How does it work?

I am often asked how I work with my clients in online counseling. So I've collected the most common questions to give you answers here. I'm talking both about my personal experiences, but I'm also including scientific studies.

Is it possible at all to create a therapeutic setting?

It is important to create a therapeutic space between me and my clients. That's why I recommend that my clients choose a quiet place for counseling and not be disturbed. Further, it is important to be alone in the room, after all, my clients should be able to speak freely. I also prepare myself emotionally and mentally for my sessions, for example, by meditating before the sessions in order to be present and fully emotionally attuned. From the experience in my previous sessions of counseling, I can say that a therapeutic space is created between me and my clients if we follow a few rules.

What are the advantages of online counseling?

A big advantage is that counseling can take place regardless of location. My clients are located in different countries in Europe, but could be anywhere in the world. In addition, my online counseling is flexible in terms of time, even appointments in the evening or on weekends are possible by arrangement. A big advantage is the familiar environment in which the counseling takes place. This helps my clients feel safe and secure. Another advantage is that you don't have to wait: I can usually make appointments within a week. You also save on travel time and can take advantage of counseling even if you are traveling abroad on business, for example.

Who books psychological counseling online instead of face-to-face counseling?

Many clients who live abroad and are looking for online counseling in their native language or in English book online psychological counseling with me. These people travel a lot, or appreciate the fast, uncomplicated appointment process. Also, many of my clients want to work specifically on relationship issues that I work with, so choose me because of my thematic focus. Some of my clients also live in rural areas, so cannot find local English counseling that specializes in their topic. My clients appreciate not having an extra commute to their counseling and feel comfortable at home, in their familiar environment. Additionally, online counseling is also conceivable for people on maternity leave who cannot leave their child alone for so long, or people who cannot leave the house due to physical limitations. Also, for couples who have a long-distance relationship, online counseling is the only option.

What are the limitations? Can you use your methods online?

Some methods I work with involve meditations: I can guide these well online. Also, I work with online tools, for example, to visualize different inner parts. If I want to visualize something, I can also share my screen so that we look at something together. Because there are extra websites that support online counseling, I can also do my counseling methods well online. I also like to give my clients worksheets to do some more reflection, or to practice a new skill, like self-compassion. That works well online, too.

Is it possible to work well with emotions online?

Certainly, when my clients get emotional, it would be nice to be able to hand a tissue as a gesture of support. Unfortunately, I can't do that online. Still, I can perceive in their face or speech when my clients are emotionally moved by something. In counseling, we can then give space to these emotions, for example, by looking more closely at the body sensations. Compared to working with clients in presence, I can say that online I can also work well with my clients' emotions.

Is the therapeutic relationship in the online setting as good as in face-to-face counseling?

Here you will find a summary of studies that have looked at the therapeutic relationship and online counseling:

Studies have shown that...

• People who are particularly anxious or socially isolated benefit from the online format and can form deep relationships online (Leibert, 2006 & McKenna & Bargh, 2000).
• People feel as emotionally understood in online counseling as they do in face-to-face counseling (Mallen et al. 2005).
• The quality of the therapeutic relationship is rated medium to high by ¾ of online clients and is similar to that in face-to-face counseling (Hanley, 2009, Cook & Doyle,2002).
  Therapists also confirm this and rate the therapeutic relationship similarly in both settings (Kubler, 2020).
• Online counseling helps clients be more open and honest in expressing themselves and more likely to seek counseling services (Suler, 2004, Cook & Doyle, 2002).

Thus, the therapeutic relationship can be established in online counseling, just as it is in face-to-face counseling.

Is psychological counseling online effective?

Some studies have looked at whether online psychological counseling is effective. Researchers have found the following results:

• Clients are more active in online therapy than in face-to-face therapy, possibly feeling more secure or taking more responsibility for the interaction (Day & Schneider, 2002).
• Treatment outcomes are similar between face-to-face and online therapy for the eating disorder bulimia nervosa (Mitchell et al., 2008).
• A meta-analysis of various Internet-based psychotherapeutic interventions showed that online interventions were as or nearly as effective as face-to-face interventions (Barak et al., 2008).
• Clients feel connected in the online setting, and experience emotional closeness to the counselor (Simpson et al., 2021).

Through the studies, it can be shown that online counseling is similarly effective to face-to-face counseling.

Conclusion on online counseling 

In addition to face-to-face counseling, online counseling services, such as mine, have increased in recent years. Online counseling has a number of advantages in this regard as an alternative to on-site counseling or therapy. From the study results and my personal experience, it can be concluded that online counseling is similarly effective as face-to-face counseling. Moreover, it is a fast, flexible and effective alternative for various counseling concerns for clients for whom face-to-face counseling is not possible.

Sources:

• Hanley, T. (2009). The working alliance in online therapy with young people: Preliminary findings. British Journal of Guidance & Counselling, 37(3), 257-269.
• Cook, J. E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. CyberPsychology & Behavior, 5(2), 95-105.
• Day, S. X., & Schneider, P. L. (2002). Psychotherapy using distance technology: A comparison of face-to-face, video and audio treatment. Journal of Counselling Psychology, 49(4), 499–503.
• Leibert, T., Archer, J., Munson, J., & York, G. (2006). An exploratory study of client perceptions of Internetcounseling and the therapeutic alliance. Journal of Mental Health Counseling, 28(1), 69–83.
• McKenna, K. Y. A., & Bargh, J. A. (2000). Plan 9 from cyberspace: The implications of the Inter-net for personality and social psychology. Personality and Social Psychology Review, 4(1), 57–75.
• Mallen, M. J., Vogel, D. L., Rochlen, A. B., & Day, S. X. (2005). Online counseling: Reviewing the literaturefrom a counseling psychology framework. The Counseling Psychologist, 33, 819–871.
• Hanley, T. (2009). The working alliance in online therapy with young people: Preliminary findings. BritishJournal of Guidance & Counselling, 37(3), 257–269. 
• Suler,  J.  (2004).  The  online  disinhibition  effect.  CyberPsychology  &  Behavior,  7(3),  321–326.
• Kubler, J. R. (2020). Wahrnehmung der Klientenergebnisse durch Therapeuten und therapeutische Allianz in der Online-Beratung. Australian Counseling Research Journal, 14 (1), 16-24.
• Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., Crow, S., Lancaster, K., Simonich, H., . . . Myers,T. C. (2008). A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimianervosa delivered via telemedicine versus face-to-face. Behaviour Research and Therapy, 46(5), 581–592.
• Barak, A., Klein, B., & Proudfoot, J. (2009). Defining Internet-supported therapeutic interventions. Annalsof Behavioral Medicine, 38(1), 4–17. 
• Simpson, S., Richardson, L., Pietrabissa, G., Castelnuovo, G., & Reid, C. (2021). Videotherapy and therapeutic alliance in the age of COVID‐19. Clinical Psychology & Psychotherapy, 28(2), 409-421.