The need for mental health support in the UK keeps growing with general psychological distress increasing from 18.9% to 27.3%. With significant differences in sub-groups (such as health care workers or students), depression and anxiety-related symptoms strongly worsened and often reached over 50% of participants. Therapists and clients had to switch to phone or online sessions regardless of their initial feelings about remote therapy. The dramatic change has unveiled a new and effective approach to attend to wellbeing in the 2020s.
People with disabilities, residents of rural areas, people who experience physical or financial issues with travel, or clients that didn't have the time to attend in-person therapy have been taking advantage of signing up for remote sessions for years. Keeping mental health professionals around in rural areas has been an issue for a long time and remote therapy was a number-one way to provide service outside of bigger cities. Before the pandemic, remote interventions only covered anxiety and depression-related symptoms and did not attend to other disorders. A limited amount of professionals enjoyed providing remote therapy and believed in its effectiveness pre-pandemic.
However, many therapists viewed online or over-the-phone sessions as less effective for losing the personal touch that comes with a face-to-face conversation, and before the first lockdown, these beliefs were never challenged or proven otherwise.
When the first lockdown started, in-office sessions got interrupted and people were worried about the effect it would have on the flow of therapy. Nobody quite knew how long it may last and if moving onto online sessions would be worth it. However, once it became clear that this is a long-term change, therapists had to turn to new ways of continuing their practices and remote therapy received a new wave of attention.
Young people, students, and parents with small children were one of the hardest-hit sub-groups of the pandemic. This group, however, is also the one that is most open to the usage of technology, and therefore, online services. The new generation of residents in psychotherapeutic education whose schooling and practice were interrupted by lockdown also demanded to include remote therapy-related strategies in their curriculum. Together, millennial clients and residents started driving the increased usage of remote therapy.
As the change continued, disorders that tend to show rapid responses to interventions quickly started showing the efficacy of remote therapy.
The results showed equal success in improving distress caused by Depression, Social Phobia, OCD, and Panic Disorder remotely as in person. The most often used talking therapy -Cognitive Behavioural Therapy- has also proven to be as effective remotely as when used in in-office settings.
This has challenged the initial negative views on remote therapy and started attracting investments into improving the delivery of remote sessions worldwide.
Two years on, studies show that therapists claim they were able to uphold the quality of their interventions remotely. Talking-based interventions seemed to have been delivered smoothly over the phone and via video chat. Professionals reported that the emotional connection and authenticity of the sessions have remained present.
Remote therapy allows for:
Reduced waiting time to receive help
Reduced cost of travel
Reduced time to get to your session
Sessions in a comfortable environment
Reduction of stigma
Help accessible for people that couldn’t receive it before
A choice between phone and video calls
More frequent sessions
After the initial strange feeling of having to speak about your most personal issues to a screen or a phone goes away, remote sessions go smooth and fast. You will find yourself hanging up, and not having to face a long journey while feeling vulnerable and being deep in thought, which might feel like a relief compared to traveling home from in-person therapy. And in terms of technical issues, remote practices use simple and user-friendly ways to deliver their sessions and help with an initial tutorial before the intervention starts. This should encourage clients that are less used to using technology to engage with remote therapy.
As remote therapy became widely used, more and more clinical advantages came to light. Several sub-groups of clients reported having preferred remote sessions.
Clients with significant childhood abuse and victims of sexual abuse and rape reported feeling safer having their sessions from home and not having to face a therapist in person -particularly at the beginning of the intervention. This could be gradually changed to a hybrid approach -a mix of in-person and remote sessions- if desired. However, many did not request to change their remote sessions and found comfort in the distance.
Children reported feeling safer and more comfortable with at-home sessions, while their therapists also reported a positive discovery of being able to observe the child in their home environment. Teenagers have also preferred the remote sessions as spending time online and using technology felt natural to this group, and the remote sessions provided independence from their parents which encouraged them to reach out and feel more relaxed with receiving help they can organise for themselves from their rooms.
Many clients with high-functioning autism enjoyed using technology and seemed to be more engaged remotely. The remote aspect of the therapy sessions can help this client group to keep their interest over time participate more comfortably.
It seemed to be more challenging to approach clients with psychosis with remote therapy as paranoid thoughts around computers and technology are common in this group. However, research found that these clients found it comforting that the therapist was not in the room and this has reduced their anxiety which helped them to be more engaged.
“Therapist alliance” is a term used to describe the strong relationship between therapist and client. This alliance creates the base for a productive intervention and enables clients to open up and engage.
Therapist alliance and presence are strongly connected to the success of the intervention. Visual and auditory information is found in behaviours like eye contact, facial expression, or body language which can be modified by online therapy or completely lost via a phone session. This could create a barrier to alliance and presence.
Longitudinal studies will reveal if these aspects are damaged by remote therapy. Some present research argues that while the alliance and presence are harder to establish at the beginning of the intervention due to the distance, once it’s done, the efficacy of the session will not be harmed.
Too much comfort, speaking outside of normal office hours, or a largely increased number of sessions are all features that can lead to overly casual interactions, harm the success of the intervention, and violate both the client and the practitioner. It is important to hold up these boundaries and keep a healthy discussion between client and therapist to ensure the success of the therapy.
Trauma, OCD, Depression, Anxiety, Personality Disorders, Psychosis, Autism, Panic Disorders, and Phobias have been researched in terms of the success of remote therapy. These all show promising results, while many other disorders are yet to be examined and might require years to establish a valid efficacy level.
While online and over-the-phone therapy was used by a small group for years prior, the pandemic created a surprising new approach to delivering sessions that were welcomed by therapists and clients equally. It is clear that remote therapy has several advantages from general perks like cost, comfort, commute time, accessibility, and reduced waiting time to more client-specific advantages, like the usage of distance, technology, or independence.
The pushing need for remote communication has revealed that these sessions can not only replace face-to-face therapy and keep its quality at the same level, but also have several benefits that enhance the success of the intervention.
The increased accessibility of mental health support will help us tackle the mental health crisis the pandemic has created. And for those that are still afraid of trying remote therapy, as lockdown has eased in most places, there is often a choice to try the remote session first, and see if you would like to change to in-person interventions later. But don’t be surprised, if the advantages of remote sessions will change your mind too!
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