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Myths about psychological counseling on the Internet

(based on the article “The Myths and Reality of Clinical Work on the Internet,” written by a group of general practitioners of the International Society for the Protection of Mental Health Online)

Psychological counseling on the Internet is a reality. At the moment there are more than 30 sites in Russian that provide psychological help online. Of course, this is significantly less than, for example, in the USA (more than 240), but the Russian market of cyber therapy is only gaining momentum. Shaping the demand for e-therapy. Scientific research in this area is also practically absent, and this, despite the fact that this form of counseling is over 14 years old. Our attention was drawn to the research work of a group of therapists working under the auspices of the International Society for Mental Health Online, which collected and analyzed data collected by them as a result of its three-year online practice. They made a list of myths that they encountered in their work.

Myth 1. Online therapy does not guarantee the safety of the client.

Disclaimer: The fact is that according to the ethical laws of full-time therapy, the specialist is obliged to respect the confidentiality of work. That is, all the information that he receives from his client, the therapist must keep secret. This is on the one hand, and on the other hand, any specialist is obliged to provide the person who applied to him for help with the necessary information about himself: education, work experience, his specialization (psychoanalyst, psychologist, gestalt therapist, e-therapist, etc. ), its limitations (with what cases it does not work).

It is generally accepted that Internet therapy cannot satisfy these two conditions. That the network is too “transparent”, therefore, the client’s confidentiality is at risk, and the therapist’s identity cannot be verified, as he can think of anything he wants about himself using virtuality. All these risks, according to the opponents of e-therapy, are so significant that this form of work is impossible at all.

Why does it exist? The answer is that the Internet is just a facet of human relations that exist in reality, and there are the necessary tools to create a security therapy: electronic signatures, email encryption, and other guarantees. Of course, personal computers are relatively easily cracked and you can get the information stored in them, but this feature is the same as hacking the therapist's office to steal files. A responsible online therapist will always take special measures to safeguard information, including the use of passwords, as well as other modern technical means.

Informed consent to online therapy is one of the main requirements before starting counseling, as well as in normal work with a specialist. Online therapists always provide the public with information about themselves, assess their qualifications and indicate their limitations, as well as the risks associated with this online treatment method. The question of establishing the identity of the therapist is one of the provisions that will continue to be actively considered and discussed, as well as the three requirements of the therapeutic interaction destroyed by Internet therapy. Visibility, conversation (to speak), synchronization of interaction (real time).

Myth 2. Online therapy, this communication by e-mail

Disclaimer: E-therapists often work with e-mail, but they also use other channels to communicate with their clients — instant messaging, chat, phone calls, and in some cases separate face-to-face meetings. For some customers, a combination of different forms of communication proves to be a very effective strategy. People express themselves differently when they communicate in voice, text and image. Unique aspects of personality are revealed in various forms. The transition from one mechanism to another sometimes turns out to be a very important event in therapy. For these reasons, specialists can develop treatment plans by combining various communication channels.

Although the text is the basis of communication now, but experts began experimenting with multimedia. Even simply including photographs, graphics, video or sound files in communication between the client and the therapist can be an effective addition to the text in the therapy. There is no doubt that the future of online clinical work will entail a number of creative approaches for mixing and matching text, sound and images.

Myth 3. Text is not enough to convey the wealth of human experience.

Denial: Why do people still say that words cannot convey the breadth of human experience? Does literature from Homer to hip-hop not make this statement absurd? It is known that Sigmund Freud himself treated some patients, solely on the basis of a written text, at a distance. Network experience shows that some people become more honest, more relaxed, and more expressive in writing than face to face. People are curious creatures. When faced with barriers, they find all sorts of ways to circumvent these obstacles, especially in those cases when these barriers are caused by communication.

This is how emoticons were invented that convey feelings, thoughts, and sometimes even actions. Color and font can also be used for self-expression. Each person has his own language, communication style, which contains many subtleties that are not immediately clear to a stranger, but in the process of correspondence partners become more sensitive to the nuances of each other's texts. E-therapists note that their clients are willing to use various forms and means of expression, from the exchange of photographs, poetry to autobiographical web pages. All this is used in the healing process and makes the therapeutic experience more comprehensive than before.

Myth 4. Intervention in a crisis situation is impossible online

Disclaimer: There is a risk of underestimating the mental state in which the client is located during online therapy. Although it is hard to believe that such a risk is absent, when working face to face. Of course the therapist can see visual cues, but there are cases of incorrect assumptions. It is believed that the errors in online therapy are more, because experts build their impressions on verbal messages, thus, the assessment of risk, such as suicide, is very limited and invalid. In addition, Internet consultations are remote, which means that the client may be at risk or in need of immediate medical attention, and the e-therapist will not be able to help.

Despite the lack of visibility and non-verbal communications, people with severe emotional distress can receive effective help through a network of communication devices.

Many people in crisis situations tend to share their experiences and feelings with anonymous, invisible network partners. There are quite a few websites that deal with suicide prevention and include valuable information on self-help. E-therapists can use these resources in their work, either directly or in search of additional help, while specialists with a helpline and face-to-face psychotherapists are deprived of this.

Myth 5. Effective online counseling is not possible for the treatment of serious disorders.

