Mental Health and E-Therapy

Mental health encompasses emotional well-being, effective coping mechanisms, and the ability to build constructive relationships. When individuals face mental health challenges, many seek help through psychotherapy, traditionally delivered in clinical settings. However, the rise of information technology has led to the emergence of e-therapy, a form of online psychotherapy conducted via messaging, chat rooms, or emails. This approach provides several advantages, such as increased privacy, convenience, and accessibility, particularly for individuals in remote areas or those hesitant to seek in-person therapy.

Despite its growing popularity, the efficacy of e-therapy requires further investigation. Research has indicated that e-therapy can be beneficial for various mental health issues, including panic disorders and complicated grief, but studies still seek to identify which clients benefit most and under what circumstances. The absence of nonverbal cues in online communication poses challenges for therapists, as it may hinder accurate diagnosis and therapy. Overall, while e-therapy represents a promising adaptation to modern communication preferences, its effectiveness and the optimal conditions for its use remain subjects for ongoing research.

Published in: 2021

By: Wienclaw, Ruth A.

Subject Terms

Mental Health and E-Therapy

Abstract

Good mental health is the condition comprising emotional well-being, good behavioral adjustment, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life. When experiencing undue stress or other problems with their mental health, many individuals turn to psychotherapy for help. Although psychotherapy has traditionally been conducted in a clinical setting, today's information technology allows therapists to use the Internet in e-therapy, psychotherapy that is conducted over the Internet rather than in face-to-face sessions. E-therapy may be conducted using real-time messaging, chat rooms, or e-mail messages. Given the fact that many people find information and communicate through the Internet, e-therapy has become increasingly popular. However, much more research is needed to determine the efficacy of this type of therapy, the situations under which it works best, and the types of clients for whom it is best suited.

Overview

When meeting a stranger at a party, I rarely reveal the fact that I am a psychologist. Too many times the conversation has quickly turned from the purely social to an attempt at a free diagnosis of self, friends, or family. I suppose this is just one of the hazards of the profession, as is the tendency to psychoanalyze things that do not require psychoanalysis. For example, last evening I was watching my favorite television show, which features a misanthrope well known for his curmudgeonly behavior with others. On more than one occasion I have been drawn into conversations with friends trying to sort out the character's problems as the writers bit by bit give the viewers more insight into his psyche. In the end, of course, I need to step back and remember that he is, after all, just a character on a television show. The writers either got the psychology right or they did not. However, diagnosing a character on a television show does no one any good. This, however, does not keep the other characters on the show from attempting to do so. In the latest episode, the character was listening intently to the current woes of his best friend. Trying to encourage the other man, the character remarked "interesting" at one point in the conversation. The friend took offense. "Why do you say interesting?" he asked. "Because I am interested," the character replied. "But you should have said 'good for you' or something else instead," replied his friend. Frankly, "interesting" was a perfectly reasonable response. However, the character's friend was looking for something else, and took the lack of what he deemed to be an appropriate response to be another example of the character's need for in-depth psychotherapy.

Although on one level, this story is merely about a fictional conversation between two fictional characters, on another level it is a good example of how the expectations of other people determine in part whether or not one is considered "normal" and whether one is considered to be mentally healthy or mentally ill. In another context or with other people, the comment that something was interesting might go unremarked. However, the expectation of the friend was that the character would say something inappropriate. Therefore, he interpreted the character's response as being inappropriate and further evidence of his lack of mental health. In fact, in many ways, mental health and mental illness are little more than social constructs. Through the process of socialization, one is taught to act in a way that is deemed to be acceptable and to act in a manner that is appropriate for the needs of the society.

Psychotherapy. Whether or not mental health and mental illness are social constructs or objective states, we treat them as if they were the latter—that is, with the attitude that the person with mental health issues needs to be treated so that he or she better conforms to the norms and expectations of society in the future. This is often done through psychotherapy, a generic term used to refer to any psychological service provided by a trained professional. Psychotherapy primarily uses communication and interaction to assess, diagnose, and treat the dysfunctional emotional reactions, ways of thinking, and patterns of behavior of an individual, family, or group. From a sociological perspective, this can be viewed as a method of socialization aimed at preserving the stability of society. There are a number of methods of psychotherapy, including the general categories of cognitive behavioral, humanistic, integrative, or psychodynamic. Typically, psychotherapy takes place in the office of a licensed psychotherapist. However, with the increasing advances in information technology today, new approaches are being tried.

