Some clinicians, including Dr Greg Mulhauser of The Counseling Resource Center, believe that it could be very frustrating for a client to wait for a counsellor to reply on email, which is asynchronous - i.e. not based in real time. “You could look at it another way,” says Cedric Speyer, Clinical Supervisor of E-Counselling for Canadian EAP provider, Shepell·fgi. “That the delay gives the client valuable time to digest and reflect on what's been said in the emails. They can print the text and refer back to the advice within at their convenience.”
Some traditional practitioners claim that counselling by email lacks a key part of therapeutic relationship by keeping the patient and therapist at a physical distance. The concern is that by not being in the same room as the client, the counsellor might miss some crucial non-verbal cues. As Dr Mulhauser warns, “Without that grin or frown, that raised eyebrow, that softened voice or dead-pan delivery, figuring out which meaning is intended can be a real challenge.”
Mixed Signals
Even for the experienced online practitioner, assessing a student's problem in the first place can be tricky. “It's vitally important to accurately grasp the student's real issue, especially in the case of severely depressed or suicidal individuals,” says Professor Palmer, who recommends an initial webcam session before starting treatment. “The warning signs can be lost in an email, which could have disastrous consequences.”
Online practitioners don't see this as a barrier to treating people effectively. “Why is it so hard to believe that a client cannot be emotionally authentic and a therapist empathic and insightful in text?” asks Cedric Speyer. “Our experience as online clinicians, as well as our personal experience with relationships on the Internet, demonstrates that some individuals are more honest, more uninhibited, and more expressive in writing than face-to-face.”
Mr Speyer and other email counsellors strongly believe that without all of the social assumptions that happen automatically when you meet someone in person - judgements based on appearance and expressions, for example - the client and therapist can get straight to the heart of the issue and connect at a deeper level. “For young female students in particular, it can be reassuring that their physical attributes play no part in the communication.”
Future of E-Therapy
Not surprisingly, the concept of delivering psychological treatment online has already been taken a lot further than email. New ways to conduct therapy over the internet are rapidly emerging - such as instant messaging ('chat-based' therapy), online support groups and videoconferencing - that blend sound, text and visuals in real time. Even the act of blogging is thought to be therapeutic for some, and Sheffield University now incorporates creative writing alongside its other support services.
The world of "cybertherapy", as it is sometimes known, is growing fast. It is already possible to "attend" a counselling session within the virtual environment of Second Life, whereby the client and therapist communicate through their avatars.
Cedric Speyer appreciates the value such internet-based therapies can bring if they attract more people who need help, especially students who are native to this domain. He makes the point, however, that many of these approaches still require the client to stick to an appointment time, “which eliminates the core benefit of email counselling - that it works around you.”
Whether these newer methods survive remains to be seen. Email counselling meanwhile is already firmly established as a permanent adjunct to traditional university support. Many counselling services, often small and overloaded, find that providing email therapy is an economical way to help more students as effectively as face-to-face sessions.
