał Kozaczuk jest psychologiem i dyplomowanym psychoterapeutą Czytaj więcej