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14 Mar 2003

Cybertherapy vs Psychotherapy
Good afternoon Cybershrink,

It is Evette here again - with the assignment on Cybertherapy.

The context of this assignment is the prediction that was made by a panel of psychologists and psychiatrists that CBT and Cybertherapy will become the treatments of choice.

From your response to me, would you say that a cybertherapist does actually need some form of linguistic training? To me that makes sense as the therapeutic setting has changed and the therapist cannot rely on the usual cues in addition to the verbal description of the problem.

Furthermore not only does the availability of technology hamper the distribution of this type of mental health service but also the levels of education and literacy for a large number of the SA population.

In USA they have gone as far as setting up Cybertherapy ethics for councellors - to prevent fraud (laymen posing as counsellors) and to protect the counsellor or psychologist legally as well.

I think this type of service has a place in the general realm of psychotherapeutic techniques and that it will also serve as an introduction to the psychotherapy and assist the client to build a relationship with the cybertherapist of choice.

What does pose a problem with the relationship building is that a psychologist is not able to earn an income unless he/she refers the clients to their own practice. Surely that would not be unethical?
Of course you would find individuals that could abuse this service from both ends - do you think that PsySSA should take the lead in setting up standards and a code of conduct for Cybertherapy - there seems to be a large market for it - even though internet access is restricted?

What is your opinion on: the way the world has changed that the Internet has become an essential ingredient of a normal way of living. Now to keep up with the changes in the world/society counselling is now available online - are psychologists/psychiatrists that offer this service not in fact supporting and maybe sustaining the symptoms of our already rushed, instant satisfaction culture that lead to individuals logging in in the first place?

Would you say that it is because of the instant satisfaction culture that CBT and cybertherapy alongside certain distance therapies will possibly become the treatments of choice as opposed to psycho- analytical techniques?

I have now really asked a lot of questions. Would it be better to make telephonic contact?
I do not want to take up time that could be spent assisting others - however I think I am now experiencing some of the benefits of cybertherapy!!

Looking forward to hearing from you.

Kind regards,

Answer 540 views

01 Jan 0001

Some further thoughts, there have never ever been good grounds for recommending or providing psych-analytical services, as, after all these years, there is still no good evidence that this extremely expensive means of treament has any reliable benefits in any conditon whatever. I consider analysts as working in a similar category of work to call-girls --- for a hefty fee, they provide at most and at best some marginally intelligent conversation.
If one believes that evidence-based therapeutic choices are preferable, then there is never an occasion when analytic methods can be chosen, as the evidence is simply not there. For CBT, and some of its variants, there is suficient evidence to proceed, for the time being, by considering such methods to be reasonably likely to be beneficial. It is more fruitful for unhappy people to play video-games than to see a psychoanalyst.

I think you are exaggerating the limitations imposed by technology distributon. Much could be done, if the govt were actually serious about encouraging it, to greatly increase access ; but it is already far more readily available to ANY SA citizen, tan psychotherapy ; and enormously more easily and cheaply available than analytic therapy ( could you send me a list of psychoanalysts practising in the townships and rural areas ? It wouldn't take up much space, would it ? )
I think better linguistic training would b benefical for all therapists, and ahree that it is particularly useful in this form of work. For instance, anecdotally, not long back we received a long and rambling message from someone, which hadly asked any clear question. But it was clear from linguistic and other internal clues ( including it's having been posted at 3am ) that the sender was in a marked manic phase, and needing re-adjustment of medication, as indeed proved to be the case.
I agree that there are far larger ethical problems routinely ignored by the Health Professions Councl, which deserve their attention long before they consider whether referral patterns in cybertherapy and cyber-advice might raise problems. I know of cases of doctors who were markedly demented, constantly drunk, and involved in massive medical aid fraud, all of whom were ignored by the Council, while it worried about the correct dimensions for a brass plate placed outside a therapist's offices.
I would worry about the settng of standards for such cyber-services, on the basis of so much bad experience of the self-serving nature of the standards that get set. Maybe it'd be better in the hands of PSYSSA ( if they also involved a few relevant psychiatrists ! ) tan in the highly unrepresenative hands of the Health Professions Council. It'd be tragic if the HPC messed up this field as they have messed up the issue of Continuing Professional Education, turning it from a genuinely educational idea into a license to print money for crtain individuals and organizations, to charge exorbitantly for sub-standard "educational" exercises, wih no relevant quality control, and not a shred of evidence that complaince with the regulations in any way improves quality of patient care, or that non-compliance in any way related to poor quality of care.
I'm not sure that cyberservices in mental health particularly encourages the existing keenness for instant gratification, except by comparison with secialist services, where patients are routinely asked to wait months for an appointment. What we provide is hardly instant gratification. We provide an opportunity for people to ask questions and seek advice whenever they feel able to make that step forwards ( often after "lurking" on the Forum for a while, to gain confidence in the system ) and to receive a reasonably prompt response. But wat maters is the nature of the response. WHere they receive information, questions, and suggestions for further consideration, thought, testing, and challenging, it's not instant gratification, but an early start of seeking solutions in a manner more likely to be successful than alternatives.
I don't post my phone number here, for obvious reasons, but if you contact my colleagues at the Health24 offices, such as Mari, she'll be able to give you my number, knowing that I have authorized this in advance.
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