Flexibility in rules about format with online therapy.

However, we also noticed that some of the writers emphasized, directly or indirectly, another factor: the question of flexibility, which is probably one of the main factors that impacts the outcome of online therapy. Once we stop being obsessed with the question how similar online therapy is to in-person therapy (still a common error which we warned against in our previous book) and acknowledge that it is NOT the same as in-person therapy, that the setting is not controlled and structured by the therapist, that failures of communication are inevitable, that it's difficult to establish conditions of safety and a holding environment – we have to flex the usual rigid boundaries and rules of conservative psychotherapy. Perhaps this is the main threat for more traditional therapists, since immediately the question that might pop up is: “how flexible should we become?”

Weinberg, Haim; Rolnick, Arnon; Leighton, Adam. Advances in Online Therapy: Emergence of a New Paradigm (p. 39). Taylor and Francis. Kindle Edition. 

Online therapy is not the same as face to face therapy. The questions of how it is the same and how it is different become relevant. The editors of Advances In Online Therapy note in their introduction that practitioners of online therapy have to be flexible. The old ideas about “holding environments” and “boundaries” no longer seem transferable to this new format entirely. So what rules should therapists of online therapy follow and what can be flexed or disregarded?

What rules can be flexed in implementing online therapy as compared to face to face therapy?

I was wrong about video therapy and telehealth.

During the pandemic there was a mass transition of therapists to online therapy, according to one survey an estimate of 98% of therapists used online therapy during the pandemic (Sampaio et al., 2021). This vast amount of health care professionals working online have created a huge body of experience, knowledge, research, and academic articles. The number of research studies about online therapy jumped exponentially in the past two years. This book attempts to share a carefully chosen part of this accumulated knowledge.

Weinberg, Haim; Rolnick, Arnon; Leighton, Adam. Advances in Online Therapy: Emergence of a New Paradigm (pp. 35-36). Taylor and Francis. Kindle Edition. 

I have argued in my posts that online therapy is not the same as face to face implying that it is not as effective. Turns out that I have been wrong. Online line therapy is different in some ways from face to face therapy but it is becoming apparent that in many cases is as effective and in some cases more effective. The devil is in the details.

Many thanks to Martha Gilmore for mentioning in one of her posts that her husband, Haim Weinberg and two of his colleagues have edited a book entitled, “Advances In Online Therapy: Emergence Of A New Paradigm.” I have bought the book both in print and kindle editions and am learning a lot. Old dogs can learn new tricks. At least this old dog can and it keeps me young.

I wondered about the finding in one survey that at least 98% of therapists used online therapy during the pandemic. The reference cited does not appear in the footnotes so I couldn’t find the source.

During the pandemic I kept my office open for face to face as well as offering video therapy and teletherapy. My experience was that 90% of my clients wanted face to face while about 4% wanted video therapy and 6% wanted teletherapy.

The sense I have gotten from posts on this list is that many therapists closed their physical offices and have moved their practices to videotherapy. Does anyone have any idea what percentage of psychotherapists have closed their physical offices and moved exclusively to video therapy and telehealth?

Perhaps 98% of psychotherapists have used some form of videotherapy and/or teletherapy, but what  kind of use is this: partial, exclusive, hybrid?

Necessity is the mother of invention and having had to close my physical office because of orthopedic problems with my legs making it difficult to stand and walk, I am now planning on opening a video therapy practice. I am learning that I was wrong about thinking that videotherapy is not as effective as face to face.

I am interested in any comments people have who have transitioned their practices from face to face to video and telehealth about the benefits and the deficits of these practice formats?