Denial: It happens that in the process of e-therapy opens a serious psychopathology. And working with severe personality disorders becomes impossible, since the client is not able to maintain therapeutic boundaries.
Although there may be such requests when a depressed client cannot muster his strength to face the therapist face to face, he can seize the moment and accept the outstretched helping hand by clicking on the online help. In this case, the specialist can assist by supporting the client in his search for a way out of this state, use the advice of a psychiatrist, prescribed medications.

Myth 6. Geography does not matter when conducting online therapy.

Denial: The fact is that the Internet is a worldwide network, which means that clients can be in different time zones. In addition, it is difficult to work with a person of a completely different culture and speaking a different language. In the USA, these subtleties are regulated by a license, which is issued to the therapist and limits his activities to a specific state. Therefore, geographic parameters affect the work of the e-therapist, but everyone decides for himself on the basis of experience, competence and personal boundaries.

Myth 7. Online therapist works with the same client.

Denial: In the traditional model of psychotherapy, the doctor is central. He manages the circulation and plays a crucial role in creating the experience necessary for change. The same goes for online therapy in many ways. However, in cyberspace there are a wide variety of resources dedicated to mental health. Starting from support groups and informational websites, ending with social connections, the so-called microcosm. As part of the consultation, the e-therapist can help the client develop a program of “networking events” that will satisfy his needs and demands. In addition, online therapists can work with face-to-face specialists and seek help from their colleagues.

Myth 8. Online therapy adheres to the same principles of work as face-to-face psychotherapy.

Denial: It is obvious that people remain people, regardless of whether we communicate face to face, or talk on the phone or via the Internet. However, when confronted with an online therapist, the client is in front of the monitor, and not in the office where he can see the smiling face of a specialist, hear his speech, as well as familiarize himself with diplomas and licenses on the wall. A recruited person cannot estimate in advance the style of writing a consultant, the typing speed, the presence of grammatical errors, etc. Therefore, the potential client’s first task is to determine whether he wants to work with this online specialist and the e-therapist should help in making this decision.

In the US, clients are now looking for therapists on the Internet who do not just know their work well, but also possess the unique nature of networking. As mentioned earlier in the online therapy process, you can use a variety of creative approaches to mix and match text, sound, and images.

Online therapy requires an appropriate set of principles that would form the basis of the theory of cyber therapy. Now we are only on the verge of developing this theory, and this allows us to analyze the effect of various “therapeutic ingredients” or various communicative ways to solve therapeutic problems. Therapists need to understand and master some of the features of networking, for example: while working on the Internet at a computer, you will be more isolated than when working face-to-face.

There is no doubt that therapists who use the network to provide therapy must receive special training in several aspects: theory, technology and ethics. Since Internet psychological counseling services are a new form of work, a specialist is required to self-educate and seek like-minded people to exchange experience and information in order to develop and not lose control of themselves. Practitioners on the Internet should develop skills that derive from their professional training (psychology, psychoanalysis, psychiatry, clinical social work) and work experience.

Myth 9. Training in the work of an Internet consultant is ineffective.

Denial: Suggestions for formalizing the training of e-therapists are now beginning to appear around the globe. For example, in the UK, the USA there are several courses on online counseling skills, and the topic of online therapy is becoming increasingly popular for graduate students.

Lists of useful sites are also compiled, which tell about the tricks of the work and give advice. Educational interactive programs are being conducted, the purpose of which is the study of psychosocial topics on the web. Increasingly, higher education teachers generally use Internet correspondence as a supplement to their studies. It is clear that these efforts are not enough; it is regrettable to note that in Russia such work is practically not carried out.

Myth 10. Any experienced psychotherapist can work online

Denial: One who works in an office and dreams that consulting online is easy. Is mistaken. Even if he types on the keyboard quickly and knows a lot of online technicians. This does not guarantee customers. There are examples when a person seeking advice feels more confident in the network. It is important to be able to establish “transparent” natural relationships in which there is sympathy, understanding and the ability to send a “return ball”, as well as a willingness to use various electronic channels for communication. Of course there are a number of advantages in this work, but there are also disadvantages.

The advantages in this case are as follows: you can be at home and when you have to go about your business, wear what you want and drink tea, when it is convenient, you can turn off the computer and do something else. However, there can be more calls on the network than with full-time counseling, so you need to be able to organize yourself so as to avoid tears of technological frustration. Working online requires word love. It is useless to proceed to the text, only as a treatment. You must be able to find the right words to express yourself when writing a letter. This is a kind of art, which requires special tact and diplomacy. The disadvantages of networking are that the client can increase the therapist’s loneliness and it’s important to maintain boundaries and professional distance.

The therapist must have the following network skills:

- own the necessary programs (for example, chat, e-mail, etc.)

- be able to respond quickly, if necessary, to the client's request

- ability to accumulate, store and use relevant web links

- the ability to receive, store and protect correspondence with customers

- know multimedia capabilities to enhance speech expressiveness

- be proficient in the word

- be able to provide therapeutic intervention using only text

- be aware of how the client perceives the therapist

- professional base (training in psychoanalysis, psychology, etc.)

- the ability to switch from online counseling to face-to-face operation

In conclusion, I would like to note that the market for providing high-quality online services in the field of mental health in Russia is very raw. Getting into the psychological Internet office, most likely you will encounter a professional psychologist who has little experience in online counseling and does not fully possess the above-mentioned skills. However, it is worth remembering that each of us started from something and in any business you can achieve significant success if you love him and always strive for perfection.
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