Online counseling

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Online counseling

Online counseling is the provision of professional mental health counseling services through the Internet. Services are typically offered via email, real-time chat, and video conferencing.[1] Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling, and a growing number of clients are using online counseling as a replacement for office visits.[1]

While some form of tele-psychology has been available for over 35 years,[2] the advent of internet video chat systems and the increasing penetration of broadband has resulted in the continuing growth of online therapy. Some clients are using videoconferencing, live chat and email with professional psychologists in place of or in addition to face-to-face meetings.[2]


In 1972, computers from Stanford and UCLA simulated a psychotherapy session that was considered the very beginning of online counseling.[3][failed verification] At the time the internet went public,[further explanation needed] this launch went hand in hand with the development of the first self-help groups on the internet who were, in that time, very popular.[citation needed] In 1995, Martha Ainsworth began searching for a competent therapist because she had some psychological complaints. Her travel requirements made it difficult for her to consult a face-to-face therapist, and she therefore searched for an effective alternative online, but only found a dozen webpages that offered online treatment for psychological complaints. Afterwards, Martha Ainsworth wanted to reach the general public with her experiences and founded a sort of clearinghouse for mental health websites, named Metanoia. This database seemed to be a very efficient store-room and by the year 2000, this clearinghouse contained over 250 websites of private practices, and more than 700 online clinics where a therapist could be contacted.[4]

According to, the first service to offer online mental healthcare was "Ask Uncle Ezra", created by staff of Cornell University in 1986 for students.[5] By mid-1995 several fee-based online services offering mental health advice had appeared.[5]

Between 1994 and 2002, a group of trained volunteer crisis counselors called "Samaritans", began providing suicide prevention services via email.[6]


Online counseling is filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents, people with disabilities and expats, along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities.[2]

Online counseling has been shown to be effective for clients who may have difficulty reaching appointments during normal business hours,[7] while decreasing the number of missed appointments for in-person therapy.[8]

Medical uses and effectiveness[edit]

Although there is some preliminary support for the possibility that online counseling may help populations that otherwise underutilize traditional in-office counseling, the question of the effectiveness and appropriateness of online counseling has not been resolved.[2]

Mental health[edit]

Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level.[9] J. Suler suggests that people functioning at a particularly high level, and who are well-educated and are artistically inclined, may benefit the most from using text-based online counseling to as a complement to ongoing psychotherapy.[10] Severe situations, such as suicidal ideation or a psychotic episode, might be better served by traditional face-to-face methods,[11] although further research may prove otherwise.[2]

Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.[12]

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition.[2] Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.[13]

Nutrition counseling[edit]

Nutrition counseling specific to conditions is available by many consultants online using Skype or another face-to-face program. This is especially effective for people with a busy work schedule, and others who can't make it to an office regularly. Online consulting for imbalances in blood lipid levels, blood sugar regulation, and other health conditions make it easier to manage when using nutritional approaches.[14][15]

Smoking cessation[edit]

The effectiveness of real-time video counseling for helping people to stop smoking is unclear. Only few studies compare video and telephone counseling.[16]

See also[edit]


  1. ^ a b Mallen, Michael J.; David L. Vogel (November 2005). "Introduction to the Major Contribution Counseling Psychology and Online Counseling". The Counseling Psychologist. 33 (6): 761–775. doi:10.1177/0011000005278623. S2CID 145615146.
  2. ^ a b c d e f Mallen, Michael J.; Vogel; Rochlen; Day (November 2005). "Online Counseling: Reviewing the Literature From a Counseling Psychology Framework". The Counseling Psychologist. 33 (6): 819–871. doi:10.1177/0011000005278624. S2CID 145429569.
  3. ^ Skinner, Ardiran; Zack, Jason (2004). "Counseling and the Internet". American Behavioral Scientist. 48 (4): 434–446. doi:10.1177/0002764204270280. S2CID 72558492.
  4. ^ Alleman, James R. (2002). "Online counseling: The Internet and mental health treatment". Psychotherapy: Theory, Research, Practice, Training. 39 (2): 199–209. doi:10.1037/0033-3204.39.2.199.
  5. ^ a b Ainsworth, M. "E-therapy: History and survey". Retrieved 22 May 2014.
  6. ^ Zack, Jason; Stricker, George (2004). Kraus, Ron (ed.). Online counseling: a handbook for mental health professionals. Amsterdam: Academic. ISBN 978-0124259553.
  7. ^ Change, T.; Yeh, Krumboltz (2001). "Process and outcome evaluation of an on-line support group for Asian American male college students". Journal of Counseling Psychology. 48 (3): 319–329. doi:10.1037/0022-0167.48.3.319.
  8. ^ Glueckauf, R.L.; Fritz; Ecklund-Johnson; Liss; Dages; Carney (2002). "Videoconferencing-based family counseling for rural teenagers with epilepsy". Rehabilitation Psychology. 47: 49–72. doi:10.1037/0090-5550.47.1.49.
  9. ^ Stofle, G.S. (2001). Choosing an online therapist. White Hat Communications.
  10. ^ Suler, J (2000). "Psychotherapy in cyberspace: A 5 dimensional model of online and computer-mediated psychotherapy". CyberPsychology & Behavior. 3 (2): 151–160. doi:10.1089/109493100315996.
  11. ^ Zelvin, E. (2004). Online Counseling Skills Part I: Treatment Strategies and Skills for Conducting Counseling Online. Academic Press.
  12. ^ Cohen, G.E.; Kerr, B.A. (1998). "Computer-mediated counseling: An empirical study of a new mental health treatment". Computers in Human Services. 15 (4): 13–26. doi:10.1300/J407v15n04_02.
  13. ^ Dongier, M.; Templer, R.; Lalinec-Michaud, M.; Meuneir, D. (1986). "Telepsychiatry: Psychiatric consultation through two-way television: A controlled study". Canadian Journal of Psychiatry. 31 (1): 32–34. doi:10.1177/070674378603100107. PMID 3512068. S2CID 27055160.
  14. ^ Mittnacht, Anne M.; Bulik, Cynthia M. (1 January 2015). "Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study". International Journal of Eating Disorders. 48 (1): 111–122. doi:10.1002/eat.22319. PMID 24976176.
  15. ^ Mittnacht, A. M. and Bulik, C. M. (2015), Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study. Int. J. Eat. Disord., 48: 111–122. doi: 10.1002/eat.22319
  16. ^ Tzelepis, Flora; Paul, Christine L; Williams, Christopher M; Gilligan, Conor; Regan, Tim; Daly, Justine; Hodder, Rebecca K; Byrnes, Emma; Byaruhanga, Judith; McFadyen, Tameka; Wiggers, John (2019). "Real-time video counselling for smoking cessation". Cochrane Database of Systematic Reviews. 2019 (10). doi:10.1002/14651858.CD012659.pub2. ISSN 1465-1858. PMC 6818086. PMID 31684699.