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Digital therapy: Can online counselling ever replace face-to-face therapy?

Digital therapy or telepsychology is on the rise as an affordable and convenient way to access counselling. Stylist meets one woman giving telepsychiatry a go.

Whether it’s a fresh gel manicure or catching up on David Attenborough’s Seven Worlds One Planet on our commute, we millennials are used to getting what we want at the click of a mouse or the tap of a thumb. So it was only a matter of time before caring for our minds went digital. And no, we’re not talking another meditation app.

Meet telepsychology – digital therapy accessed via your phone or laptop, rather than in an office armchair. This style of treatment is on the rise in the UK, thanks to the smartphone you might be reading this on. With increased awareness of mental health issues, and the inability of traditional therapy to meet growing demand, there’s a huge shortfall in our mental health services. That’s where digital therapy or telepsychiatry comes in.

Digital therapy and online counselling: Telepsychology, or online therapy, is on the rise in the UK

A total of 1.4 million people were referred to NHS talking therapies for anxiety and depression in 2017. And, according to a recent Royal College of Psychiatrists study of 500 patients across the country, a quarter of patients wait more than three months to access NHS mental health treatment, while 6% wait at least a year. 

Huge waiting lists can make going private the only option – if you can afford it. According to the NHS, a one-hour session can cost up to £70. And while there may be 39,000 therapists practicing in the UK, finding the right one for you (who’s not only within reasonable commuting distance, but also has space in their diary) can prove to be a headache.

It’s little surprise that the brand of ‘on demand’ online therapy offered by many new apps and websites – all immune from issues of cost, time and location – sounds so tempting. 

Take, for example, app Spill which allows users to ‘text’ with a counsellor registered with the British Association of Counselling and Psychotherapy (BACP). Or website, which offers unlimited online therapy for as little as £37 per week. “We found a huge desire for Skype sessions,” says Kruti St Helen of – another website which matches you to your ideal therapist. The NHS also refers some patients for a range of digital therapy solutions.

What’s more, research suggests the results can be the same as face-to-face. Two studies, published in the Journal of Affective Disorders and Cyberpsychology, Behavior and Networking, showed ‘texting’ a therapist to be just as effective as meeting them IRL. 

But, in the US, where telepsychology or online therapy has become phenomenally popular, the American Psychological Association has expressed concerns over privacy and whether users can easily check therapists’ qualifications. Plus, how deep can you really go when there’s a screen in the way? To find out, asked a woman who’s undergone digital therapy herself…

Amy*, 32, a lawyer in London, says:

“I was 18 when I first saw a therapist. There were problems at home in Germany, triggered by my parent’s divorce. Over the next two years, regular sessions kept my anxiety under control – and the stability helped me achieve the grades to get into an impressive British university to study law, and then onto a high-flying training contract to be a solicitor.

For a while I was happy. I was successful at work, and my social life was just as glowing. But below the surface, long hours in the high-pressure city were starting to take their toll. I was in a foreign country so far from truly close friends and family. My anxiety was spiraling out of control. I felt isolated and couldn’t sleep.

Realising I needed help, I quit my job and returned to Germany for two years. My doctor there recommended a private therapist who specialised in trauma and also somatic therapy, which looks at the connection between the mind and body. I instantly clicked with her.

Feeling much better, I moved back to London to begin a new job in a less pressurised field. But, despite moving countries, I didn’t want to give up on the two years of progress I had made with my therapist. The thought of having to build that trust up with someone else seemed so counter-productive. 

Digital therapy and online counselling: “The thought of having to build that trust up with someone else seemed so counter-productive”

This dilemma led to my first foray into digital therapy. Our weekly in-person sessions turned into weekly Skype ones, and she was also happy for me to email and text her in a moment of crisis. So, at the same time each week when I get home from work, I’d change into my comfy gym kit and sit in my favourite cosy spot on the sofa before logging in to speak to her for an hour.

And six months down the track, I’m still logging in. Before I found her, I saw some other therapists I didn’t gel with and it made me realise that finding the perfect therapist for you - regardless of the medium through which you talk to them – is the most important thing. 

Just because someone is qualified doesn’t mean you’ll be able to build a relationship. That said, trying out therapists in real life first is the best way to gauge whether there’s a connection and if you like their style, before asking about video calls.

Speaking to her simply by opening my laptop has also paved the way for invaluable texting and email contact for quick support when I’ve been in a really low place. If you’re having a bad day and you have to wait five more days until your next in-person appointment, it could reverse your progress. 

But what digital therapy offers with ease of communication, it perhaps lacks in connection. I don’t think I get quite as much out of our sessions as when we’re in the same room. Yes, I might be able to see her facial expressions and hear her tone of voice, but the geographical barrier means I do hold back a bit.

Then there’s human contact, which therapists in some circles believe can be hugely healing for trauma. Mine used to occasionally pat my back if I started to cry which was incredibly helpful. And just someone nodding and listening as you say personal things a matter of metres away is so nurturing.

There’s also the danger that texting a therapist doesn’t force you to delve into those uncomfortable places. Like crafting a message to a guy you fancy, it allows you time to build an answer and perhaps dodge the ‘hard’ questions which would actually benefit you. If you’re in a room with a therapist you don’t have time to ‘present’ what you say. And it’s certainly odd to hit ‘send’ about something in your childhood, when a moment later an Instagram notification pops up.

Digital therapy and online counselling: “Treating therapy like Netflix (to be consumed whenever) isn’t advisable”

Finding balance is key. Treating therapy like Netflix (to be consumed whenever) isn’t advisable, even if it gives you immediate relief. The boundaries traditional therapy creates – a fixed slot at a specific location – are actually really helpful to force to you to learn tools that will help you cope if difficult moments arise between appointments. The ideal for me would be in-person therapy with telepsychology as a safety net back up.

Because, at the end of the day, your end goal is to slowly and gradually not need to have therapy at all. IRL or digital.”

*Name has been changed

Images: Getty, Unsplash

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