The practice in clinical psychology has always been sustained as a relationship established between a professional and a person seeking help due to an emotional difficulty that disrupts their life’s balance. The psychologist is a person who has a reference framework on health and uses techniques that allow them to intervene in the problems of those who come to therapy (Coderch, 2005).
Most interventions in clinical psychology were designed to be implemented in face-to-face encounters between a psychologist and a patient, and are based on verbal exchange. The encounters are governed by a set of rules (cost, frequency, and duration of sessions) and work objectives are set according to the intervention modality and the designation of roles for each of the process’s protagonists. This framework has been altered by the impact of new Information and Communication Technologies (ICT) in clinical psychology and the birth of E-therapy, or the use of text messages, emails, and other written means to conduct therapy.
The use of the Internet in psychology, initially, is applied in situations where traditional interventions are not possible, due to distance or stigmatization. But increasingly, lack of time or the instantaneity it offers become the most significant reasons to implement it. In recent years, the community of psychology professionals has found itself needing to reformulate pre-established theories and paradigms. Now, the Internet allows distance and presence not to be understood as antonyms. Lévy states that virtualization modifies experience and deterritorializes it, separating “the here and now” and making the physical location of an encounter no longer important. The encounter between patient and therapist becomes a simple communicative exchange, stripped of physical and tangible characteristics: a new way of providing therapy is born.
Advantages and limitations of e-therapy
Online psychotherapy has advantages over traditional therapy, such as increased frequency of therapeutic sessions, as it allows easier contact with the therapist (using WhatsApp, for example). And it is an option for users who otherwise could not receive therapeutic interventions, whether due to economic, geographical, physical, or psychological limitations, such as in cases of major depression, severe schizophrenia, or phobias, among others. An online psychological intervention is better than the absence of treatment (Carlino, 2010; Kraus, Zach, & Stricker, 2004; Proudfoot, 2004).
The therapist’s invisibility can also be an advantage, offering greater confidentiality and self-disclosure. Some authors (Copeland & Martin, 2004 as cited in Elliot et al., 2008; Elliot et al., 2008; Proudfoot, 2004) argue that they even allow greater openness and honesty from clients: the patient may feel less ashamed by not being exposed face-to-face with the psychotherapist, show greater adherence to therapy, and increase their perception of self-efficacy.
It also facilitates a more exhaustive analysis of the verbal component, highly valued in cognitive orientation.
As limitations, e-therapy causes important aspects of non-verbal communication, which are also a source of information for the therapist, to be lost, and their absence does not allow for a clear evaluation of the quality of the therapeutic relationship. Also, it obliges both participants to have an Internet connection and technological devices, which represent an additional cost to the therapy itself.
Recent studies show that there are various e-therapy applications that achieve results similar to traditional treatments, such as remote cognitive rehabilitation, treatments for panic disorders, depression, or suicide prevention. But there is still a long way to go.
More and more psychotherapists offer e-therapy. There are not many manuals or guides for implementing therapy through these systems, and few training programs include the application of ICT in psychological treatment. The need exists, but knowledge is being created day by day. ISEP, a pioneer in the specialization of psychology professionals with over 30 years of experience, includes in its Master in Third Generation Therapies and Application of New Technologies specific content to promote interest and an approach towards ICT and its possibilities in clinical psychology. It aims for professionals to understand and evaluate current technological applications directed at psychological treatment through e-therapy, tele-assistance, virtual reality, augmented reality, and mobile devices.