Aisha hurries along the hall, keen not to be late for her appointment with her therapist. But she hasn’t had any of the usual delays on the way, such as getting stuck in traffic or failing to find a place to park. She’s also not bothered by the fact that she lives in Dubai and her therapist is in the US. In fact, she hasn’t actually left her apartment. She’s just overslept.
Aisha is one of the pioneers of a radical new approach to counselling and therapy. Rather than travelling to an appointment, sitting or lying on a sofa and talking to a therapist, both sides stay at home and connect over the internet. Settling down on her own sofa, Aisha, who has self-esteem issues, has a sip of coffee, picks up her laptop and logs onto a chat program. “How are you feeling?” asks her therapist, and the session begins.
As more and more patients get off the couch and into the cloud, the practice and image of therapy is going to change drastically. “It’s surprising it hasn’t happened sooner,” says Joanna Bawa, a psychologist who studies internet-therapy links. “There have always been other ways of offering psychological help, such as phone helplines, and video chat, which has been around for a number of years. But the whole move to the web has only taken off recently.”
As well as abolishing geographical constraints, net-therapy can also improve the experience for shyer patients. “The fact that you can’t see the other person can be very liberating, people become very focused and can get to the heart of their problem quickly,” says clinical psychologist Nadine Field, who set up PsychologyOnline.co.uk several years ago to speed up access to therapists in the UK.
In fact, a trial of 300 people, which was published in The Lancet, found that online counselling can actually be more effective than face-to-face therapy.
“People with serious depression were much better after seven or eight sessions, compared to the 15 to 20 face-to-face sessions it usually takes to reach that point,” says Field. As well as getting better service, patients could also get more power as therapists will be in the unfamiliar position of having to sell themselves.
At a relatively new site called Mootu, there is a database of therapists, each of whom has a promotional video, so you can flip through to see who you’d feel comfortable with. Then, once you’ve selected a few, you can book a free 15-minute trial to see which one you click with.
While in countries such as the US and UK therapy online is growing rapidly – it could soon be available for free via the National Health Service in the UK, for instance – it is still a nascent industry in the Middle East. “It is only in the past few years that I have heard of the development and use of online therapy sites,” says Dr Tara Wyne, clinical director of the The LightHouse Arabia community psychology clinic in Dubai. “It’s more an alternative if a current client is travelling or unable to come into the clinic – it’s rare for clients to request online versus face-to-face therapy.”
But there are specific benefits for those living in this region, says the clinic’s Dr Saliha Afridi. “Seeing a mental health practitioner still carries a certain stigma in this part of the world, which means some people might not feel comfortable to go into a clinic and make themselves vulnerable. The screen of the computer allows for an extra layer of ‘protection’ or anonymity.”
This also comes with a downside, however: “So much of therapy is about feeling a person’s mood and energy by being in their presence,” say Dr Afridi. “So often people will come in, they will sit, smile and just by being in the room with that person, I will know that they had a rough day. This is lost when you do therapy online.”
The potential lack of regulation is another grave concern. “Not all websites offering online therapy are robust in their security, so explore their confidentiality agreements thoroughly,” says Dr Wyne. “Look at user reviews and make sure the website has given some indication that the therapist’s listed qualifications have been verified and that he or she has the competence to deal with your particular problem.”
Most of all, all doctors emphasise that therapy online is not for those in a vulnerable state. “If the client is in a crisis, their online therapist has severely limited ability to detect and intervene in the emergency,” says Dr Wyne.
Any new technology generates new opportunities and new fears. Perhaps the fears are greater in therapy because its basic structure – two people in a room seeking understanding – has not changed in a century. What’s certain is that its transformation has only just begun.
-- additional reporting Tabitha Barda