Arlene Unger, Ph.D.


This week, Breakthrough provider and author, Arlene Unger, shares Part 1 of her series on internet counseling in the new millennium. This week she helps us understand the recent studies on the effectiveness of video counseling and also clarifies who is a great candidate for online therapy.

Web, internet, cyber, or online therapy is rapidly catching up to face-to-face (F2F) sessions in popularity and utility. A recent University of Zurich study showed that an internet-based Cognitive Behavioral Therapy (CBT) model using written tasks was about equal to F2F therapy when both sets of patients went through a series of eight sessions; both were around 50% effective and the online therapy group actually had slightly higher satisfaction ratings. Each therapy reduced the effects of depression, but over the long haul subjects were found to fare about 15% better with online therapy.

At the end of the treatment, no more depression could be diagnosed in 53 percent of the patients who underwent Online-therapy—compared to 50 percent for face-to-face therapy.” Perhaps what’s more interesting though is what happened after the sessions. Three months later, depression continued to decline in individuals of both groups, but 15 percent more of the Cyber-therapy group saw improvement.Source

Online therapy is not without its problems. It’s easy to misinterpret a sentence during chat or email sessions. Also, during “real time” video conferencing sessions, facial expressions may not be easy to “read” because the computer may mask a certain degree of facial/body cues, vocal intonation and timing.

Online sessions can be a technological challenge, at first, for novices – both computer and online therapy novices.

An additional problem is proper pre-screening and authentication of the identity of the “client” by the online platform provider. And, then there is the matter of The Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy..

Since I began using online therapy in 2001 I have witnessed how email therapy has replaced the telephone, chat has replaced email, video chat has replaced chat and, now, virtual worlds are replacing video chat. So, today, as long as you have a computer, microphone, ear buds, and a webcam you have what you need for an interactive therapy session (i.e., equipment embedded in most smart phones).

However, not all software systems are safe to use. For example, Skype is neither HIPAA compliant nor completely secure, nor is regular email, so it’s best to find a service that has its own secure video conferencing technology like Breakthrough Behavioral Breakthrough’s technology is easy to use. I tell all my prospective Breakthrough clients that I can guide them through the registration and scheduling processes, and the website has its own method for testing the adequacy of computer equipment.

I have been doing online therapy/counseling/coaching for 12 years, and F2F therapy/counseling/coaching for 28 years. I have found that both are effective for different situations.

Online therapy is great with time limited concerns like trauma, depression, stress, anger, parenting, relationship issues and grief. Also, most of my online clients either have limited physical access or a lack of time. They are: serving in the military, shift workers, busy executives, stay-at-home moms, work-from-home employees, disabled individuals, or single parents, and so forth.

A great advantage for online therapy is that the client can be wherever it is convenient, and still be connected to a licensed behavioral health expert (licensed in their state of domicile). The therapist has the advantage of observing the client in the client’s comfortable and familiar surroundings, rather than in an impersonal office. The client may also have a written record of chat/email sessions to refer back to.

On the other hand, if clients have been diagnosed with serious mental issues like schizophrenia, major depression, or anorexia, they’re much more likely to benefit from traditional F2F counseling. This is especially true if they are in crisis or feeling suicidal. Meeting with a counselor in person, or going to the nearest emergency department would be the most appropriate choice.

Lastly, if the client doesn’t have privacy in their home/office, or can’t open up and be honest with an online therapist, meeting a therapist in person would be the best therapeutic option.

The use of online therapy has proliferated in recent years, and due it it’s clinical efficacy, is clearly here to stay.

My next blog will focus on the therapeutic techniques that I have found most amenable to online therapy.

Dr. Unger, a licensed psychologist, has a busy private clinical practice in Dana Point, CA.  Arlene offers clients F2F and internet counseling/coaching. She lives with her spouse, Stefan Unger, Ph.D., Photographer/Web Designer of 34 years. They are blessed with 2 successful adult children and 2 grandchildren.  Arlene believes that no one gets through life unscathed and everyone from time to time needs a counselor/coach to help move toward positive change. Using a combination of neuroscience, mindfulness and CBT, Arlene has helped people with depressive, anxiety, anger, addiction, eating, pain, personal trauma and relationship issues. She is completing her second book on Mindfulness. Her first book is “Presence of Mind – Mindful Affirmations.”  Check out the scores of articles Arlene has authored listed on the Resources page on her website