1. Online Therapy: Where We Are and Where We Need To Go
Priscilla Zoma, M.A., Melanie Ho, M.A., Dustin K. Shepler, Ph.D., & Jessica Dluzynski, M.A.
Michigan School of Professional Psychology
Correspondence should be addressed to: Dustin K. Shepler, Michigan School of Professional Psychology, 26811 Orchard Lake Road, Farmington Hills, MI 48334 (dshepler@mispp.edu)
 Therapists interested in online therapy should familiarize
themselves with APA ‘s 2013 Guidelines for the Practice
of Telepsychology.
 Clinicians should conduct a risk assessment prior to the
expansion of practice to include online therapy with
consideration for all necessary provisions (Maheu et al.,
2012). Steps in this process should include an
exploration of individual state licensing requirements
regarding use of online therapy. Doing so will prevent
any unintentional regulatory infractions (Glueckauf et al.,
2003).
 Steps to become competent in applying online
therapeutic services in practice:
1. Have appropriate technology and the ability to
employ these technologies for online services
(Elleven & Allen, 2004). Therapists should be
technologically well informed (Gale & McKee, 2002).
2. Prior to implementation, considerations should be
made regarding the targeted population and factors
associated with use, including insurance coverage
and ability to navigate software (Nelson & Velasquez,
2011). In addition, parameters need to be set for
session frequency, length, attendance expectations,
and ramifications for missed sessions (Glueckauf et
al., 2003).
3. Obtain informed consent regarding online therapy
from the client (Barnett & Sheetz, 2003).
4. Ensure client confidentiality through ACA, ISMHO, or
NBCC (Elleven & Allen, 2004).
5. Create an online account and familiarize oneself with
the modality that will be used for the online therapy
sessions.
6. Provide adequate training to clients on how to use
these online services
7. Attend to cultural, ethnic, language, and other
differences that may impact the ability to effectively
communicate with and treat clients (Barnett & Sheetz,
2003).
 Though client perceptions of effectiveness of online
relationships do not differ significantly from face-to-face
interactions (Bickel et al., 2008), therapists should
explore differences in the development of such
relationships with attention to various contributing factors
associated with online work (Colbow, 2013).
Findings from the LiteratureAbstract & Purpose Recommendations
 This presentation reviews the effectiveness of online therapy.
Ethical considerations related to conducting therapy online
have been discussed in the literature (e.g., Corey, Corey, &
Callanan, 2011) and are beyond the scope of this
presentation.
 Advances in technology have
increased ease in
communication
between clients and therapists
between sessions, as well as
offered an additional modality
in which therapy may be
conducted.
 Previous research has
reported a positive correlation
between acceptance of online
therapy and familiarity with the technology (Alleman, 2002).
 Relevant literature regarding both the process and
effectiveness of online therapy are reviewed; key findings are
highlighted. For example:
 Individuals may reveal personal information more readily
in online therapy than in traditional therapy. Cook and
Doyle (2002) attributed the phenomenon of quickly
revealing personal information to disinhibition from the
anonymity offered by online interaction.
 Simpson, Bell, Knox and Mitchell (2001) and Simpson,
Deans, and Brebner (2005) reported significant client
benefit from online therapy. In particular, previous
research indicated client gains through online therapy in
the treatment of eating disorders, depression, and anxiety.
These studies utilized not only video conferencing, but
also the use of instant messaging and email.
 A psychotherapist, regardless of theoretical orientation, can
move from the traditional face-to-face setting to an
environment based on Internet tools. In e-therapy, the focus
of the treatment does not shift to technology, but remains on
the traditional process of psychotherapy. The traditional
setting could move into a virtual environment without affecting
the basic principles and phases of treatment (Castelnuovo et
al., 2003).
 Clinicians attending this presentation will become familiar
with the current findings regarding therapeutic effectiveness
of online therapy. Those considering expanding their practice
to include online therapy and those interested in including
online therapy research in evidence-based therapy classes
may be particularly interested in this presentation.
Benefits to Clients
 Current research suggests that telepsychology offers
effective means of delivering CBT, consultation, and
continuing education services for disorders such as adult
anxiety, depression, insomnia, pediatric recurrent pain and
anxiety, oppositional defiant disorder, and attention
deficit/hyperactivity disorder (Dyck & Hardy, 2013).
 The efficacy and effectiveness of online therapy groups is
supported in studies of eating disorders and depression
(Castelnuovo et al., 2003).
 Bickel et al. (2008) found that computerized behavior
therapy produced comparable results to therapist
interventions for clients with opioid dependence.
 Fitt and Rees (2012), indicated that “videoconferencing
can be a highly effective and acceptable means of
delivering psychotherapy” (p. 227). All participants in this
study stated that videoconferencing helped them to stay
focused between sessions (e. g., seeing therapist's face
on the screen served as a memory aid between sessions)
and they felt less intimidated than in face-to-face sessions.
 Internet-related technologies have significantly and
positively affected the outcomes of treatments
(Castelnuovo, et al., 2003).
 Morgan et al. (2008) reported no significant differences
between telehealth and face-to-face delivery modalities for
perceptions of the therapeutic relationship, post-session
mood, or general satisfaction with services were found (p.
161).
 The therapeutic alliance appears comparable in online
versus face-to-face services (Dyck & Hardy, 2013).
 The social stigma regarding attending therapy can be
lessened for many individuals with the use of online
treatment.
 Clients will benefit from online therapy with the ability to
contact their therapist at any distance, at any time, at their
convenience, and from their home. In this way, the
traditional office-bound, prescheduled, face-to-face,
therapist-client appointment has become irrelevant (Barak
et al., 2009).
 Online therapy has proven to be a viable option that allows
access to multicultural counselors and gives clients more
therapeutic options.
 Schopp et al. (2000) and Bickel et al. (2008) found that
telehealth services are significantly lower in cost than in-
person services. This is important when serving
populations that are lower in SES.
 Many clients trying to seek psychological services are
unable to travel great distances or afford the costs incurred
with travel (Backhaus, et al., 2012).
 Online therapy provides clients with synchronous
communication. This involves clients and therapists sitting
at their computers at the same time and interacting with
each other in the moment. The client and therapist
interaction occurs simultaneously just as in normal face-to-
face sessions (Roseth, Saltarelli, & Glass, 2011).
 Online counseling affords various distinct advantages,
such as convenience and the ability to overcome existing
psychological and physical barriers that individuals can
face in assessing counseling services (Richards, 2012).
Effectiveness of Online Therapy
In 2010, Monitor on Psychology reported that a study by APA found that:
“Psychologists are increasingly using the telephone and e-mail to provide
services including psychotherapy, counseling, consulting and supervision.
Overall e-mail use more than tripled among practicing psychologists between
2000 and 2008, with approximately 10 percent of providers using it weekly or
more in 2008.
Practitioners’use of videoconferencing, while still rare, increased from 2 percent
to 10 percent during that same time period. Internet chat room use remained
unchanged, with less than 1 percent of respondents taking advantage of that
medium.” (Quote and Figure from:
http://www.apa.org/monitor/2010/03/telepsychology.aspx)