Online therapy can be described either as synchronous or asynchronous:
- synchronous – taking place in real time – examples include: instant chat, Skype.
- asynchronous – taking place over a more prolonged period – for example e-mail.
Online therapy works best when both client and therapist are comfortable with the technology being used and have easy access to it. Email is still one of the most popular forms of communication between therapist and client because it is easy to use, available to almost everyone, and very familiar.
E-mail is by far the most common form of online communication. It is accessible and easy to use. This mode of communication can be extremely efficient and is available to virtually every client and therapist. It works best for clients who are comfortable putting their feelings and experiences down in writing.
Instant chat allows two or more users to communicate together at close to real time (synchronous). This type of communication might appeal too clients who enjoys receiving a quick response from their therapist. Chat sessions can be structured in a very similar way to standard face-to-face sessions. Many therapists are able to provide a secure instant chat system.
This technology is rapidly improving and will soon provide most of the advantages of traditional face-to-face therapy. Video conferencing allows the therapist and client to see each other in close to real time. However, to be effective video conferencing requires that both therapist and client have a high speed, reliable Internet connection. This means that video conferencing may be out of reach of some clients. In addition, even with a good Internet link there is some time delay in signals and, often, image distortion, so it is more difficult to interpret facial expressions and body language accurately.
Skype is an increasingly popular technology that is widely available today. It is also relatively low cost so it is accessible to a wide range of clients and therapy providers.
Skype offers the advantage that therapist and client can hear each others’ tone of voice and other verbal cues that may lead to a clearer understanding of each other. Skype can easily be combined with a web cam to allow the therapist and client to see each other too. This brings the advantages of video conferencing, in an affordable and accessible form. However, there can be a time lag on web cam images and some clients find this confusing or off-putting because it means that it is difficult to interpret body language accurately.