An overwhelming one in four people in the UK experience a mental health problem each year. With lengthy waiting lists for support on the NHS and costly fees for private healthcare, many sufferers are turning towards treatments which lack the physical presence of a therapist, such as self-help or online therapy. One popular website for online therapy known as Breakthrough is used by over 30,000 people monthly. However, the advantages of getting help from professionals in person are far too valuable for these types of therapies to be considered equally effective alternatives to traditional treatment.
Before online therapy even begins, it is incredibly challenging for a psychologist to accurately diagnose a patient without being in their presence. Psychologists consider verbal and non-verbal interactions essential for gauging how the client is feeling and what they are thinking. Online therapy does not give the psychologist a clear indication of voice tone, facial expression and body language- this can negatively impact the ability to diagnose and treat the client. With self-help therapy, the patients often diagnose themselves, which can have several adverse repercussions. One danger is that they may miss a physical disease that masquerades as a psychiatric syndrome; for example, some brain tumours have side-effects of personality changes or even depression, and can go undetected without professional input. Additionally, sufferers who self-diagnose themselves may miss something that they cannot see. They could be overwhelmed by anxiety and diagnose themselves as having anxiety disorder; however, this experience of anxiety may be just one aspect of an unnoticed major depressive disorder which could have been identified by a psychologist.
With online treatment, there is also the issue of confidentiality and privacy. According to the guidelines from the British Psychology Society, clients can expect that “information they give to psychologists will remain confidential”, though of course only to an established limit- if the psychologist deems their patient to be at risk, they have a duty to disclose necessary information to whomever it may concern. Concealing personal information is a major concern in psychotherapy, but online treatment adds a further layer of complexity; when information is being transmitted virtually, privacy leaks and hacks are more of a concern. Additionally, the client receiving online therapy has little reassurance about the qualification and credentials of their therapist, exposing them to exploitation of inexperienced individuals pretending to be approved counsellors. This makes it even more important to refer people to credible therapeutic services such as those with the NHS.
Medical interventions such as prescriptions and regular monitoring of the drug effects can only occur with the physical assistance of a medical professional. The use of drugs as a form of treatment or as an addition to support such as cognitive-behavioural therapy has been seen to be beneficial to many individuals. In 2009, psychologist Soomro conducted a meta-analysis that investigated the success of selective serotonin reuptake inhibitors (SSRIs), which work by increasing levels of serotonin in the brain, on treating obsessive compulsive disorder in comparison to participants who were only given placebos. In all 17 studies included in the meta-analysis, the SSRIs were significantly more effective than the placebos in treating obsessive compulsive disorder. Methods of therapy such as self-help or online treatment cannot take advantage of medical interventions.
Online or self-help therapy is simply not appropriate for patients suffering from serious psychiatric illnesses that require close and direct treatment. It is also inappropriate for people with more intricate problems- the scope of therapy tends to be limited, so it is rarely effective in more complex situations. Schizophrenia, for example, is a form of psychosis in which contact with reality is impaired; symptoms such as hallucinations and apathy make it very difficult for the patient to drive their own recovery, either through self-help methods or online therapy.
The bond between the client and therapist is considered a vital step in the recovery process; this is lost in self-help or online treatment. At least 30 per cent of positive change in a patient is due to the face-to-face therapeutic relationship, which should revolve around authenticity, empathy, insight and unconditional positive regard. Having a therapist who will accept and support the patient without conditions or judgments is paramount in their relationship and consequently the effectiveness of treatment; it encourages clients to entirely open up, permitting the therapist to understand what is necessary for their recovery.
Another issue with treatment without a therapist present is that it is difficult for anyone to respond quickly when a crisis occurs. Devastatingly, suicide is becoming more and more of a problem; in 2014, 6,581 people took their own lives in the UK and Republic of Ireland. If a patient is experiencing suicidal thoughts, it is impossible for an online therapist to provide direct assistance
Of course, online and self-help therapy can indeed be suitable for those who struggle to access traditional therapy, for example due to mobility, financial or severe mental health issues. However, the most effective means of treatment is through direct contact with a professional, and making this accessible to those who need it should be of the upmost importance to healthcare services. To combat the issue of mental health, it is tremendously important that sufferers engage in the most effective types of therapy, and it is clear that this should generally involve a direct and personal therapeutic relationship. Online and self-help therapies should not be promoted as equal alternatives to traditional treatment.