If the crucial piece of good behavioral healthcare is an effective therapeutic alliance, the future of online behavioral therapy seems assured. Why? One has only to think of the current uses of apps such as FaceTime, Google Hangout or Skype. These are no longer futuristic forms of interpersonal communication; they are used by millions of people every day, and they are very effective in making and maintaining personal relationships. The emotive and individual aspects of “in person” contact are largely present in these connections; and there is no doubt that the most important aspects of “therapeutic alliance” are also inherent in them.
One need not look hard (Google it!) to find good examples of the use of these technologies in the realm of personal relationships: the Internet and the typical newspaper can yield many instances. Behavioral healthcare is now following the cyber-path of med-surg, such as the telemedicine which has been used for decades. Obviously, as communication technology improves, and larger numbers of people use it preferentially, it becomes the basis for expanded behavioral healthcare.
In many instances, clients are unable to get to a therapist’s office, for reasons ranging from hospitalization and incarceration to disabilities and rural settings, as well as small children, tight schedules. In other instances, it is not a matter of need but of preference (some clients are more comfortable not making the trip to an office and are more likely to relax and make valuable disclosures from home).
Online therapy has its issues, at the moment, mainly because the world of regulation and “standard” healthcare delivery has not yet caught up to it. Still, millions are using it. Skype and Google Hangout may not meet HIPAA privacy rules, but that has not kept hospitals and agencies from creating their own software or establishing policies in which the client is informed that online therapy may raise HIPAA compliance issues. Too, online therapy is not generally reimbursed by health insurers; but the client may well decide that the advantages of online therapy justify the costs.
In comparison with one major alternative—no therapy at all—online therapy is a very attractive choice, and there is no doubt that the already-established widespread adoption of “remote a connections’ between people and their families and friends (for even the most personal and intimate purposes), combined with never-ending and always-welcome advances in communications technology, will ultimately produce a new standard in the ways in which clients and therapists interact, and a new assumption about the nature of a therapeutic “office visit”.
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