Omnichannelled Therapy

During one of my infrequent bouts of insomnia last night, it occurred to me that in 2015 we ought to be celebrating the 20^th birthday of online counselling and therapy. It now also occurs to me that thinking about such things at 3am is a bit odd, but then those who know me know that the practice and ethics of online work is the thing that keeps me awake at night, so I’ll choose the word passionate rather than odd…

Anyway, as outlined in my 2010 book Online Therapy: A Practical Guide, co-authored with the lovely DeeAnna Nagel (now of Havana Wellness – check it out!), it’s established that the first paid-for online mental health services started appearing in mid-1995, led by pioneers such as Leonard Holmes, John Suler, David Sommers and of course, John Grohol of PsychCentral. There’s a timeline here up to 2002 from the old Metanoia.org site, one of the first websites I came across when starting to look into the emerging field in 1998.

20 years old in 2015 – that means the field is almost an adult! So I am constantly surprised when it is referred to as “new” – it may be young and dashing, but at 20 years old, it’s not exactly new anymore!

In fact, it also now occurs to me that my training programmes first emerged in a face-to-face capacity in 2000, so the sub-field of training for online services is already a teenager (read my recent BJGC paper about that here)! And let’s not forget Supervision and Coaching also taking place online!

So I was pleased to be invited to Switzerland next year to speak at a conference being offered by the University of Basel. The conference theme is “Typing Yourself Healthy…”, and I was reflecting how nice it is to see the original online therapy modality being aired – a part of online therapy which remains robust despite the great technological developments we have seen over the years, particularly with video now being a reliable method of communication with clients (this wasn’t the case back in 1995, trust me!). Even if you picture “online therapy” as “video therapy”, I’m pretty sure that there is a lot of text-based work involved. And if you have joined the excellent free-to-sign-up platform PlusGuidance, you’ll know that text-based work is very much a part of the communication tools you can use with clients.

So, apart from making me feel very old, what can we take from the history of online therapy? Our 20-year old is maturing, no doubt – BACP will shortly publish new Good Practice Guidance for working with both text and audio/video – the latest set of ethical advice from a professional organisation that first looked at the area back in the late 90’s, and first published guidelines in 2001. The number of doctoral-level studies in the field has increased since my own was awarded back in 2010, and I see many on the horizon as trainees with the Online Therapy Institute find their own burning research topics as a result of their studies. The media is less shocked by the concept of using the World Wide Web for mental health support, although they still love a story about it going pear-shaped (and always will, I suspect). Even using avatars and virtual environments for therapy doesn’t raise too many eyebrows these days.

So join me in lighting a candle for the 20^th anniversary of online practice going live! It’s been a thrilling (and sometimes frustrating) journey to adulthood, as the Internet became an everyday part of our lives and more and more clients reached out through their personal devices rather than calling their medical practice. Having an online element to your practice shouldn’t be intimidating – the pioneers of the field have had your back for ages – so maybe it’s time to reach back out to the clients who are trying to find you online!

For a while now when describing the rise of using technology to deliver therapeutic services, I’ve found it helpful to include traditional ways of how we work within the definition. This was helped immensely by taking the writing of my hero Douglas Adams into account, and particular his thoughts on technology itself in his seminal 1999 article “How to Stop Worrying and Learn to Love the Internet”:

“We no longer think of chairs as technology, we just think of them as chairs. But there was a time when we hadn’t worked out how many legs chairs should have, how tall they should be, and they would often ‘crash’ when we tried to use them.“

It could be argued that chairs themselves are a necessity of being a therapist – I’m pretty confident in saying we all use them when communicating with clients. So in considering this traditional way of conducting a therapeutic session, we can include face-to-face work as a technology as well. Adams published that article at around the same time that I joined forces with the British Association for Counselling and Psychotherapy to develop the early Guidelines for Online Counselling and Psychotherapy, the backbone of the ethical advice and competencies for online practitioners we have today, and so I think the time is ripe for us to move on as a profession after over 15 years.

I just did a podcast with the lovely people over at counsellorcpd.com (available early September, check back for the link), and it started me thinking again about how we talk about online therapy as a whole. I described during the podcast how only last year I yet again had the debate about what to call services delivered over the Internet – is it e-therapy, is it teletherapy, is it online therapy…?

Well, how about we take the technology out of the description and just go back to not thinking about that too much? How about we go back to the core of what we do – two or more human beings working together with therapeutic intention to improve someone’s mental health and ability to deal with life’s challenges?

How about we just call it, er, therapy?

So I want us to look at this in a new way, taking into account all the many avenues of communication we have available to us now – be that face-to-face, telephone, email, chat, video, virtual environments or smoke signals. It’s a therapeutic interaction, a relationship, two or more people talking intentionally. It really as simple as it’s always been – we just need to recognise that if we take away the need to think about the screens and keyboards and plugs and chargers and on-buttons and pretty flashing lights, we’re left with the therapeutic relationship itself.

We can offer this relationship in a myriad of ways now, and we can be less restrained by factors such as place or time. The client can choose how and when they want to work, and the practitioner can choose how and when to offer their services. Want to work for 50 minutes in a room with two chairs and a box of tissues? Fine! Want to pick up a telephone and call a helpline spontaneously? Also fine! Want to reach out to your therapist via instant message but not book an entire session? Very fine! Want to journey through a virtual world as an avatar on an epic journey with your counsellor, seeking self-enlightenment? Awesome! That’s just omnichannelling, a word already widely used by marketers looking to improve their customer experience (thanks to ForeSee for the image I borrowed btw).

So I’m going to move further away from the distinction of the offline and the online, take away the need to define therapy by how we deliver it rather than what it is we are actually doing, and if we really need to call it something to remind us we’re not necessarily physically in a room anymore (but it’s OK if we are!), just call it omnichannelled therapy.

I like to think Douglas Adams would be proud of me.

🙂

Happy Birthday Online Therapy – 20 years old!

Omnichannelled Therapy – the Future of the Profession