The Benefits And Challenges Of Online Therapy

Online therapy options are still comparatively new and have not yet been scientifically researched to the same extent with regard to their effectiveness and possible risks as the classic structure of psychotherapy with exclusively personal therapy sessions face to face.

Possible Advantages Of Online Therapy

In this way, more patients could receive psychological support and the waiting time for a therapy place could be reduced. Therapists need to spend less time with online therapy than with face-to-face therapy to achieve the same improvements.

For example, the therapist emails the patient feedback once a week. As a result, a therapist can look after more patients at the same time, which benefits patient care and can shorten waiting time for a therapy place. Ultimately, this can contribute to cost savings in the healthcare system.

Access For Patients Who Can’t/Don’t Want To Do Any Other Therapy

Patients who otherwise can’t or don’t want to take part in psychotherapy can also be reached via the Internet. These can be patients for whom the journey to a therapy practice is very long or who can’t come to the practice themselves due to physical limitations. There may also be patients who are currently unable to come to a psychotherapeutic practice because of their psychological complaints (e.g. severe fears or obsessive-compulsive symptoms).

There may also be people seeking help who do not want to do psychotherapy because of shame and fear of stigmatization. Therapy can also take place anonymously via the Internet. In addition, online therapy offers can address new target groups, for example, adolescents and young adults, who often have a great interest in digital media.

Finally, online therapy can be a first step in which the person seeking help can gain experience with psychotherapy. As a result, some patients may also decide to continue working in face-to-face psychotherapy.

Specific Offers That Would Not Be Available Otherwise

Because online therapy can also take place over long distances, it gives patients who want to find a therapist the opportunity to use very specific offers that are not available in their immediate vicinity. In this way, patients with a different cultural background can use culturally sensitive offers or find offers in their mother tongue that are not available in their immediate vicinity.

Diversity And Flexibility

Theoretically, there are endless possibilities of what online therapy offers can look like and how they can be combined with conventional psychotherapy.

In this way, the type and extent of therapeutic support can be individually tailored to the symptoms and needs of the patient. For example, more appointments in the therapist’s office can be offered if the patient needs more support. As he gets better and needs less support, a transition to more online therapy can take place.

At the same time, internet-based approaches offer many opportunities for a patient to work intensively on changing their problems between therapy sessions. Each patient can decide for himself how often and how intensively he works on his problems.

In addition, he is flexible and can work on the tasks when it suits him best. If the communication between therapist and patient takes place in writing (e.g. by e-mail), this has the advantage that both can calmly think about what the other person has said and about what they themselves would like to write. In this way, a patient may be able to describe his problems, his current condition, his feelings, etc. better than if he had to do this spontaneously in the therapy session.

Sense Of Self-Determination

Because patients work more independently in online therapy than in conventional psychotherapy, they have a stronger feeling that they have achieved their success themselves and not with the help of a therapist. This can be very motivating to keep working on overcoming your problems.

Possible Disadvantages And Risks Of Online Therapy

A disadvantage of online therapies is the lack of non-verbal communication, as the therapist and patient do not sit directly opposite each other. Without the physical presence, non-verbal signals of communication such as facial expressions, gestures, voice pitch, and posture are missing. This makes it easier for misunderstandings to arise. These features are also important for making an accurate diagnosis and assessing the current condition of the patient.

This is more likely to be the case with video calls. However, the person would be limited to the camera only and the therapist does not see, for example, how the patient moves, how he enters the room, etc. The transmission of full-length views at least promises the potential for improvement with regard to the use of video calls on the part of the therapist by positioning a webcam accordingly.

In purely written communication, there is also no direct exchange, which means that the interlocutor can react immediately to what has been said or the behaviour of the other person. For example, in written communication, it is more difficult to provide immediate comfort or an immediate understanding, empathetic response.


The Federal Chamber of Psychotherapists (BPtK) demands that the diagnosis of the mental illness should always take place in direct contact between the specialist and the patient. The patient should also be informed about the procedure in the therapy and possible risks as well as his consent in direct contact. In this way, the patient can be comprehensively informed verbally, and questions can be answered directly.

If an online offer does not include this procedure, a person seeking help should first have their problems clarified in a psychotherapist’s consultation hours before starting therapy or a self-help program via the Internet.

If online therapy is carried out exclusively in writing, it is important for the therapists to express themselves clearly in order to avoid misunderstandings.

Dealing With Crises

Another problem with online therapies can be providing sufficient support when the patient is in crisis. On the one hand, it is more difficult for the therapist to recognize whether the patient is endangering himself or intends to kill himself if the communication takes place exclusively via the Internet. On the other hand, even with online therapy, a patient must know where to turn in the event of a crisis. In addition, a contact person must also be available here in a timely manner.

Therefore, it is therefore important that the therapist continuously monitors the patient’s symptoms and condition, even during online therapy, in order to recognize crises and prevent self-harm or suicide. Furthermore, it should be clarified at the beginning of the therapy where the patient can go and what he can do if he gets into a crisis. In any case, he should know how to reach his therapist in an emergency or who else to turn to.


An important aspect of therapy via the Internet is data protection. For example, sensitive data from psychotherapy should be specially protected and not accessible to third parties. In addition, the patient should be able to decide for himself how his data is used.

To ensure this, it is important that all components of online therapies (e.g. emails, video calls, questionnaires that are filled out online, or health apps) are encrypted to a high technical standard. In addition, patients should be informed about what data is collected and stored, who has access to it and how they can have the data deleted. After all, every participant in online therapy should know that on the Internet in general – including therapy via the Internet – 100% protection of data cannot be guaranteed.

Quality Of The Sessions And Qualification Of The Specialist

One problem with online therapy is that you can’t always check the qualifications of the specialist. While some services use psychotherapists or medical specialists, other programs only use support staff who may have received only brief training.

The extent of support from a therapist can also vary greatly in online therapies. For example, the support for some programs consists only of motivating the participants to continue participating in the program and possibly also to answer questions.

If the participants in online therapy do not feel sufficiently supported, overwhelmed with the tasks, or badly advised, they may drop out of the program. In addition, they may develop a negative attitude towards psychotherapy and are then no longer willing to use other therapy options (possibly including face-to-face therapy).

A possible solution is to set clear quality criteria for online therapies and to mark offers that meet these criteria in your own way.

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