Online Couples Therapy: Does It Work?
Orange County Christian Counseling
Online couples therapy is a type of mental health counseling that treats couples who are having problems in their relationships. Issues can range from communication breakdowns, psychological disorders, disagreements about the division of household chores, child rearing and discipline, tension over financial problems, infidelity, and much more.
The objective of couple’s therapy is to address the reasons why the couple is struggling and to come up with a plan to restore harmony and build a strong and lasting relationship.
A therapist who works with couples can choose from a number of treatment models based on different schools of thought. Most therapists combine two of three types of treatment that they have found to be most effective in their practice.
Here are some of the more common therapy models that your counselor may use with you and your partner:
- Traditional behavioral therapy starts with interviews, observation, and assessment of the problem(s), followed by some form of remediation, followed by more observation to determine if the treatment is working.
- Psychoanalytic therapy explores past experiences, often forgotten or repressed (especially from childhood) and helps couples understand how unconscious thought patterns can affect their present relationship.
- Emotionally focused therapy focuses on how couples can build trust that leads a more secure bond. The therapist will observe the dynamics of the couple’s relationship and help them understand and express emotions and vulnerabilities.
- Integrative behavior therapy integrates the goals of acceptance and change. Couples work to change behaviors to accommodate their partner while simultaneously learning to accept and love their partner for who they are.
- Cognitive behavior therapy helps solve relationship problems by changing negative thinking and behavior patterns. The couple will learn how their thoughts and attitudes affect their behaviors, and how they can relate more positively.
As you can observe, the main difference in the models of therapy is the ultimate goal and what is done to achieve that goal. Several theories focus on changing thinking and behaviors to help the couple, while others focus more on developing trust, empathy, and acceptance to strengthen the relationship. The appropriate therapy relates to the specific problems the couple has, as well as how much they trust each other.
How does online couples therapy work?
Online counseling is usually delivered via some means of online video conferencing, using a laptop, iPhone, or iPad and an app similar to Skype or Facetime. Most online counselors prefer one of the online counseling platforms that are HIPAA compliant.
Couple’s online or “e-therapy” is a relatively new model of delivering counseling that is gradually gaining acceptance and popularity. Up until several years ago, it was illegal in some states because of concern that it would not be as effective as counseling in a clinical setting.
Another issue was that counselors must be licensed in the states they live in, and should only be providing services in the state in which they are licensed, but online counseling often takes them across state lines.
In the last few years, laws and licensing boards have been slowly changing, and more individuals and couples have access to online counseling. Some couples prefer this model of delivering therapy because they can do it from home, where they feel more comfortable and don’t need to pay a babysitter. The therapist doesn’t need to be in the same area, and the fees are lower.
However, there are downsides to online therapy. When conducting therapy in an office setting, the counselor looks for body language and subtle cues, such as eye contact, facial expression, voice nuance – which sometimes communicate more than what is being said. Unlike a clinical setting, where the couple would focus on the therapist and each other, in the home setting there can be a variety of distractions.
Distractions can include children in the home, perhaps even in the same room, and occasionally needing attention. Also, the rest of the family can usually hear what the couple and the counselor are talking about, so there’s not enough privacy. Because they’re in their own home, a couple might get into an argument, forgetting that they’re online with the therapist.
If online counseling is to be effective for the couple, they need to believe and demonstrate that they’re actually in therapy. They need to find an appropriate room with enough privacy from the rest of the family, and a caregiver for young children. They need to give their full focus to the therapist and what is taking place in the counseling session, just as they would if they were sitting in an office.
Online counseling can have good outcomes in some situations, but be inappropriate for others. It can be especially helpful for patients with disorders that make it stressful to be in public places – such as anxiety, panic attacks, PTSD, and depression. However, online therapy is inappropriate and unproductive for couples or individuals in a crisis – such as suicidal ideations or rage attacks or abusive situations.
One common reason couples seek counseling is that a partner has been unfaithful. Extramarital affairs are unfortunately all too common – affecting 20-40% of married couples and leading to a high divorce rate, as well as feelings of betrayal, hurt, shame and conflict. Discussing bruised emotions and sexual matters online, where privacy may be lacking, can be awkward.
Although online counseling has difficulties, it’s possible to have productive therapy sessions if the right dynamics are in place, including enough privacy for the couple, minimal distractions, and trust and rapport with the counselor, even though they are meeting in cyberspace, and not face to face. The couple needs a level of commitment, and the counselor needs patience and skill for the challenges of online counseling.
