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Is video counselling the future of one-on-one appointments?

Illustration of a video counselling session
vectorjuice | Freepik

Insight by Amy O’Neill

One of the oldest methods of helping people better understand their mental health is in-person counselling. But with the advent of new conferencing technologies, video is revolutionising how these appointments work. Mental health mentor and trainee counsellor Amy O'Neill offers her insights on whether video can truly replace in-person counselling for good.

“It’s just not the same online”

This is a common phrase among many practitioners when referring to remote means of mental health support which is borne largely from the impact of the COVID-19 pandemic. Occurring overnight in many cases, mental health practitioners were whiplashed from their comfortable in-person model of working, to the unfamiliar territory of remote working, naturally inspiring an initial reluctance to this mode of support and doubt surrounding its effectiveness.

Even so, technology has played a huge part in facilitating mental health support for some time now, from helplines to online chat services. And now, since the emergence of COVID-19, access to one-on-one mental health support through technology has unsurprisingly risen, with video conferencing software like Zoom, Skype, Microsoft Teams, and Google Meet all offering a platform for clients and practitioners to visibly see each other, despite being geographically separated.

Video counselling is likely here to stay. But what exactly does it offer, and will it ever be enough to replace in-person treatment?

The benefits of video counselling

In my own work, where I provide one-to-one mental health support to university students through video conferencing, I have found that although online support may not be the same as in-person support, that does not mean it is not as effective. In fact, online support has its own unique benefits to both client and practitioner:

  • Affordability - Research overwhelmingly agrees that conducting support sessions remotely rules out many financial barriers, such as costs of travel, deeming it a more affordable option for support. The financial savings not only benefit the client, but also the practitioner with travel costs, and extra costs such as renting an appropriate counselling room. Therefore a huge benefit to online support is that it is more cost effective.

  • Accessibility - Mental health services that take place remotely opens up opportunity for those who otherwise may not be able to access mental health support in-person, whether that be for caring responsibilities or health and mobility reasons. A study also described technology as a practical way to offer a solution to geographical barriers. Not only are advances in technology offering clients with an alternative to in-person support, it may also open the door to practitioners who find this a more accessible path than a traditional in-person way of working.

  • Approachability - People are becoming more tech-savvy, particularly young people who are comfortable with using technology as a means of accessing support. Research has shown that when accessing mental health support through video conferencing with a therapist, clients found that they were less intimidated and felt more willing to discuss their issues. Therefore, for some people who have already got a good grip on technology, this may be a more approachable way to receive support.

  • Convenience - Support through video conferencing means that there is more time in-between sessions, and clients and practitioners need not worry about practical issues that may arise with in-person work, such as challenges with parking or taking into account travel time. This also offers more flexibility in their day.


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How video counselling affects the working alliance

A legitimate worry for practitioners moving online is the potential barrier of establishing a strong therapeutic alliance, also known as the 'working alliance'. This factor is fundamental to positive outcomes in mental health support. So the question lies: can a strong alliance be formed between client and practitioner through means of video conferencing technology?

A literature review explored this question and found that the results overwhelmingly supported the view that a strong working alliance can be developed through video conferencing, with clients rating both online and in-person sessions equally in terms of their relationship with their therapist. Interestingly, this research showed some additional benefits provided through video conferencing;

  • In most cases, there was still a felt sense of warmth and empathy on screen

  • Therapists were more aware online of clients’ non-verbal language (fidgeting, eye-contact) and were more likely to ask for clarification around this

  • Clients felt that being physically in their personal space enhanced the alliance

  • Clients felt they were able to be more active and take more responsibility in online therapy than in-person, and felt safer and less intimidated to open up about their mental health

Addressing the ongoing reluctance among practitioners

Although there is evidence that a good working relationship can be established online, many practitioners still feel weary in taking that technological leap.

A recent study indicated that a therapist's professional self-doubt around their abilities to establish a working alliance online often plays a part in their reluctance to use this means of support. That is to say, practitioners' confidence seems to play a big part in their adoption of video counselling.

To get around this issue, appropriate training in the area of online support will be essential in encouraging practitioners to believe in themselves and their abilities to provide this type of support. The more practitioners who are open to working this type of way means that mental health support will be more accessible.

The "Online Disinhibition Effect": can it be a good thing?

The “online disinhibition effect” is a term coined by psychologist John Suler which refers to the concept that people may act with more intensity online and may be more likely to self-disclose information at a quicker pace.

The research on whether this effect is good or bad represents a truly mixed bag. Some people may feel anxious and overwhelmed that they have shared too much, too quickly. But equally, some report that video counselling helps lessen the stigma around receiving support, with clients feeling less intimidated online than sharing a physical room with a counsellor. Clients have also expressed their preference to meet via video conferencing as they felt it was a less confrontational option than in-person therapy, with geographical distance playing a part in this.

It seems then that the online disinhibition effect can go both ways, and it is important to consider what works for one person may be incredibly unhelpful to another. Understanding and knowing how to work with online disinhibition is a crucial part in therapeutic online training.

Video counselling helps, but it might not be for everyone

Video conferencing for mental health support has its limitations. Not everyone has the means to engage in this type of support, nor is it to everyone’s taste.

But video conferencing software does appear to act as a solution to barriers that many clients and practitioners face. It can be a more affordable, accessible, approachable and convenient way to help those who are seeking mental health support, whilst still being able to foster a strong relationship between professional and person. Perhaps with the right training and support for practitioners getting more familiar with this way of working, mental health support can reach more people and therefore be more accessible.

So, yes. It may not be the same online, but it can be a very effective alternative.


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