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Elisa Goldstein, Ph.D.Elisha Goldstein, Ph.D.
A blog about mindfulness, stress-reduction, psychotherapy and mental health.

Would You Want to Do Therapy Online?

Elisha Goldstein, Ph.D. Updated: Sep 28th 2011

online psychotherapyAs more and more people grow up in the digital age, we are become more accustomed to connecting to people through online pathways. If you grew up only knowing the internet, this all makes sense, it doesn’t seem strange to walk around and talk to your friend or family on the computer while seeing their face. You’re even used to the fact that you don’t actually look into one another’s eyes but at the respective screens instead (although I’m guessing that will change). But what about therapy online?

There are many therapists who are jumping on the bandwagon and connecting through various secure sites to do their online therapy. Companies like Skype,, and are banking on the idea that video-based therapy is going to be in big demand. There’s less obstacles, it’s cheaper without gas and rent, and you can be more flexible with your time. Seems attractive to both sides. But what gets lost?

When I’m doing therapy with someone I’m not only looking at their face, I’m having an awareness of their body, what are they doing with their hands? How are their feet positioned, are they shaking? What does their breathing look like, is it rapid through the chest or does it seem calm? Unfortunately, I can’t see these things when I’m no Skype.

That doesn’t mean therapy can’t be effective online, but it does simply point to the fact that the therapist can’t get the whole story.

With that said, I run a number of groups online where there have been wonderful changes and insights by the participants. Some have said they like the online version better because they feel less intimidated and feel safer to open up which enables greater change and healing.

Whenever looking at a new medium, it’s too easy to feel threatened by it in some way if we’re comfortable in our old ways and throw the baby out with the bathwater. It’s also too easy for other people to blindly embrace it overlooking certain deficits or challenges that may arise.

It seems to me that in the coming months and years ahead, video-based therapy is going to become a reality as an option to do psychotherapy and it’s going to be very attractive as life gets busier and connecting through a screen becomes more comfortable.

This is all a great experiment at this point. Some people have tried it and loved it while others have gone back to traditional face-to-face. Some do a hybrid, seeing therapists when they can live and online the rest of the time.

What are your thoughts on this experiment? What are the benefits that you see, the drawbacks? Let’s allow this to open a discussion to this important new phase that is upon us.



Elisha Goldstein, Ph.D.

Elisha Goldstein, Ph.D. is a clinical psychologist in private practice in West Los Angeles and is author of the upcoming book The Now Effect, co-author of A Mindfulness-Based Stress Reduction Workbook, Foreword by Jon Kabat-Zinn, author of the Mindful Solutions audio series, and the Mindfulness at Work™ program currently being adopted in multiple multinational corporations.

Check out Dr. Goldstein's acclaimed CD's on Mindful Solutions for Stress, Anxiety, and Depression, Mindful Solutions for Addiction and RelapsePrevention, and Mindful Solutions for Success and Stress Reduction at Work. -- "They are so relevant, I have marked them as one of my favorites on a handout I give to all new clients" ~ Psychiatrist.

If you're wanting to integrate more mindfulness into your daily life, sign up for his Mindful Living Twitter Feed. Dr. Goldstein is also available for private psychotherapy.

Reader Comments
Discuss this issue below or in our forums.

Options provide choice - Rae - Oct 5th 2011

I am an employment counsellor and in my field there is talk that the future will also include online counselling.  I understand the need for face-to-face counselling to observe body language, among other things.  My personal opinion is that having the option for both online and in person counselling gives people an opportunity to choose what will work best for them.  After all it is about what works for the client and every client/person's needs, comfort level, etc. are different.

I think ideally it is always best to meet with a client in person.  However, we are all aware that we do not live in an ideal world.  I think there is a risk that people may stop opting for the in-person option in favour of convenience, which is a shame because quality could be the casualty if we lose that in-person contact all together.  On the other hand, we may be able to reach more people through the online option.  I think as this option becomes more available perhaps new strategies and guidelines will emerge to help maximize the quality of the process.  I think innovation always brings new opportunity and it is certainly a good idea to always be looking for new ways to improve.

Therapy Online - - Oct 2nd 2011

My comment is that I found this article because I was seeking this option. I haven't found it yet and because I have isolated myself to such an extent, I cannot afford a doctor even if I could muster the courage to go see one. So yes, I think it would work to help because it could reach those which otherwise would not get help. 

Online therapy has its place - Janet Singer - Oct 2nd 2011

This is definitely a hot topic and I do think online therapy is here to stay. I wrote about it in relation to OCD just recently:

While I think face-to-face therapy has many advantages, the convenience and availability of this therapy can't be denied. Just tonight a woman commented on my blog saying her son was just diagnosed with severe OCD and the nearest therapist specializing in this disorder was an hour and a half drive away....they have few therapy may be a viable option for this young man.

My Opinion - Cathy - Sep 29th 2011

My opinion, and I always have one on everything, even though I have strong opinions about mental health and therapy, I can see a great benefit by having this available online.  Just look at how people feel comfortable opening up in the forum about their issues.  I would have to say that I think that is more about having peers and the group experience than anything else.  Someone who has been there (where you are right now) and has come "back" is priceless.  Too often, people want help but can't face a therapist with their problems.  Too often, the therapist cannot identify with the problem or a therapist with a specialty is needed and in the backwoods, you get "counselors" usually someone with an endorsement for addiction counseling and they do everything so this would help in that you could get someone specializing in your particular issue.  People in the big cities don't understand this and it is very frustrating to try to explain that when you work 40 hours a week for slave wages that you can't take off to drive to therapy that is 3 or 4 hours one way plus the cost of fuel.  Ah, reading the body language and I am familiar with that but I also know that when I am looking at someone taking that in and also making eye contact that I can make the person very nervious and self-conscious and this is more of a reflection on myself and what I do to people (certain people on purpose) than of that person.  It is intimidating!  I think online support is a great idea and groups moderated by professionals would be super. 

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