The Emerging Role of E-Therapy: Online Services Proving to Be Effective

Article excerpt

Even though most EAPs today have some kind of website presence, the use of online or web-based tools for the delivery of clinical services between EAP counselors and employees is far less common (Richard, 2009). However, e-therapy is advancing as a new practice model with early users being more prevalent among Canadian EAPs (Parnass et al., 2008; Wittes & Speyer, 2009).

One reason that e-therapy is likely to continue to grow is due to the strong research support that has emerged over the last decade that provides evidence of its clinical effectiveness, particularly for common types of mild to moderate mental cases that are often appropriate for EAP counseling services. This article provides a summary of some of this research and what it means for the EAP field.

What is E-Therapy?

Technological forms of mental health and addiction treatment are now widely available and are referenced by a variety of names: online therapy, cybercounseling, e-counseling, Internet-based therapy, among others (Christensen & Hickie, 2010). Online therapy has been defined as "any type of professional therapeutic interaction that makes use of the Internet to connect qualified mental health professionals and their clients" (Rochlen, Zack & Speyer, 2004).

The majority of online therapy today takes place via e-mail. E-mail is "asynchronous," meaning that communication does not take place in "real time" but rather in delayed exchanges between client and the therapist as they respond to one another--often within several days from the last contact. The practice of online therapy using synchronous live exchanges is not as prevalent. This format takes place in "real time," often using chat-based computer interfaces (e.g., via Instant Messaging--IM) or specialized website tools (e.g., via Skype and others) for live video-conferencing sessions between client and counselor (Richardson et al., 2009).

Other applications in this area feature the interaction of multiple clients at the same time for supportive group therapy, with the interaction managed by a counselor (Griffiths, Crisp, Christensen, Mackinnon & Bennett, 2010). As a result, a variety of Internet-based approaches for the clinical treatment of mental health and substance abuse disorders offer promising alternative and supportive methods for more commonly used in-person and telephonic modalities.

Is it Effective?

Perhaps contrary to current opinion among more traditionally trained clinicians, a growing body of international research indicates that Internet-based delivery of mental health psychotherapy services is actually as effective as traditional face-to-face treatment conducted in clinical offices for many common mental health conditions. There have been more than one dozen studies using a randomized control trial (RCT) experimental research design that have tested the general clinical effectiveness of Internet-based therapy approaches (Griffiths & Christensen, 2006). There are also twice as many additional studies that have been performed using a variety of less rigorous research designs. All told, the general finding from these studies is of positive clinical results, with many on par with traditional studies of in-person therapy (see reviews by Barak, Hen, Boniel-Nissim & Shapira, 2008; Reger & Gahm, 2009; Rochlen, Zack & Speyer, 2004).

For example, in one meta-analytic review of 12 studies involving over 2,000 individual cases, the effect sizes for Internet interventions were mostly in the medium size range of 0.20 to 0.50, which is similar to that often found in outcome studies of face-to-face (FTF) therapy (Spek et al., 2007). A second example specific to EAP comes from a recent Canadian study of EAP clients who were first assessed by telephone for risk and appropriateness and then assigned to either FTF or online counseling, which found no differences in clinical outcome measures between the two therapy modalities (Murphy et al. …