February 8, 2024

Is online ‘chat’ therapy as good as face to face?

In the current climate it seems logical that, just like everything else talking therapy should become digitalised. Whilst I’m not usually one to stand against change, it is important to make sure that with this change comes evidence of efficacy, especially when it comes to something like our mental health. Is free text-based psychological therapy really the best solution to our hectic schedules, or is it more effective to dedicate some time and money to receiving face to face or video conferencing based therapy?

There are many reasons why we may choose chat talking therapy over attending a clinic appointment or schedule a video call with a therapist.

- It seems more convenient: The moment a thought pops into your head, you can send a message to your therapist and then get on with your day.

- You can avoid showing your face: For some people, they may feel more comfortable opening up when they retain an element of anonymity.

- Talking therapy using chat can be more affordable:  Attending sessions with a therapist in a clinic or through video conferencing can be more expensive.

- There is evidence for its effectiveness: For less complex issues such as mild insomnia automated dCBT (digital Cognitive Behavioural Therapy) shows positive results for improving your sleep (Espie et al., 2012).

So engaging in therapy via chat appears attractive. However, it is also important to consider the following when making choices about your care and treatment:

  1. One key factor contributing to the efficacy of therapy is therapeutic alliance, which is the reciprocal bond you form with your therapist through the work you do together. Evidence suggests that higher ratings of this alliance are predictive of treatment outcomes (Horvath, Del Re, Flückiger, & Symonds, 2011).  In other words, the better the bond, the more likely you are to experience improvements through therapy. We need to ask ourselves, can we truly form a working bond with our therapist if we never experience the rapport of back and forth, face to face conversation. It may be more likely if your therapist responds to your message quite quickly, but waiting hours between messages could leave the relationship feeling disjointed. The current landscape for the effectiveness of online therapeutic alliance requires further research in order for us to determine its effects on therapeutic outcomes (Sucala et al., 2012).
  2. The smaller cost or sometimes the complementary offer of chat therapy can definitely be appealing. However, it is important to tread carefully - whilst some of this reduced cost is due to lower overheads, some of it may be due to its limited effectiveness or the need to have more or longer sessions in order for it to be as effective as traditional therapy. On average, research has shown that a session of chat therapy can take up to thirty minutes longer than a face to face session (King, Bambling, Reid & Thomas, 2006), and participants may need more than double the number of sessions (Ruwaard et al., 2007). Make sure to read any terms and conditions carefully.
  3. Reviews of the efficacy of text-based therapy in comparison to face to face therapy for more complex mental health difficulties currently remains inconclusive. There is still much we don’t know about the effectiveness of this kind of therapy. Having said that, the current available research demonstrates an emerging trend of effectiveness in using text-based therapy to treat common mental health problems such as reducing anxiety or improving low mood. However, when you dig a little deeper it becomes clear there are a lack of research trials measuring the outcomes of text-based therapy alone in comparison to it’s verbal equivalent. For example, the success of chat therapy is generally measured in instances such as e-CBT versus a waitlist condition in which the participant receives no treatment at all (Hoermann, McCabe, Milne & Calvo, 2017). This same review also suggests there is some evidence which goes as far as to say that text-based therapy remains inferior to traditional forms of treatment. It should be noted that a proportion of this positive research is lacking in neutrality; research is being carried out by those who are invested in the software itself. See the following paper conducted by TalkSpace

It is therefore safe to say that at this present time, the recommendation remains for psychological therapy to be delivered verbally either face to face, via video conferencing or over the phone (Carroll & Rounsaville, 2010).

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