How Much Online Therapy Really Goes On? Part 1

Reporting Online Therapy Experience Openly, Honestly and Transparently

While working therapeutically via the internet — whether by chat, video, email, or some other modality — is relatively new, the internet seems to be awash with sites trying to offer the service. One of the questions prospective clients will ask themselves is what experience these online therapists have working with clients like them via an online modality. Experience working in a face-to-face setting is great, but competence in the consulting room does not always translate straightforwardly into competence as an online therapist.

Having personally surveyed scores of sites attempting to sell online therapy services, I have found virtually none that represent actual bona fide online therapy experience in a way that is open, honest, and transparent to the end user. Although many practitioners state how many years they’ve been offering online therapy, or will put a number on how many clients they have worked with, these kinds of numbers unfortunately offer almost no insight into the amount of actual online therapy experience a given practitioner might have.

I explore this fact more below, but before doing that, I think it’s worth drawing attention to something else: what I explore below will probably be fairly obvious to any practitioner who has done a fair amount of online therapeutic work. In other words, I do not claim any great insights when I suggest below that figures like the number of years of experience or the number of clients worked with tell very little about actual online therapy experience; most experienced online therapists probably came to the same conclusion long ago. Therefore, there seem to be two possible conclusions: either the practitioners who claim experience in numbers of years or numbers of clients don’t really do enough online therapy to realize how little use these claims are, or they do realize it but choose deliberately to withhold more informative details about their online therapy experience. Either way, it doesn’t seem to me to reflect very well on the state of the field, and I think consumers are right to be cautious.

What’s Behind a Given Number of Online Therapy Clients?

Many practitioners like to promote themselves as having worked with a certain number of clients in online therapy. I know of some online therapists who claim literally thousands of clients. This sounds awfully impressive, doesn’t it?

Well, I think it would be pretty impressive — were it not for the fact that without further information, the number of clients doesn’t actually tell us very much at all about how much online therapy a practitioner is doing. Worse, the number risks seriously misleading clients and fellow mental health professionals alike.

Why? Without additional information, we can’t tell what sort of a correlation there might be between number of clients and amount of actual online therapy or online counselling work.

For example, without further information, how would a consumer tell the difference between online therapists who work with real bona fide clients for just a few weeks, on the one hand, and those who work with clients for many months or even years, on the other hand? And of course, even within a given range of calendar time, the nature of online therapy is such that some practitioners might be exchanging communications with a given client on a daily basis, while others might be doing it on a monthly (or even less frequent) basis.

It gets worse.

Some online therapists may count ‘agony aunt’ style advice-giving as counselling, and each person on their mailing list counts as a ‘client’; add another subscriber to the mailing list, and presto, there’s another client. Others may count as clients members of the public who write to them with one-time requests for information or advice; in other words, there might not be any ongoing therapeutic work, but still they are counted as clients. Still others may include in the ‘client’ count all the individuals who contact them about online therapy but who do not wind up beginning online work with the practitioner.

In other words, as I suggested above, without knowing more about an online therapist’s style of working (including duration and frequency of contact), not to mention who exactly they count as a ‘client’, the number of clients an online therapist has worked with is virtually meaningless.

What’s Behind a Year of Online Therapy Experience?

So client numbers, by themselves, are not very helpful. How about years of experience?

Many practitioners prefer to promote themselves as having a certain number of years of experience as online therapists: “I’ve been an online therapist for 5 years”, or “I have 3 years of experience offering therapy online”. Unfortunately, without further information, this type of statement is once again at best meaningless and at worst deeply (and perhaps deliberately) misleading.

Why?

When it comes to time allocations, ‘being an online therapist’ is fundamentally not at all like being a (full-time) dentist, or plumber, or schoolteacher or [fill in your choice of occupations]. When Fred says “I’ve been a plumber for 5 years”, most people will assume that plumbing is what Fred has been doing for the last 5 years, to earn a living; the natural assumption will be that Fred probably works full-time, or close to full-time, being a plumber. In other words, we assume that most days, Fred does at least a little plumbing — if not mostly plumbing.

But is the same true of Alice, when she says “I’ve been an online therapist for 5 years”? Clearly not! Sure, it might be that Alice actually does some online therapy every day. But one can also ‘be an online therapist’ by working with just a handful of clients per week…or with one client per month…or by working with a couple of clients for a little while and then publishing lots of articles about it. (This last one, I think, is especially popular.) This wild variation in the possible underlying facts is why I suggest that such statements are at best meaningless and at worst misleading — apt to be interpreted in a way that grossly overstates how much online therapy a practitioner is actually providing. I can pretty confidently assert that full-time online therapists do not exist. (In actual fact, full-time therapists of the mental health variety typically do not exist anyway, whether they work online or solely face-to-face, because ethical practice generally requires that client contact hours are kept well below the number of hours that would be considered full-time for most other professions. But the problem of communicating information about experience in a way that is ultimately misleading is far more insidious when it comes to online therapy or online counselling.)

So, as with the case of client numbers, it seems straightforward to conclude that without additional information to help clarify and disambiguate, the number of years in practice as an online therapist is virtually meaningless.

A Side Note on ‘Years’

Questions surrounding the general idea of reporting ‘years’ of experience as an online therapist reminds me of those surrounding the reporting of years spent in training. Especially in the UK, it is very common to read statements like “I spent 4 years qualifying to be a counsellor”. On the face of it, this seems perfectly straightforward, and it sounds much like studying for an undergraduate degree. This is how it seems, anyway, until you discover that the 4 years was actually spent in part-time study and might have occupied just one year of full-time work.

Don’t get me wrong: I’m not hung up on paper qualifications, and I feel I have plenty of them myself. Moreover, empirical evidence strongly suggests that paper qualifications have virtually nothing to do with clinical effectiveness. (See, for example, the book by Hubble, Duncan and Miller on the subject, reviewed here at CounsellingResource.com.) Rather, if I’m hung up about something, it’s about communicating a message such that it is received by the consumer in a way that is ultimately misleading — whether that be a message about studying for paper qualifications, or a message about how many ‘years’ of experience one has as an online therapist.

The second part of this article (“How Much Online Therapy Really Goes On? Part 2”) covers a simple suggestion for ways in which practitioners can communicate their experiences with online therapy or online counselling more openly, honestly, and transparently.