Information Technology. In many ways, information technology has transformed our lives over the past few decades. As societies transition from being industrial (using mechanization to produce the economic goods and services within a society) to being postindustrial (primarily based upon the processing and control of information and the provision of services), we frequently find ourselves turning more and more to electronic communications media in general and the Internet in particular to communicate with others. In the workplace, this means a heavy reliance on such things as e-mail and teleconferencing rather than the more traditional written correspondence, faxes, or business travel and meetings. At home, this means such conveniences as the ordering of goods and paying of bills online. However, it is not only correspondence that is carried on over the Internet. One can easily use the knowledge base of a manufacturer to determine how to troubleshoot software or repair an appliance. Even medical sites are available so that one can learn about the possible diagnoses for one's symptoms or research alternative treatments. It is also possible on some sites to chat online with a physician or nurse practitioner by e-mail rather than going into the office. These two features of postindustrial society—greater reliance on non-face-to-face methods of communication and the ability to solve one's problem online rather than in person—have combined in the mental health professions to create a demand for psychological services over the Internet. This approach to psychotherapy has a certain logic to it. People are used to communicating electronically and to receiving their information over the Internet. By extension, chatting with one's therapist online is just the application of these principles in the arena of mental health.

E-Therapy. This distance approach to psychotherapy using the Internet is known as e-therapy or online therapy. This is a form of psychotherapy that is conducted over the Internet rather than in face-to-face sessions. E-therapy may be conducted using real-time messaging, chat rooms, or e-mail messages.

E-therapy has a number of potential advantages including being more convenient than going to a therapist's office as well as being more private than going to an office and waiting in a public waiting room. It is theorized that more people needing psychological help might be willing to receive it over the Internet since they do not have to go into a therapist's office with the risk of being seen by others, fear of embarrassment, or unwillingness or inability to get to the office. The Internet allows the therapy client relative anonymity and, perhaps, engenders a concomitant greater willingness to open up to the therapist for the very reason that he or she does not have to see the therapist's reaction.

E-therapy can also provide a more convenient alternative for getting the help needed to those in rural areas where access to a therapist is exceedingly difficult. In addition, e-therapy tends to be less expensive than in-office therapy, another factor that might increase the likelihood that it will be used by those who need it.

As attractive as e-therapy may sound to overly busy professionals in today's society, it is also not without its drawbacks as well. Despite the fact that many of us in the twenty-first century are used to communicating through e-mail, online chat, or instant messaging, these communication methods have the drawback of not allowing the two parties in communication to receive important cues about what the other person is trying to communicate such as tone of voice, facial expression, and body language. In general, this can lead to potential miscommunication. This risk may be acceptable most of the time for normal communications. However, nonverbal cues are often essential to the task of the psychotherapist and not having these cues can potentially lead to an incorrect diagnosis. In addition, psychotherapists frequently use proprietary clinical assessment instruments to help them diagnose a client. However, many of the tests and instruments used in diagnosis tend to be not only ethically but legally required to be given by a credentialed professional in a controlled situation. This cannot be done over the Internet because there is no control over who will see the test, how long the client takes to answer the questions, or even whether it was the client or someone else who took the test.

Applications

Treating Mental Disorders. The literature shows evidence that e-therapy can be successfully used to treat a number of mental disorders including panic disorder, social phobia, child adjustment after traumatic brain injury, and complicated grief. However, a great deal more research is needed in order to answer questions such as what types of disorders as best suited to the e-therapy approach, what type of clients are most likely to benefit from e-therapy, what methods can be used to successfully overcome the disadvantages to diagnostic and therapeutic progress that result from the inability of the client and therapist being able to see each other. In addition, e-therapy is currently performed using a variety of electronic media. Research is needed to determine the relative efficacy of each approach in various circumstances.

