Depressed patients turn to the internet for 'Skypotherapy’

By Jerome Burne

The therapist’s couch has long been a staple of books and movies, a place where unpleasant truths are revealed and neuroses untangled. But, almost unnoticed, the delivery of psychological support is being transformed – by the internet. 

If you need NHS help for common problems such as anxiety or mild depression, you won’t necessarily meet your therapist face-to-face. You could be at home or even by the pool, typing your emotional secrets into a dedicated instant messaging service. You might be following a computer program that takes you step by step through a CBT (cognitive behavioural therapy) programme, or having a digital face-to-face on Skype. 

“The benefits of online therapy are considerable,” says Joanna Bawa, a CBT practitioner with the NHS in Hereford. “Going into the cloud abolishes geography. You can be at home in Brighton and your therapist can be in Bradford.” Timing can be much more flexible, too, she adds. “No more having to miss work, or pay a babysitter, or spend half an hour travelling each way.” 

The anonymity is particularly attractive to men, who, says Bawa, “are more likely to go for therapy if they can confess to feelings of weakness and inadequacy without being recognised”. 

But does internet therapy – or “Skypotherapy”, as it has been termed – work? Surely there is something special about the intimacy of the consulting room? “That’s what many of the more traditional therapists thought,” says Nadine Field, a qualified therapist who set up PsychologyOnline.co.uk several years ago. The company, which now has more than 100 accredited CBT therapists on its books, many of whom work for the NHS, uses an instant messaging system which can be accessed 24 hours a day. 

“We find people become disinhibited much more quickly,” she says. “Messaging is like writing in a diary just for you. The therapist’s comments pop up but you needn’t worry about what they think of you. And patients get a print-out of their conversation which helps them remember and learn from the insights.” 

A controlled trial of 300 depressed patients published in The Lancet in 2009 found that CBT via instant messaging helped more of them get better than standard GP care; while a small study from Zurich, published last year, showed the benefits of online treatment for depressed patients may last longer than face-to-face time. 

The delivery system closest to traditional therapy is Skype, which offers internet flexibility and the added visual element. The main provider of one-to-one consultations over the internet is mootu.com, with 160 therapists, who according to the website, all belong to professional organisations such as BACP (the British Association for Counselling and Psychotherapy). It’s a bit like a dating site, in that you can watch a short video of each therapist describing their approach before you commit. As John Witney, the site’s founder, says: “This gives you the best chance of finding one that feels right for you.” 

If you’re considering private e-therapy, it’s important to check a site’s credentials and also to ensure your privacy is protected. 

Researchers at the University of Berne reported that a comparison of seven therapies, including psychodynamic therapy (which focuses on unconscious thought processes) and social skills training were found to be equally effective whether delivered via the internet or face-to-face. 

When it comes to therapy, it seems, the medium isn’t the message. 

psychologyonline.co.uk