I have been an online counselor for personal and relationship problems since 2010, having worked with more than 1000 clients from the U.S. and over forty other countries. Although counseling/therapy in an office setting is still standard practice in the mental health professions, that is changing, and research indicates online aid is as effective as the traditional approach.
My experience highlights several distinct advantages of online help. Most people with personal or relationship problems neither seek nor need psychotherapy. Short-term counseling, often one session of 30-60 minutes, is perfectly adequate for the approximately 50 percent of my clients who have a crisis with a lover, spouse, child, parent, sibling, co-worker or boss. They might be confused, anxious or depressed, but these emotions are situation-specific. They just have no one they can confide in who is empathetic but capable of providing evidence-based advice—as opposed to expressions of their own biases (i.e., “I would ___; you should too.”)
About 30 percent of those I have counseled have long-standing psychological or interpersonal challenges but indicate an aversion to discussing them without the anonymity that online counseling can provide. For example, I had two clients who self-diagnosed as psychopaths. Both were respected members of their communities, one a health professional. They swore they never would harm anyone despite wishing for that, but wanted to discuss their total lack of empathy for other human beings and how to manage it in their thoughts and actions. Yet another client, from a small town where everyone knew each other, was struggling with the realization she was in love with her fraternal twin sister.
Most common in requiring anonymity are clients with sexual issues, e.g., a fetish, such as cross-dressing or infantilism; erectile dysfunction; concerns about their sexual orientation or whether they are transgender; fears about sex addiction; or, sexual desires, such as pedophilia, which could put others and themselves in danger, who want to cope with their sexuality responsibly and safely.
Perhaps 10 percent of those seeking my help live in societies or communities where their lifestyles, values, and aspirations, while accepted elsewhere, cannot be freely expressed. I have counseled gays in Nigeria, Saudi Arabian females oppressed by rigid gender roles, and Americans rejecting religious beliefs their families and friends presume they embrace (e.g., Mormonism, evangelical Christianity).
A final 10 percent are suffering from severe psychiatric conditions, e.g., schizophrenia, bipolar disorder, major depression, and crippling anxiety. They require medication only a psychiatrist should provide. However, while drugs can eliminate or reduce symptoms, they don’t provide coping skills. An online counselor can be readily available to handle the ongoing and unexpected problems of daily life for these individuals once their symptoms are controlled, such as helping address ruptures in social relationships frequently caused by the onset of the underlying disorder.
Critics of online counseling observe that not being able actually to view the person being helped can often limit one’s assessment of specific issues. This can be true, but, when anonymous, clients can be brutally candid about their perceived appearance if they believe it plays a role in their problems. As for reading body language, and sometimes noting a discrepancy between a client’s self-report and actual emotions, online counseling is at a disadvantage. However, anonymity removes the need to mask true feelings.
While it’s risky to draw generalizations, even from the large number and diverse kinds of clients I have worked with, I do find specific issues arise with high frequency. Among these are fears romantic partners are having affairs, often based on “discoveries” of their social media activity. Also, more than a few men are plagued by largely unfounded beliefs that they are sex addicts. Finally, “social anxiety” among young adults, which is both a cause and effect of the increasing reliance on texting as a substitute for face-to-face interaction.
Online counseling is not appropriate for everyone. Those who are suicidal are better served by calling dedicated hotlines available 24/7 in many countries. Ironically, this widely lauded life-saving service also does not involve face-to-face contact, though calling local police or going to an emergency room might be the best option when the stakes are so high.