Online Therapy Programs
Several factors need to be considered when choosing a platform for online counseling: promote effective sessions, protect privacy, and meet licensing and insurance standards:
- Web site rebuffering and stability can cause problems with clearly hearing what is being said as well as trying to catch non-verbal cues
- The platform should be HIPAA compliant to protect sensitive client data.
- The video therapy program should be encrypted, so it’s not susceptible to hacking by third parties.
- Will video sessions be recorded? Will anything from the session be stored on your computer or in the cloud?
- The app should be affordable for the clients and easy to sign up for and use.
- The app should be able to download to a variety of devices, including laptop, tablet, and phone.
Several online therapy apps that are HIPAA compliant and have proven satisfactory for clients and counselors include TheraLink, DoxyMe, VSee, and Wecounsel.
What about online therapy by email?
Some couples are attracted to the idea of using email for counseling. This type of “therapy” would involve the clients engaged in a sort of journaling at any time day and night (rather than both client and counselor engaged at the same time). Many of the online counseling apps do not support email counseling.
Other drawbacks would be lack of instantaneous responses to questions or comments and the inability to observe body language and cues. However, journaling has proved a useful tool for many clients in counseling, so journaling via email could be a sort of “add on” to online counseling.
What ethical, legal and practical issues should be considered with regard to online couples therapy?
The counselor and couple cannot connect and develop rapport in the same way they would if meeting face to face. The question arises as to whether additional training and credentials should be required for this specialized form of therapy.
Certainly, online counselors need to be aware of ethical and legal considerations such as being compliant with HIPAA law to protect the privacy and confidentiality of clients and ensuring security provisions for safeguarding medical information.
Because online counseling is so new, there’s a lack of research to prove its efficacy compared to traditional counseling. In the next few years, we can expect ongoing studies comparing the two models of delivering therapy, and also determining which mental health needs and relationship issues are best suited for online counseling.
What should couples expect when they engage in relationship therapy?
Before engaging in therapy, the couple and the counselor need to come into agreement on what the goals and expectations are in couple’s counseling and how long the therapy will continue. Some couples seem to believe that just by engaging in counseling they will automatically have a better relationship. Is this a realistic expectation?
Emotional scars, faulty thinking patterns, toxic behaviors, and communication breakdowns don’t magically disappear when a couple clicks the counseling app button. Many things can interfere with the success of therapy, including the couple’s commitment, whether or not the counseling environment is distraction-free, whether the couple put the concepts being taught into practice and whether the couple terminates the sessions too early.
The function of the therapist is to explore the problems the couple is having, the reasons behind the problem, and changes the couple need to make in thinking, in behavior, in trust, and in communication. The counselor facilitates necessary changes by teaching communication and relationship skills.
Couple’s therapy is a powerful tool to create positive changes as long as the couple follows the recommendations carefully, and doesn’t terminate the counseling too early. The therapist and counselor should discuss during the initial intake what they expect to take place in the sessions and what they expect to achieve. The couple needs to determine if the goals they want to happen is what the counselor can help them attain.
One issue with online counseling is that it’s all verbal and it’s all through the computer, so it’s somewhat more difficult to make expectations clear in this venue. Since good outcomes depend on positive engagement with the counselor and upbeat feelings about the therapy process, this can be hindered a bit by the more impersonal model of online counseling.
Is online couples counseling the new wave of the future?
Online couple’s counseling has benefits and drawbacks. One aspect of couple’s counseling is meeting with the couple together, and then with each partner individually. This is a good time to explore individual goals and problems that are specific to each partner. Online counseling lends itself to split sessions – one partner could be discussing things with the therapist, while the other is putting the children to bed.
Online couple’s counseling could also be used for partners in a long-distance relationship – such as when the husband is deployed overseas and the wife is home with the kids – as long as the app can handle three person conferencing. Online counseling may be the only model available to couples living in remote rural areas or who are mostly homebound due to the illness or disability of one partner.
Online therapy presents benefits and hazards. Initial studies indicate that online counseling has a similar efficacy rate to face to face counseling for a number of relationship issues, but much more research needs to be done. When considering online counseling, be sure to determine if a prospective therapist has the correct training and licensing. Check credentials and reviews and be sure the program is HIPAA compliant.
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