This research has begun. Pier, Austin, Klein, Mitchell, Schattner, Ciechomski, et al. (2008), for example, performed a controlled trial of Internet-based cognitive behavioral therapy (an approach to psychotherapy that emphasizes the correction of distorted thinking patterns and changing one's behaviors accordingly) for panic disorder with both face to face support from a general practitioner and e-mail support from a psychologist. Panic disorder is an anxiety disorder in which an individual experiences sudden, debilitating attacks of intense fear. This is one of the most common anxiety disorders that are seen by general practitioners today. Previous research has indicated that cognitive behavioral therapy is the most effective approach to treating this disorder. However, most general practitioners are not trained in this method. In addition, in the area in which the research was conducted, access to a psychotherapist trained in cognitive behavioral therapy is not always available and often prohibitively expensive. Such a situation is a good example where e-therapy—if effective—could do great good.

Panic Online Research Study. Subjects in the study were 65 individuals with panic disorder who participated in the Panic Online research study. The program included six modules: an introductory module, four learning modules, and a relapse prevention module. The material covered in the program included techniques typically covered in cognitive behavioral therapy (e.g., control breathing, progressive muscle relaxation, cognitive restructuring, and situational exposure). Audio material for the muscle relaxation techniques with downloadable off the Internet and gradual exposure exercises were also available. Thirty-one of the subjects are placed in the Panic Online with psychological assistance group. Each subject in this group was assigned to a treating psychologist who communicated with the subject using e-mail. This e-mail support was intended to allow the therapist to provide support and feedback to the subject as well as to guide the subject through the program based on the individual's needs. Although the psychologists initiated contact with each subject at least weekly, the subjects were allowed to e-mail their therapists as frequently as they desired. The therapists responded to all e-mail from the subjects within a 24-hour period. The remaining 34 participants were put in the Panic Online general practitioner group. Interaction with the general practitioners occurred face-to-face. The general practitioners provided support and feedback to each participant as well as guided him or her through the program according to each individual's needs a request. Subjects and the general practitioners were encouraged to consult each other on a regular basis for the duration of the 12 weeks of the study.

The study showed similar results for those subjects who worked with the online materials with the support of their general practitioner as did those who worked with the online materials with the support of an online psychologist. The researchers interpreted these results to mean that the online tools were a useful adjunct to the support given by general practitioners to clients with panic disorder, making e-therapy a helpful tool for situations in which there is little or no face-to-face access to trained psychotherapists. Both groups of subjects experienced significant improvements in their experience of symptoms include depression, anxiety, stress, and frequency of panic attacks. In addition, both groups experienced significantly increased quality of life. However, although the results of the study are encouraging, they are limited by several methodological considerations. One of the most important of these is the fact that the study included no control group to compare the efficacy of the use of a therapist in an online setting with use of a therapist in a traditional face-to-face setting using the same tools.

Whether or not e-therapy is effective is a moot point, however, if those who need therapy do not trust it enough to participate. Skinner and Latchford performed a study to compare the attitudes to e-therapy of those clients currently using e-therapy, individuals who participate in support groups on the Internet and who are familiar with talking about mental health issues online and individuals who were used to face-to-face psychotherapy but not e-therapy (2006). The factors included in the study were:

The use of computers to facilitate therapy,

The ability to meet for therapy at a convenient time,

The advantage of therapy being conducted anonymously,

The advantage of being invisible during therapy, and

A greater ability to concentrate on the therapy

Subjects included 39 individuals who were face-to-face therapy clients and 130 individuals who participated in Internet support groups. Although the study was originally designed to include a third group comprising e-therapy clients, only three individuals meeting this criterion agreed to participate, so the group was dropped from the study. Results of the study indicated that although clients of face-to-face therapy tended to be more likely to disclose personal information, both groups had similar self-disclosure styles. Members of Internet support groups tended to be more positive about e-therapy than were the subjects who were only used to face-to-face therapy. The study further found that attitudes toward e-therapy were more positive if the individual had experience both with online support groups and with face-to-face therapy.

Conclusion

Although mental health and psychotherapy in many ways is the domain of psychologists, sociologists have an interest in this area as well, particularly from the point of view that the concept of mental health is a social construct and that society socializes its members to behave within acceptable norms and parameters. Further, the concept of e-therapy is of particular interest to sociologists as an artifact of postindustrialization. Given the fact that many of us today live our lives in great part based on the availability of information on the Internet and by communicating through the Internet, e-therapy certainly makes sense. E-therapy is becoming increasingly popular. However, much more research is needed to determine the efficacy of this type of therapy, the situations under which it works best, and the types of clients for whom it is best suited.

