Online Psychotherapy: What is it and why?

Dr. Salih Murat PakerClinical PsychologistPsychotherapist November 2021

Like many endeavors during the Covid-19 pandemic, psychotherapy had to be done online for a while. With the increase in vaccination rates, some therapists have started to do therapy in person, completely or partially, but some prefer to continue doing online therapy. This situation is not different for clients. The pandemic seems to have seriously changed the practice of psychotherapy and this raises various questions for both therapists and clients. Let’s take a brief look at some of these questions.

What is online therapy (also called teletherapy)?

Online therapy is therapy that the therapist and client do remotely, using technological tools, without sharing the same space. There are currently four methods that we know of: a) Non-real-time correspondence such as via e-mail messages, b) chat (real-time correspondence without audio and video), c) real-time phone calls without video, and d) real-time video calls. Undoubtedly, video calls are the closest to the therapy in-office, and this is the most frequently used method today. Depending on the possible developments in the metaverse field, it is expected that online therapy in three-dimensional or holographic style could be realized in the coming years. In this article, I will mainly focus on the online therapy conducted via video calls.

Did online therapy applications start with the Covid-19 pandemic process?

No. It was actually a method that had been being used for many years in parallel with the development of technological opportunities (telephone first and then video chat), but it was previously applied by much fewer therapists and only in very limited cases (for example, when the client moved to another country/city). Throughout this whole process, the need for online therapy increased as the rhythm of modern life and clients’ (and sometimes therapists’) mobility increased; but the rate of therapists who were open to applying this method was still very limited until the pandemic. Most therapists were conservative about this until the pandemic, with some even claiming that online therapy would never be possible.

I started using online therapy first in 2007 when a client of mine moved abroad for a few years. I was too hesitant for such an attempt at first but was encouraged by my client’s insistence. After a few online sessions, I was convinced that it was very convenient. However, until I went abroad for six months on academic leave in 2017, I only used online therapy when absolutely necessary, meaning when clients move to a different city or country. During that six-month period, I followed my ongoing clients completely online, and in addition, for the first time, I had the opportunity to start working with new clients living in other countries and cities. This experience has increased during the pandemic process and all therapists who were against online therapy found themselves doing online therapy within days. Starting before the pandemic, large companies providing online psychotherapy services in the Western world were already established, these companies reached gigantic sizes during the pandemic, and many research studies began to be published in this field. In short, a significant accumulation of knowledge/experience started to emerge in this field.

Is online therapy suitable for everyone?

Just as everything is not suitable for everyone, online therapy is certainly not suitable for everyone. In terms of both therapists and clients, those who do not like online therapy categorically for one reason or another, of course, should not choose online therapy if they have the opportunity to go to in-office therapy. Apart from this, working online with clients with severe/risky problems should not be preferred if there are other options. It is known that doing online work in therapy with pre-adolescent children is not very productive. But apart from these limitations, if the therapist and client are open to working online, it is possible to work very efficiently.

What opportunities does online therapy provide?

Online therapy is very valuable primarily because it can ensure the uninterrupted continuation of therapy work in extraordinary situations, as it did during the COVID-19 pandemic. Contrary to our optimistic fantasies, disasters due to ecological crisis, pandemics, migration, political tension/violence, and the possibility of war are the ever-present realities of our world. It is both a necessity and a great opportunity to provide all health services, including mental health, partially or completely online when necessary. This path is now permanently opened, and it seems that it will be used increasingly.

However, in this process, it has become clear that the use of online therapy will not be limited to extraordinary situations. Because it offers much wider possibilities for both therapists and clients than classical therapy. Geographic boundaries and proximity to receive and provide therapy are no longer important. As long as you have a good internet connection, you can find a therapist from your preferred culture / subculture / language from wherever you are in the world.

Now, there is clearly the opportunity to find and work with a qualified and affordable therapist. It is a huge blessing for those living in places that do not provide physical access to a therapist (or a suitable therapist). It is also a blessing for metropolitan residents who do not want to spend many hours commuting in traffic to access a therapist. In today’s world where migration movements are and will be increasing, it is also a great blessing for migrants who have not yet adapted to the culture / language of the place of migration and who may not be able to find a therapist in their native language / culture. If the language / culture barrier can be overcome, it would be a great blessing for those living in areas where therapy services are relatively expensive to have access to the same quality but inexpensive therapy elsewhere. It is also a blessing for clients who may have great difficulties in going to a therapist’s office because of problems such as agoraphobia and social anxiety, or because of geriatric difficulties.

All these possibilities show that even if the pandemic is over, online therapy has entered our lives permanently and will become more widespread.

Does online therapy help?

A limited number of scientific studies have yet been published on this subject, but all published studies reveal that online therapy produces very similar effects to classical therapy, so it can be quite beneficial in general. The impressions of most of the therapists who do online therapy and the clients who receive this service are also in line with this finding.