Psychotherapy via the Internet?

A study found that online psychotherapy is just as efficient as conventional therapy. Researchers at the University of Zurich have conducted a study in order to compare online psychotherapy with conventional face-to-face therapy. Six therapists treated 62 patients, the majority of whom were suffering from moderate depression. The patients were divided into two equal groups and randomly assigned to one of the therapeutic forms. The treatment consisted of eight sessions with different established techniques that stem from cognitive behavior therapy and could be carried out both orally and in writing. Patients treated online had to perform one predetermined written task per therapy unit — such as querying their own negative self-image.

Three months after the end of the therapy, patients with online treatment displayed fewer symptoms than patients treated face-to-fac

“In both groups, the depression values fell significantly,” says Professor Andreas Maercker, one of the investigators. At the end of the treatment, no more depression could be diagnosed in 53 percent of the patients who underwent online therapy — compared to 50 percent for face-to-face therapy.

Three months after completing the treatment, the depression in patients treated online even decreased whereas those treated conventionally only displayed a minimal decline: no more depression could be detected in 57 percent of patients from online therapy compared to 42 percent with conventional therapy.

For both patient groups, the satisfaction with the treatment and the therapists was very high. 96 percent of the patients given online therapy and 91 percent of the recipients of conventional treatment rated the contact with their therapist as “personal.”

In the case of online therapy, the patients tended to use the therapy contacts and subsequent homework very intensively to progress personally. For instance, they indicated that they had re-read the correspondence with their therapist from time to time.

“In the medium term, online psychotherapy even yields better results. Our study is evidence that psychotherapeutic services on the Internet are an effective supplement to therapeutic care,” concludes the study.


The study is probably based on a sample that is too small. It would also be important to know how these patients were selected and instructed about the study.  Did they have other therapy before or after the study was conducted, and how did the therapy methods compare between the online group and the in-person group? It’s the same problem with all psychotherapy research – questionnaires are not enough.

Nevertheless, the findings are a good starting point for a broader discussion. As the second article under “References” shows, web-based psychiatry (Telepsychiatry) is taking off, but it consist mainly in online consultations with a psychiatrist for medication decisions. Online psychotherapy is more difficult, but in principle just as good as in-person meetings. The advantage is that we can reach remote populations, and extent badly needed mental health services everywhere. The obstacle is the licensing process: as a therapist licensed in California, I am currently not allowed to treat a patient in New York via online technology. if it were allowed, it would greatly increase competition among therapists  and licensing bodies. What would happen to New York therapists who charge $250 an hour?  I hope the laws that regulate these new avenues for psychotherapy will soon get created.


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