TILT – Therapeutic Innovations in Light of Technology
Research Review
When Em A recent study carried out by the University of Portsmouth Counselling Service, and part funded by the British Association for Counselling and Psychotherapy (BACP), has reported interesting distinct advantages for asynchronous, email therapy provision in comparison with f2f work. The study (Dunn, 2011a, 2011b, in press) gathered data from six University counselling services and 10 former clients through semi-structured electronically conducted interviews, analysed through Interpretive Phenomenological Analysis (IPA), to elucidate the experience of receiving therapy online and to investigate the impact of this modality on the therapeutic relationship. Among others items of interest, reported with rich detail in the qualitative evidence presented, recurrent themes included ‘the ability to conceal oneself’(Dunn, 2011a, p. 24), perhaps concomitant with the anonymity and disinhibition also reported, the distinct uses of text and images (e.g. emoticons, different colours or fonts, interpolating replies into a conversational ‘living document’ (Anthony and Nagel, 2010, p. 54) etc.), the value of clear, consistent boundaries and the role of fantasy. Shame and fear were mitigated by the felt possibility to “hide behind a computer screen … it gave me the confidence to tell the truth … email just gives you that little bit of distance that protects you”. Similarly, “by doing it online, I could see what they said without having to see their
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reaction … I have always found it hard to explain my feelings in person”. Counsellors concurred, while also indicating that email therapy is not for everyone: “some people have chosen online but find it too distant and want to see the therapist”. They agreed with clients, however, on the freedom inherent in cyberspace as a location for therapy where one can be “unaware even of the room or time of day … walking around and thinking about someone else’s world, with time to explore what’s important without distraction”, noting also that “Freud would have loved it – free association!” The creation of a permanent record of exchanges was considered valuable (“One of the best things about email counselling, and … that makes it better than face to face counselling, is that your [sic] can read back over the reply again and again… at different points throughout the week and in various different frames of mind. I think as a result I was able to get a lot more out of this counselling than previous face to face counselling”) as was the time to think afforded by asynchronous working, despite the obvious loss of immediacy (“the additional time allowed me to consider … if necessary i [sic] could type out a response and then come back to it a few hours/day later and rewrite it if my feelings had changed”). Reasons for choosing online work included “heightened self-consciousness and lowconfidence” possibly creating “a half-way house