Terms & Concepts

Chat Room: A space on a web site or network server that allows multiple people to communicate by entering text messages at their individual computers. The messages are viewable by all in the virtual "room," and messages appear almost instantaneously once they are sent.

Electronic Therapy (E-Therapy): A form of psychotherapy that is conducted over the Internet rather than in face-to-face sessions. E-therapy may be conducted using real-time messaging, chat rooms, or e-mail messages. Internet-based therapy is also called online therapy or Internet-based therapy.

Electronic Mail (E-Mail): A system for sending and receiving messages electronically through personal computers or other computer network. Usually, it takes only a few seconds or minutes for e-mail to be sent from one computer and received at another.

Information Technology: The use of computers, communications networks, and knowledge in the creation, storage, and dispersal of data and information. Information technology comprises a wide range of items and abilities for use in the creation, storage, and distribution of information.

Instant Messaging: A method of electronic communication that allows two or more people to communicate nearly instantaneously without using a chat room. Instant messaging is much like a telephone conversation with text messages conducted using a computer rather than a phone. The sender types a message at his or her computer, which is then sent to and received at the other person's computer. Instant messaging can be used in much the same way as a private chat room.

Mental Disorder: A psychological illness that is characterized by any one or more of the following: abnormal behavior, impaired functioning, or psychological symptoms.

Mental Health: The condition comprising emotional well-being, good behavioral adjustment, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life.

Norms: Standards or patterns of behavior that are accepted as normal within the culture.

Postindustrial: The nature of a society whose economy is no longer dependent on the manufacture of goods (i.e., industrial), but is primarily based upon the processing and control of information and the provision of services.

Psychotherapy: A generic term used to refer to any psychological service provided by a trained professional. Psychotherapy primarily uses communication and interaction to assess, diagnose, and treat the dysfunctional emotional reactions, ways of thinking, and patterns of behavior of an individual, family, or group. Within this broad categorization there a number different types of specific approaches to psychotherapy, most of which fall into one of four general subgroups: cognitive behavioral, humanistic, integrative, or psychodynamic.

Socialization: The process by which individuals learn to differentiate between what the society regards as acceptable versus unacceptable behavior and act in a manner that is appropriate for the needs of the society.

Social Construct: Any phenomenon that is invented (i.e., constructed) by a culture or society. Social constructs exist because the members of a society behave as if it exists rather than because of the availability of criteria that are necessarily obvious to an objective outside observer. Race and ethnicity are both examples of social constructs. (Also referred to as a social construction.)

Society: A distinct group of people who live within the same territory, share a common culture and way of life, and are relatively independent from people outside the group. Society includes systems of social interactions that govern both culture and social organization.

Subject: A participant in a research study or experiment whose responses are observed, recorded, and analyzed.

Bibliography

Morrison, A. (2017). Online therapy: friend or foe for social work? New Social Worker, 24(2), 18–19. Retrieved February 28, 2018, from EBSCO Online Database Sociology Source Ultimate. http://search.ebscohost.com/login.aspx?direct=true&db=sxi&AN=122342315&site=ehost-live&scope=site

Pier, C., Austin, D. W., Klein, B., Mitchell, J., Schattner, P., Chiechomski, L., et al. (2008). A controlled trial of Internet-based cognitive-behavioral therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist. Mental Health in family Medicine, 5 , 29-39. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=33018285&site=ehost-live

Skinner, A. E. G. & Latchford, G. (2006). Attitudes to counseling via the Internet: A comparison between in-person counseling clients and Internet support group users. Counselling and Psychotherapy Research, 6 , 92-97. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=22018334&site=ehost-live

Wienclaw, R. A. (2007). Internet-based therapy. In L. J. Fundukian & J. Wilson (Eds), The Gale Encyclopedia of Mental Health (2nd ed.). Detroit: Thomson/Gale.

Mental Health and E-Therapy

On this Page

Subject Terms

Mental Health and E-Therapy

Abstract

Overview

Applications

Conclusion

Terms & Concepts

Bibliography

Suggested Reading