Mental Health Online: Is Online Therapy a Welcome Change?

Has the shift to online therapy affected the quality of mental health services? 

Updated
Mind It
6 min read
Has the shift to online therapy affected the quality of mental health services? 
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The weekly ritual of driving to my therapist every Tuesday evening has been temporarily halted. Instead, I now find myself opening another tab on the same laptop I have been staring at since 9 in the morning - as the mental health practitioner greets me with a warm, familiar and weary smile on-screen.

The pandemic has shrunk our worlds. Everything we need and want is delivered right at our homes - from groceries and clothes to even doctors’ consultations. But while telemedicine had already been booming, the kind of push it has received due to our collective inability to step out of our houses has been massive. For many healthcare facilities, this shift has come as a blessing. But what has it meant for a particularly intimate field like mental healthcare?

Parallel Pandemic, Surge in Mental Health Services

The fear and uncertainty accompanying the pandemic has led to a heightened sense of acknowledgement of its mental health ramifications. The conversation around psychological wellbeing has never been this diverse and open, a development that has now created space for people to access and demand services that they may have shied away from earlier.

To understand the extent of this shift, FIT reached out to platforms offering medical help online. Vikram Beri, founder of BetterLYF.com, an online platform that aims to support those in need of counselling, said, “Five months into the pandemic, the awareness around mental wellness seems to be growing much faster than it ever has.”

“We have seen a massive spike of about 400% in the number of people reaching out to us.”
Vikram Beri

The same is true across the board. Anmol Arora, CEO, DocVita, a pan-India teleconsultation platform, shared, “This pandemic and the consequent social isolation has collapsed the support system around us. Never have people in the last decade dealt with so much uncertainty with so little support. Online therapy platforms have helped people find the right care, which would've otherwise gone untreated on such a large scale. The focus of therapy has shifted from being a squishy emotional outlet to being a necessary life tool - helping people slow down, reflect, and listen.”

But while it’s true that the circumstances have necessitated the shift to seeking help online, is this trend here to stay? What benefits does it offer?

Online Therapy: The Pros

Mental Health Online: Is Online Therapy a Welcome Change?
(Photo: iStock)

Shama Parkhe, the co-founder of Hank Nunn Institute, a non-profit working with persons with a diagnosis of personality disorders/difficulties, is among the many mental health professionals who have had to adapt to the ‘new normal’ brought about by the pandemic.

A psychotherapist herself, she shares, “Most of us have been compelled to offer sessions on Zoom since April. For me, personally, it has been a huge shift. It wasn’t something I was open to earlier, because I never believed it was possible to make a connection across the screen. But now, things have certainly changed.”

“Over the past few months, we have all found a rhythm. We are now able to connect with our service users as deeply as we did in in-person sessions.” 
Shama Parkhe

When I ask her about the biggest challenge she has faced due to this online shift, she speaks about client confidentiality and safety.

“As a mental health practitioner, one of the first things I need to ensure is the safety and confidentiality of our therapeutic interactions. This is now a challenge because a lot of things are not in my control anymore. Earlier, we had a fixed setting, day, and time where we would meet and talk. I could ensure that there is nobody in the room and there are no disturbances or interruptions. Even the smaller things, like keeping a bottle of water, making specific seating arrangements or managing the temperature in the room were in my control.”

“As things moved online, we had to start talking to our service users about how it is now their responsibility to ensure the consistency of the setting and carve out a space for themselves. In fact, I have noticed an element of personal growth in a lot of my patients because of this. Some of our service users have realised the importance of demanding privacy for themselves and respecting their own personal boundaries. There is also, of course, a downside to this, because not everybody has the luxury of a separate room or a safe space from where they can talk freely.” 
Shama Parkhe

It is, however, undeniable that the availability of these services online has meant an erasure of geographical boundaries and limitations. It has made mental healthcare accessible to people who may not be able to find a reason to step out even otherwise - owing to the stigma that continues to be attached to mental health. “People have been reaching out to us from different parts of the country now, many from towns and cities that do not have therapy services available,” Parkhe says.

Anmol Arora from DocVita adds, “For most people, depression and anxiety are isolating and emotionally exhausting. Online platforms offer direct access to the specialist anywhere with the tap of a finger, removing the barriers to seek care, and making the journey frictionless.”

Online Therapy: The Challenges

Mental Health Online: Is Online Therapy a Welcome Change?
(Photo: iStock)

Apart from getting accustomed to online interactions and ensuring the space and privacy to engage in meaningful conversations, a major challenge this digitalisation has posed is that counsellors can no longer observe the body language of their clients.

“I can only see their faces and sometimes their hands. It is almost like you are only interacting with a part of the person, because I don’t know what else is happening. Are they shaking their legs? Fidgeting? I don’t know how they smell. There is no way to know. We now have to rely a lot more on what we see on the screen, and pay closer attention to the pauses in conversation, and their tone of voice. It wasn’t very different earlier as we would sit diagonally. However, I do miss the physical presence in the room which certainly added to my connection with my patients. I cannot comfort them by placing my hand on their shoulder or offering them water.” 
Shama Parkhe

Technology poses its own issues. Lags, buffering, missing voices and half-heard sentences could interrupt assessments and conversations. Most importantly, it has led to screen fatigue among both mental health practitioners as well as the patients, who anyway all spend their days glued to the laptops.

“The fact that I am on the screen for 10-12 hours, something that hasn’t been a part of my lifestyle before, certainly impacts my capacity to engage with the patients. It definitely has put many of us professionals at a risk of burnout. But here, there is also a silver lining,” says Parkhe.

“They notice how the pandemic is impacting us too. It increases their sense of understanding and empathy - just because we are mental health practitioners, we are not unaffected. It adds to the relational aspect of a therapeutic relationship. It helps them see the therapist as a ‘human’ or a ‘person’, and not someone who has everything sorted. This adds a different layer of intimacy in our relationship.” 
Shama Parkhe

Importantly, individuals with severe mental health issues, such as those who may have suicidal inclinations, would need in-person visits and treatment. But for others, online therapy seems to work well, experts say.

“Despite the challenges, I wouldn’t say the transition to online therapy has impacted the quality of work overall. If you were to ask me this in the first few months, I would have been highly sceptical. But now, I feel we have found some ways to cope with it as we continue to adapt to the changing world around,” Parkhe adds.

A Guide: What You Should Keep In Mind While Looking for a Therapist Online

The transition to seeking mental health online has also meant that people now have an array of apps and platforms available to look for a suitable therapist from the comfort of their homes. However, there still remain some basics that we must ensure before deciding on a professional for ourselves, especially if we have never been to one before.

  • Make sure you opt for verified platforms, organisations or apps.
  • Ideally, websites should have therapists’ profiles listed with credentials. Check the credentials and years of experience of the mental health professionals thoroughly.
  • Confidentiality and privacy are non-negotiable. Be certain that your online interactions are safe and secure, and that proper security protocols are in place by the telehealth provider.
  • Building a rapport with the therapist is extremely important. Look for someone who seems to understand you well.

You can read more about choosing the right expert here.

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