What is online counseling, (also referred to as “e counseling”, “e therapy”, internet therapy, distance therapy, or telemental health) and does it work for expats? This is a relatively new field, although not as new as some might think. The American Psychology Association (APA) has recognised online therapy since 1995. There is now a body of research which shows that both clients and therapists view online counseling as effective as face to face (FTF) counseling, particularly for anxiety, depression and eating disorders. There is even an academic journal, the CyberPsychology Journal which reports such research.
The above terms have been used to refer to counseling or therapy using email, online chat, internet telephone and video conferencing. I use online therapy almost exclusively with Skype, with phone as backup if the internet is down. I find that counseling with video conferencing lends itself particularly well to working with expats who might be posted in a place where there is little or no access to a qualified English speaking therapist.
Most expats, it is safe to say, are typically Type A personalities. They usually have high powered jobs either as diplomats or senior executives in multi-national corporations. Their spouses, we find, also tend to be Type A personalities. One of the characteristics of a Type A person is a perfectionistic streak, which frequently leads to anxiety as it’s impossible to be perfect. We’re just not built that way. Pleases see my article on this site, The Expat Perfectionist; Top 10 Tips for Withdrawl.
Many expat spouses report feeling that everyone seems to have it all together except them. So there is a value placed on appearing to be strong, self-reliant, and a super mom (or dad) in the expat community.
Many of these spouses left their own high powered careers to follow their husbands or wives overseas. As it is often difficult for a spouse to work abroad, this can result in a loss of identity which can sometimes lead to feelings of low self-esteem and depression.
The literature as well as my own experience supports the fact that online therapy is as effective as FTF therapy when dealing with anxiety, depression, eating disorders and relationship issues. I have found there to be no difference in the quality of my relationships with my clients using Skype. Research has shown that the quality of the relationship between client and therapist is the single most important variable in predicting a positive outcome of therapy.
I have also had success with online marriage counseling using Skype. It is interesting to note that in order for us all to see each other, the husband and wife must sit close together. This in itself can result in a re-bonding, or bring to light what is uncomfortable about being in close proximity to one another, which is grist for the mill.
There are some issues that do not lend themselves to online therapy. Psychosis, such as paranoia, and suicidal thoughts and feelings would not be appropriate for online therapy as there might not be enough back up support for the client.
But for most of the issues which expats deal with, I have found online counseling with Skype to be supportive and highly effective. In other words, it works!
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