Pandemic forces mental health care workers to embrace online therapy

Until recently, online therapy was a bridge too far for many practitioners in mental health care. But then came COVID-19. Because psychologists, psychotherapists and psychiatrists could no longer treat their clients face-to-face, they switched en masse to online video platforms. In many cases it turned out to work better than expected, according to new research by the Eindhoven University of Technology. Among other things, many therapists are positive about the effectiveness of the therapy, the experienced flexibility, the lower threshold for contact and the lack of travel time. But there are disadvantages too, and online therapy doesn't work for everyone.

In recent decades, more and more tools have been developed for remote therapy. Previous research has shown that this online form of treatment—also known as eMental Health—is on average as effective as face-to-face treatment, despite the distance between practitioner and client.

Nevertheless, up till now many therapists have been very hesitant to adopt these tools. "They are afraid of technical problems, and fear virtual contact will affect the quality of the treatment," says Milou Feijt, Ph.D. student in the Human Technology Interaction research group, and one of the researchers. "Practitioners also often feel that these tools are imposed on them by insurers or management in order to save costs."

Video conferencing

In March, when all face-to-face contact with clients became impossible due to the pandemic, the practitioners switched en masse to video conferencing tools like Zoom or Skype, or to secured applications in online platforms. "A unique experiment," says Feijt. "Due to the exceptional situation, the therapists were forced to gain experience with online therapy. For the first time, they were able to indicate explicitly what went well and what didn't, and what their most prominent needs were in the use of eMental health."

From April 1, some two weeks after the Netherlands imposed its so-called intelligent lockdown, Feijt and her colleagues interviewed a representative group of 51 Dutch therapists about their experiences and the consequences of the virtual contact for themselves and their clients. Because of the pandemic, the research had to be done via online questionnaires.

The participants reported a number of benefits of working online. For example, the sessions were often more efficient, because both they and their clients spent less time traveling, and the conversations were more focused. The low-threshold nature of video calling also allowed for more frequent, shorter moments of contact, which improved the therapeutic relationship. According to the practitioners, their clients were also predominantly positive about the experience. In fact, some of them even benefited from the remote therapy because they felt less inhibited to express themselves.

Challenges

Of course, there were also challenges. Many problems were of a technical nature, such as a faltering internet connection, others had to do with the fact that the practitioners now had to interact with their clients through a screen. As a result, important non-verbal signals, such as posture, hand movements and smell, were missing. This made it more difficult to tune in with their client, especially in very emotional conversations or crisis situations.

Online therapy also turned out to be less suitable for treating traumas, and for people with psychotic or social anxiety symptoms. Sessions with children and groups also work less well in an online environment.

Blended care

According to Feijt, it is vital that the technical problems are solved, if eMental Health is to be a real success in the long term. The researcher is also looking for ways to enhance the mediated interaction between therapists and clients. Think of technical solutions that compensate for the lack of non-verbal communication, such as sensors on fingers, that give the therapist information about the emotional state of the client.

Meanwhile, Feijt and her colleagues have started an additional study among a larger group of therapists. "The sudden and massive switch to online therapy provides us with a unique opportunity to see how we can further improve eMental Health. Of course, we can't let this pass us by!"

The researcher doesn't think that in the future, once the pandemic is over, therapists will all keep zooming or skyping. "We believe in blended care, which uses both face-to-face and online elements, depending on the need and the situation."