Due to the current global pandemic, every counsellor and psychologist around has suddenly switched to offering their services by video sessions only (or phone, in some cases). We are all thankful that mental health support can continue to be provided at all during this challenging time, especially when the need for psychological counselling will inevitably only increase as the public health crisis progresses.
Naturally, many people are wondering, is video counselling:
a) Just as effective as in-person sessions?
B) Almost as effective?
C) Not effective at all?
D) Even more effective?
E) It’s all we've got, so let’s do it regardless of the actual answer.
Jokes aside, of course we want to KNOW what the research says!
My feeling, before researching for this article, was that in-person sessions are better, and that video sessions are okay, but not preferable — just a decent second best that will do in a pinch (like in a pandemic). They’ll do in this crisis situation, but we will get back to in-person ASAP. But that was just a feeling — and a feeling about something is not a fact.
(I also FEEL that getting needles are bad, but I will welcome even a big, fat, painful one when the Coronavirus vaccine is ready!)
Knowing that I can’t trust my hunch, I was keen to know what scholarly research tells us — is my feeling correct? What do we know about the effectiveness of video counselling (often referred to as ‘Teletherapy' in the research) when compared with in-person sessions?
Here are a few references I dug up that report on the effectiveness of video sessions:
Novotney writes,
A 2008 meta-analysis of 92 studies found that the differences between Internet-based therapy and face-to-face were not statistically significant (Novotney as cited in Journal of Technology in Human Services, Vol. 26, No. 2). Similarly, a 2009 review of 148 peer-reviewed publications examining the use of videoconferencing to deliver patient interventions showed high patient satisfaction, moderate to high clinician satisfaction and positive clinical outcomes (Novotney as cited in Clinical Psychology: Science and Practice, Vol. 16, No. 3).
Novotney reports that:
a 2010 study in the Journal of Clinical Psychiatry (Novotney as cited in Vol. 71, No. 7) found that videoconferencing can be successful in treating post-traumatic stress disorder. In that study, researchers compared the effectiveness of 12 sessions of anger management therapy delivered via video to in-person delivery of the same treatment to 125 rural combat veterans with PTSD. The researchers found that the video-based anger management therapy was just as effective as the face-to-face care.
Wagner, et al found that:
Effects of online psychotherapy outlasted face-to-face counseling: A University of Zurich study divided a group of 62 patients in half and found that depression was eased in 53% of those given online therapy, compared to 50% who had in-person counseling. Three months after completing the study, 57% of online patients showed no signs of depression compared to 42% percent with conventional therapy. (Journal of Affective Disorders, 2013)
Urness, et al report that:
Online therapy found beneficial in treating mental health problems: ...researchers...have shown online treatments are just as effective as face-to-face therapies for a wide range of common mental disorders. Anxiety, social phobias and depression are all conditions that respond well to clinician-supported internet-based treatments, the researchers found, with program participants recording recovery rates comparable to those in face-to-face therapy.
...Telepsychiatry clients demonstrated significant improvements.
Both telepsychiatry clients and traditional face-to-face psychiatry clients were satisfied with their experience of mental health care service provision, and mental health improvements were evident in the telepsychiatry patients.
(University of New South Wales | 2009)
Thompson (2016) writes in his paper Psychology at a Distance: Examining the Efficacy of Online Therapy,
teletherapy appears to produce therapeutic changes in a client in a similar manner to traditional therapy. This occurs in spite of the obvious differences in the medium of transmission and communication (i.e. speaking directly to a person in the same room versus digitally facilitated communication over a distance). Obviously, these studies have some limitations given the small sample sizes and the prevalence of convenience sampling. The evidence provided, however, strongly points in the direction of seeing online therapy as roughly equivalent to FTF (p. 18).
Thompson (2016) writes that "findings appear to suggest that online therapy is clinically efficacious and is roughly equivalent to traditional therapy." (p. 16)
Cohen and Kerr,
determined that there were no functional differences between between the FTF and CM group; both groups had the same decrease in anxiety symptoms. The authors also noted both groups gave similar session evaluations. These findings present a clear case for viewing online therapy as substantially similar to traditional therapeutic routes. (as cited in Thompson, 2016, p. 16)
Cohen and Kerr,
conclude that the ability for either modality to bring about therapeutic change is supported, and both modalities appear equally efficacious. In the criteria of client satisfaction, both modalities were scored quite similarly.” (as cited in Thompson, 2016, p. 17)
Palus writes,
video-based teletherapy has been fairly well-tested. One trial that ran from 2006 to 2010 involving nearly 100,000 patients receiving care from the U.S. Department of Veterans Affairs found that those who used video versus traditional services actually saw a decreased need for hospitalization. The researchers theorized this might be because care to keep them from reaching a breaking point was so accessible.(Palus, 2019, web article)
As you can see from these examples, video sessions have been shown to be just as effective as in-person sessions. I am relieved to have my hunch that counselling sessions by video are just a decent second best disproven.
(Interestingly, text-based therapy does not fair as well, here is an article exploring it.)
But I still prefer in-person sessions. (Why is fodder for a different article.)
And you may prefer in-person sessions as well! But we can now rest easy knowing that video counselling allows you to do the work of therapy just as well.
I can see how this makes sense — because, in reality, the work is YOUR’S to do.
While a lot happens in each session, most of the work is done out in the world while you are experimenting with and practicing the things we talk about in session. The goal is not to be good at therapy, the goal is to feel and be better at life!
Therapy is a place to learn about yourself and take what you learn out into the world and change your experience.
The therapy work in session is intended to be a place where you can have a new experience and learn about yourself with the collaboration of a skilled therapist and in a protected relationship where the intention is to help you see yourself more clearly and support you in taking different, more supportive actions in your life.
“Therapy is a place to learn about yourself and take what you learn out into the world and change your experience. ”
I want to end with noting a few more positive aspects of video counselling that I have noticed during the past few weeks of holding only video sessions and from my research:
People often seem more relaxed when they are in their own homes.
No one arrives rushed, stressed, or out of breath from hurrying to an appointment time and location.
Everyone always starts on time because transit and parking troubles are just not a thing anymore.
Location is not an issue: someone from the Fraser Valley or remote BC can see me just as easily as someone from Downtown Vancouver — so counselling is more accessible. This can be very helpful for queer or gender variant folks who are looking for a progressive, non-pathologizing counsellor familiar with these struggle queer and gender variant clients face and have not found such counsellors in more remote areas.
Some people stuck at home have extra time and energy to focus on progressing their inner work of discovering patterns that are holding them back.
The public health crisis can highlight some of our most prominent struggles, therefore provide plenty of opportunities to practice new approaches (granted, this may not FEEL like a positive, but we learn by grappling with hard things!)
Sessions may be easier to fit into one’s schedule, therefore more convenient.
With all this in mind, now might be a great time for you to reach out and get started or continue with your counselling work. You might find yourself ready to do the work because you have more time and fewer distractions. OR you might find you need to reach out because you are under significant additional stress and pain because of the public health crisis, such as traumatized healthcare workers, people with ill family members, people struggling with intense loneliness due to isolation, corona related worry, fear and anxiety, job loss, and so many more reasons we all may be feeling worse right now.
Counselling support can help you through these hard times. You do not have to go through this public health crisis alone.
Feel free to reach out to set up a video session!
(Bonus: I do not have a waiting list right now — act soon before I fill up again.)
Warmly,
Laurel
Mindsight Counselling and Wellness