Log on for therapy
10:20am Sunday 17th February 2013 in News
IT seems the internet can be used for everything these days - and that includes therapy. For those who find the idea of baring their soul in person too daunting, online therapy could be an ideal solution.
Martha 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 Kent and her therapist is in Manchester. In fact, she hasn't actually left her flat. She's just overslept.
Martha 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 couch and talking to a therapist, both sides stay at home and connect over the internet.
Settling down on her own sofa, Martha has a sip of coffee, curls up, picks up her laptop and logs on to Skype, the video chat program. Her face and that of her therapist both appear. "How are you feeling?" he asks.
The therapist's consulting room has long been a staple of books and films - a place where unpleasant truths are revealed and neuroses soothed, or a stage for couples to exchange witticisms.
The cliches are well known: the interesting bits start emerging just when time's up; wanting to leave is a sign that uncomfortable progress is being made. But 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 working in Herefordshire who studies internet-therapy links.
"There have always been other ways of offering psychological help, such as phone helplines, and Skype has been around for a number of years. But the whole move to the web has only taken off recently."
It could soon be available on the NHS through your GP, thanks to the campaigning of clinical psychologist Nadine Field, who set up PsychologyOnline.co.uk several years ago to speed up access to therapists, a service that can still be painfully slow.
"We've now got the evidence to show what we offer is actually more effective than face to face, and we can get someone an appointment within 36 hours," she says.
The magic of the internet abolishes the constraints of geography.
"You may be in Bradford, but your therapist could be in Bognor or Brisbane," Field continues.
What's more, by tapping in to global demand, therapists will be able to narrowly specialise and become really skilled at treating very specific problems such as claustrophobia or obsessive compulsive disorder.
Surprisingly, the site doesn't use anything more sophisticated than a web version of text messaging.
You sign up to the site, give your doctor's details, and then a window comes up where the therapist types a greeting such as, "Hello, what's happening?" and you can hit the keyboard and tell them.
"It works like a diary, only there's someone there who can ask questions about your beliefs, or how the problem is affecting your daily life, and suggest other ways of looking at it," explains Field.
"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.
"A trial (of 300 people published in The Lancet) found that people with serious depression were much better after seven or eight sessions. These patients would normally need 15 to 20 face-to-face sessions on the NHS to reach that point," she says.
Unfortunately, that's still in the future. Right now, you can only access PsychologyOnline through your GP if you're in Oxfordshire, Buckinghamshire or Southampton, although it's hoped Peterborough and Cambridge will sign up soon.
But much speedier delivery and greater specialisation are just a few of the benefits of therapy's move to a new realm.
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.
Everyone agrees that a rapport between you and your therapist is key to a positive result but, at the moment, you pretty well have to take what you're offered on the NHS, and rely on word of mouth if you're going private.
But at a relatively new site called Mootu - which Martha now uses - the situation has become closer to internet dating.
Set up by successful entrepreneur John Witney, who made his money with the recruitment website JobServe, Mootu has a database of more than 70 therapists and counsellors who will see you through Skype for between £40 to £60.
Its unique feature is that each therapist sells themselves with a promotional video, so you can flip through to see who you'd feel comfortable with. Then, once you've selected a few - there's a button to store potential ones - you can book a free 15-minute trial to see which one you click with.
Bawa, an advocate of cognitive behavioural therapy (CBT), believes greater use of the internet will tailor therapy to people's needs.
"Old-style psychotherapy, where you recline on a couch, sometimes silent for a long time, is a very unstructured process.
"A leisurely rummage around in the subconscious has become unsustainable in an age of evidence-based medicine. It's very difficult to assess its benefits. CBT, which involves changing the beliefs you have about negative feelings, is increasingly being used, and it's a much more systematic approach.
"There's good evidence not only that it's effective but also that it can be successfully delivered online with just a computer program."
A long-running worry about therapy in general has been regulation. How well is a therapist qualified, and what sort of comeback is there if things go wrong?
Here in the UK, therapists aren't licensed - anyone can put up a sign and start seeing clients.
"Moving on to the internet could make it even more difficult to ensure that you're getting someone who's properly trained," says Nisha Makan, policy and campaigns officer of the mental health charity Mind.
"But there are undoubtedly benefits. The anonymity it offers means that people who are very shy or who have 'shame issues' such as sexual problems, or many men who are depressed or anxious, will find it easier to get help."
Others, however, fear that the anonymity could backfire.
"What happens if a client who's talking to me on Skype suddenly starts becoming really distressed or suicidal, and he's on the other side of the country or even in a different country?" asks psychotherapist Martin Pollecoff.
He says he appreciates Skype as a valuable tool, but insists on a face-to-face meeting first to gather basic information.
"I have a lot of City clients who are cash-rich and time-poor. They can't come in regularly and are often away travelling. Skype is a marvellous way of letting us stay in touch."
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 by the web has only just begun.