Online therapy?

[JeyRo]

I know this has been asked before (back in 2007, apparently). Have people's opinions about it shifted in the interim?

I have a personal fantasy about setting up an online storefront at some point in the future and selling at least some professional consultation services online, and definitely having a way for people to pay using online payment systems (e.g., Paypal, maybe Bitcoin).

I'm not so sure about straightforwardly providing chat-based or teleconferencing-based 1:1 psychotherapy, however, although perhaps I could see offering email consultations on specific problems, maybe professionally moderating an online support group, "coaching" services for caregivers (e.g., offering behavior management tips), etc.....

Ethical, risk management, logistical issues abound, but I would think they've become more manageable over the last few years. Opinions?

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[Pragma]

I know this has been asked before (back in 2007, apparently). Have people's opinions about it shifted in the interim?

I have a personal fantasy about setting up an online storefront at some point in the future and selling at least some professional consultation services online, and definitely having a way for people to pay using online payment systems (e.g., Paypal, maybe Bitcoin).

I'm not so sure about straightforwardly providing chat-based or teleconferencing-based 1:1 psychotherapy, however, although perhaps I could see offering email consultations on specific problems, maybe professionally moderating an online support group, "coaching" services for caregivers (e.g., offering behavior management tips), etc.....

Ethical, risk management, logistical issues abound, but I would think they've become more manageable over the last few years. Opinions?

Maybe you can check with the folks over at prettypaddedroom.com and get some advice, lol (if you didn't see, there is a thread about that because it is an online therapy site where the owner went on shark tank recently and did poorly).

I'd say go for it. If it is not being done yet, it will be soon. Best to start the process and streamlining things so that once these things do become more common, you could be a step ahead. The types of consultation you are talking about seem very appropriate for an online format.

 

[graduatingsoon]

here is an article about online therapy: http://www.nytimes.com/2011/09/25/fashion/therapists-are-seeing-patients-online.html?pagewanted=all

By the way, if you do a search for online therapy, there are a million websites dedicated to offering online therapy. Most are shady and do not have qualified practitioners.

 

[fallen625]

I could see it becoming more popular in the future. I know there are research studies being done right now showing promising results (ei: CBT for Bulimia Nervosa)

 

[psych for path]

There is A TON of research out there on this from everything between therapeutic alliance building to efficacy of various treatments...seen a lot in the way of social anxiety etc.

 

[psychRA]

She took a sip of her cocktail. The session began.

This jumped out at me right away, and underscores one of the things that makes me nervous about online therapy. You have no way of knowing what's going on in the patient's physical space. I would never consider meeting with a patient who was currently under the influence, let alone one who was drinking during our session. Granted, a patient who's sitting in my office might be able to fool me by spiking their soda or coffee, and I may not notice. But at least I have some control over/knowledge of what's happening in the environment during the session.

I do think that technology can be used to improve access to mental health services. For example, I'm a VA intern, and I know that patients who are in very rural parts of our VISN can access therapy via telehealth. However, they don't just do this from their living rooms; they go to their local community clinic, where there are staff in place to set up the computer, and to be available in the event of an emergency. I can't provide telehealth as an intern, but in the future, if I'm seeing a patient by computer and they suddenly announce that they're suicidal and walk out of the room, I can contact someone in that clinic immediately, and I have a reasonable sense of the patient's physical location.

 

[Therapist4Chnge]

There have been some good papers and talks at conferences on this topic. Tele-health is really growing, though talk therapy as an offshoot is still really iffy. I'd tread lightly bc most of the ppl doing "online" therapy are fringe. There are multiple ethical, legal, and contractual issues involved (if you have agreements w. insurance companies).

 

[paramour]

This jumped out at me right away, and underscores one of the things that makes me nervous about online therapy. You have no way of knowing what's going on in the patient's physical space. I would never consider meeting with a patient who was currently under the influence, let alone one who was drinking during our session. Granted, a patient who's sitting in my office might be able to fool me by spiking their soda or coffee, and I may not notice. But at least I have some control over/knowledge of what's happening in the environment during the session.

I do think that technology can be used to improve access to mental health services. For example, I'm a VA intern, and I know that patients who are in very rural parts of our VISN can access therapy via telehealth. However, they don't just do this from their living rooms; they go to their local community clinic, where there are staff in place to set up the computer, and to be available in the event of an emergency. I can't provide telehealth as an intern, but in the future, if I'm seeing a patient by computer and they suddenly announce that they're suicidal and walk out of the room, I can contact someone in that clinic immediately, and I have a reasonable sense of the patient's physical location.

We have the same set-up for psychiatric patients at the CMHC where I work. There's one psychiatrist who provides telehealth services, but patients are required to come into the agency to be seen and checked out by the APN prior to the visit (the psychiatrist is off-site). Our local hospital no longer has psych services available and they reportedly have contemplated providing telehealth services in the ED but they've been discussing this for some time and there remains some uncertainty re: logistics.

 

[ResearchGirlie]

I think telehealth has expanded more in other countries such as Australia and the UK. I'd check the research and programs available and see how they are doing. I think it could be an extremely valuable service if done carefully.

 

[G Costanza]

This jumped out at me right away, and underscores one of the things that makes me nervous about online therapy. You have no way of knowing what's going on in the patient's physical space. I would never consider meeting with a patient who was currently under the influence, let alone one who was drinking during our session. Granted, a patient who's sitting in my office might be able to fool me by spiking their soda or coffee, and I may not notice. But at least I have some control over/knowledge of what's happening in the environment during the session.

If you work outpatient sub abuse, it's pretty much impossible to expect that all your clients will be sober all the time in session. It's all grist for the mill as they say.

Would you see a client that is abusing Xanax daily?

 

[psychRA]

If you work outpatient sub abuse, it's pretty much impossible to expect that all your clients will be sober all the time in session. It's all grist for the mill as they say.

Would you see a client that is abusing Xanax daily?

I work in SUD now, and I absolutely expect my patients to be sober in session.

If you are under the influence of a substance in session, you don't have access to the full cognitive resources required for the work that we're doing in therapy. We use a DBT approach - if someone shows up drunk or high, I'll meet with them for a few minutes to do a basic safety check, reschedule the appointment, and I send them on their way. Now, I don't administer a breathalyzer and UA at the start of each session, so obviously, if someone is under the influence and is able to hide it from me, there's nothing I can do about that. Unfortunately, they're only undermining their own progress. If I'm aware that they're drunk/high when they show up to session, though, I'm not going to reinforce that behavior. If someone is outpatient and is unable to abstain for a mere 50 minutes a week, in my opinion, they need a higher level of care.

Taking medications as prescribed is a separate issue. I've treated patients with anxiety, and if their psychiatrist has them on Xanax, I don't think it's within my scope of practice to tell them not to take it, even if I were inclined to do so. However, if this is a patient with SUD concerns, I'm going to want to be in communication with the prescribing doc to be sure that they're aware of this.