Online counseling and general online modes of delivering mental health support and general acceptance by the public. In the broadest sense, online counseling “the delivery of therapeutic interventions in cyberspace where the communication between a trained professional counselor and client(s) is facilitated using computer-mediated communication technologies.”
This translates into a range of services including real time chats and video calls, and asynchronous communication through a modality such as e-mail. These online services may be offered as a service in its own right or as an add-on to other services.  Does the space of online counseling merely serve as a replication of familiar models of therapeutic engagement, mediated by technology, or does it represent a revolution in the way we understand the therapeutic process? This article will attempt to address this question.

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Existing or New Approach?

Online Counseling: Revolution or Replication?
In starting to conceptualize online counseling, some have argued that it simply represents a transposition of in-person counseling to a technological setting. This point of view sees online counseling as an extension of existing approaches to therapy and, as such, would hold that no new framework for thinking about this therapeutic approach is required. In contrast, others (Fenichel et al. 2002; Grohol, 1999, 2001, ) view it as an entirely different beast – a novel therapeutic approach to mental health interventions that requires its own conceptual framework. This approach views online counseling not as a second-rate substitute for in-person counseling but rather as a dynamic and versatile resource that can serve as a stand-alone preferred intervention in its own right, or as a useful support to other therapeutic interventions.

A Range of Benefits

Online Counseling: Revolution or Replication?
This way of thinking about online counseling recognizes the opportunities inherent in using multiple modes of communication in working with a client. For instance, a depressed client could benefit from a combined or scaffolded service offering a computer-based program for managing depression, direct asynchronous e-mail communication with other sufferers of depression or expert professionals, access to chat rooms and the possibility of professional counseling.
For conditions such as depression and anxiety, these online interventions offer a multi-modal, pronged approach to treatment. This in turn addresses many aspects of the condition, including social support, psychoeducation and therapeutic intervention often in a more comprehensive and accessible way than face-to-face (once a week) counseling from a private therapist could achieve. In addition, the client has the autonomy to pick and choose the interventions that speak to him/her. As such, he/she can come into the therapeutic process from a more informed and empowered perspective.
The dynamic, fluid and potentially multi modal nature of online interventions makes for a broader, diverse and more flexible approach to mental health interventions. Online interventions are not merely a convenient morphing of face-to-face counseling into a technologically delivered model, but rather offer unique possibilities for more diverse and comprehensive mental health interventions.

Perspective is Key

Online Counseling: Revolution or Replication?
This perspective of online therapy has implications for the conceptualization of and development of training for online therapy. If online therapy is its own separate approach, then therapists should receive training in optimizing this modality and the mechanisms for it. The efficacy of this treatment approach should be more clearly understood, and its conceptualization of what constitutes mental health and the therapeutic relationship should be part of an ongoing conversation. While indeed there have been advances in the knowledge base that underpins online therapeutic interventions, research in this field is still very much in its infancy. As such, the nature and impact of online counseling is still open to debate.
About the Author
Dr. Stacey Leibowitz-Levy is a highly-experienced psychologist with a Master’s Degree in Clinical Psychology and a PhD in the area of stress and its relation to goals and emotion. In addition to her private therapy practice, she currently runs , a mental health resource with self-help guides on stress, anxiety, depression, and many other areas. During her spare time, Stacey enjoys spending time with her husband and children, being outdoors and doing yoga.
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