The Rise of Online Therapy: History and Challenges

by Allegra Hamilton | May 05, 2023 |
The Rise of Online Therapy: History and Challenges

Healthcare staffing agencies have noted the rising demand for virtual practitioners within the counseling and psychotherapy professions as online therapy takes a firm hold in healthcare. Online therapy, also known as telepsychology, e-therapy or e-counseling, refers to therapeutic interventions conducted through digital platforms. While the term predominantly encompasses live video therapy, it can also include other forms of online communication such as email or instant messaging. Healthcare staffing agencies find that some potential candidates are at first resistant to practicing online therapy, but once familiar with the practice express overall positive experiences and a willingness to continue using it.

The concept of using technology for therapeutic purposes is not new, with early examples dating back to 1959, when the Nebraska Psychiatric Institute pioneered the use of videoconferencing to deliver various forms of therapy and training. Massachusetts General Hospital followed suit in 1969 by providing psychiatric consultations at an airport health clinic. Over time, videoconferencing became increasingly common, expanding to include most diagnostic and therapeutic interactions during the 1970s-80s.

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During the 1990s, videoconferencing gained global popularity and researchers began studying remote therapy’s ability to improve access to care. In the 2000s, it was recognized as an effective alternative to in-person care when it proved successful when implemented across international settings.

But the biggest boon to teletherapy occurred as a result of the COVID-19 pandemic, when telehealth underwent a significant test to determine its effectiveness. Statistics cited by the American Psychological Association (APA) reveal that over 80% of psychologists treating anxiety disorders reported an increased demand for treatment since the pandemic began.

As a result of in-person treatment restrictions, healthcare providers were compelled to offer telehealth services. Consequently, the utilization of online therapy for outpatient mental health and substance abuse treatments rose from 0% to 36% between March and August of 2021, according to the APA. Notably, almost all clinical psychologists continue to provide services remotely post-pandemic, with 93% of psychologists planning to maintain telehealth as an option.

Several studies have provided support for the effectiveness of online psychological interventions as stand-alone therapies. Online therapy has shown comparable outcomes to in-person therapy, offering convenience, increased accessibility and even making contact possible for individuals who may have been excluded from traditional therapy due to economic limitations.

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But a 2021 study published in the International Journal of Environmental Research and Public Health confirms that online therapy presents unique challenges for therapists. While acknowledging the benefits and positive aspects of virtual therapy, many practitioners have reservations about its efficacy. These concerns stem from the inherent limitations of remote communication and the potential impact on the therapeutic relationship. In particular, the study noted that therapists agreed on the following potential pitfalls:

Technical Difficulties

Unstable internet connections, audio or video glitches or other technological issues may sound like small inconveniences, but therapists report they can disrupt the flow of therapy sessions and impact the overall therapeutic experience. These disruptions can lead to frustration, interruption of sensitive communications and may hinder the ability of both the client and therapist to fully engage in the therapeutic process.

Lack of Non-verbal Cues

In face-to-face therapy sessions, non-verbal cues such as facial expressions, body language, and tone of voice play a crucial role in understanding a client’s emotions and reactions. Virtual therapy may limit the visibility and interpretation of these non-verbal cues. Factors like poor video quality or camera angles can make it challenging for therapists to accurately assess a client’s non-verbal expressions. This limitation can potentially impact the therapist’s understanding of the client’s emotional state, leading to misinterpretations or less nuanced therapeutic interventions.

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Limited Physical Presence

Building rapport and establishing a sense of shared goals for therapy can be more challenging when there’s a physical distance between the two individuals. Without the ability to have face-to-face interactions, the client may miss out on the personal connection and sense of presence that can be cultivated in traditional therapy settings.

Confidentiality Concerns

Engaging in virtual therapy introduces potential risks to confidentiality and privacy. With information transmitted over the internet, there is a possibility of security breaches or unauthorized access to sensitive data.

Inability to Provide Certain Interventions

Therapeutic techniques that require hands-on interactions, such as some types of bodywork or art therapy, may not translate to a virtual platform. Group therapy, which relies on the dynamics of in-person interactions, may also be less effective when conducted virtually.

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Healthcare staffing agencies deal with resistance by underscoring teletherapy’s potential benefits, including increased accessibility, reduced stigma and flexibility for clients. However, challenges related to technology, environmental factors and the absence of non-verbal cues require careful consideration. Despite these drawbacks, virtual therapy continues to evolve and improve, bridging the gap between individuals and mental health support. Healthcare staffing agencies encourage provider clients to consider including the use and challenges of remote services in therapists’ training and developing research-informed guidelines that may reduce potential challenges.


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