Is Online Couples Therapy Right for You?

Before evaluating the effectiveness of online couples therapy, let’s first look at what couple’s therapy entails. By definition, couples therapy comes under the category of mental health counseling, with a focus on addressing the issues causing difficulties in relationships, such as limited communication skills, unsuitability, and other problems. Couples therapy seeks to repair disordered functioning in the relationship and address the difficulties behind it.

A number of models of couples-based therapy have been developed and proved successful. While not providing a comprehensive list of available couples therapy models, The Encyclopedia of Mental Disorders (www.minddisorders.com) lists the most common modes of counseling couples as:

• Conventional behavioral therapy with priority given to changing behavior, addressing communication, and troubleshooting problems.
• Psychoanalytic therapy which looks at the impact of conflicted relationships in childhood on adult relationships
• Emotionally focused therapy that develops partners’ abilities to express their feelings related to the relationship
• Integrative behavior therapy which guides couples in improving patterns of behavior and communication that have caused repeated marital difficulties
• Cognitive behavioral therapy which aims to bolster positive interactions for the partners

For Perissutte and Barraca (2013), rather than utilizing common behavior therapy models, which they consider ineffective in severe cases of marital distress, counselors should focus on helping couples to increase their tolerance and acceptance of intense feelings. But how is acceptance defined in couple’s therapy?

There are two principle aspects of acceptance in couple’s therapy. The first is known as “empathic joining” and includes the ability to discuss their painful emotions without attributing blame or holding the other responsible.

The second is called “unified detachment” which may be broadly described as developing a means for both partners to detach the self from arguments and heated discussions (Perissutte et al, 2013). This type of therapy has the most effect on couples dealing with issues of infidelity.

Until recently, online or “e-therapy” was not held in very high regard, and in some states was entirely prohibited. There are various reasons for these views, but predominantly there was debate doubt about the efficacy of online therapy when compared to in-person therapy (Heitler, 2014).

This was compounded by the fact that the majority of licensing boards refused to recognize online therapy as valid. Given that all therapists were required to be licensed in the state in which they resided, online therapy faced considerable challenges.

These restrictions have, however, been gradually lifted so that online therapy is more widely available. A simple Google search will reveal a variety of online platforms through which therapists and clients are able to converse.

This means that people are no longer restricted to therapists within their own locality and are able to access therapy at a reduced cost and with greater levels of privacy. It is convenient for people to be able to access therapy in the comfort and privacy of their own homes, both via online platforms and via email.

When it comes to couples therapy, the therapist is trained to be aware of a range of both verbal and non-verbal signals that may pass between the couple. With online therapy, this is more difficult, particularly when it comes to eye contact. There may also be distractions in the surrounding environment for both the clients and the therapist.

Some couples may attempt online therapy while their children are in the room with them, for example, and others may use a room where the whole family can hear what is being said. Such situations can cause the therapist to feel uncomfortable, even if the couple are happy with the setup. These distractions have a significant negative impact on the efficiency of the therapy, hindering progress.

Additional challenges exclusive to online therapy may arise when a couple begin a heated argument during the session and completely ignore or fail to hear the therapist on the computer screen. The therapist’s ability to mediate in such situations is diminished.

The efficacy of online therapy is reliant on the degree to which the client understands that they are in therapy despite being in their own home. It is important for boundaries and appropriate expectations to be respected.

There are some situations in which online therapy has proved to be both appropriate and effective. Attridge (2011) highlights positive results when online therapy is conducted with people who suffer from disorders including anxiety, depression, disordered eating, PTSD, phobias and panic disorders.

For individuals who are in the midst of a serious crisis or actively suicidal, online therapy is not recommended. Therapists should make clear that online therapy is only for clients who are stable enough for it to be effective.

One of the most common reasons that couples seek therapy is infidelity. Marin, Christensen, and Atkins (2014) claim that 20-40% of relationships are impacted by marital affairs, and up to 42% of marriages will result in divorce. Adultery causes an abundance of shame, distress, and conflict.

While it is somewhat difficult to adequately address these difficulties through the medium of online therapy, it is not impossible. If a therapist is able to create a connection with the couple and work on getting the clients to engage and build a rapport, it can be effective.

One area which Attridge (2011) debates concerns whether clients can gain an appropriate level of trust in the therapist through online therapy. However, many therapists would argue that although building trust and connection online is more challenging, it is still achievable.

Ethical, Professional and Pragmatic Concerns

It is indisputable that there are considerable differences between online and face to face therapy, and this has an impact on the level of connection possible between client and therapist. Additional training is needed for any therapist considering online therapy, due to these differences.

As regards ethical concerns, platforms offering online couples therapy should ensure high standards of confidentiality and compliance with HIPAA regulations (Murphy, MacFadden and Mitchell, 2008).

Some therapists may offer Skype and WhatsApp therapy options, but these are far less reliable and secure than the HIPAA regulated therapy platforms.

The question of the efficacy of online couple’s therapy remains in dispute. There is only a small body of research specifically on online couple’s therapy, while there is considerable research regarding couple’s therapy in general.

This research suggests that couple’s therapy has achieved success in helping people to work through their relational difficulties. Additionally, more couples seem to be turning to couple’s therapy now than in the past.

Expectations for Online Couples Therapy

When a couple embarks on a journey of couple’s therapy, they undoubtedly have expectations. It is important that those expectations are realistic. Online couple’s therapy is not a magical solution, nor will the therapist be able to resolve issues without effort from the couple themselves.

Rather, it is the therapist’s role to tease out the reasons behind the difficulties the couple is experiencing and help the couple to move towards change. Clients who have unrealistic expectations of therapy will generally not have outcomes that are as favorable compared to couples with realist expectations.

Couple’s therapy has been shown to have success in establishing positive changes in clients’ lives, reducing the chance of divorce and improving the overall health of the family (Tambling, Anderson and Wong, 2016). Despite these statistics, not all couples who enter online therapy will succeed, for various reasons. What is termed early, or premature termination of therapy often stands in the way of change.

One reason for early termination in couple’s therapy is due to the client’s expectations. It is vital, therefore, that therapists begin the therapeutic relationship with an understanding of what the clients expect and hope to get out of therapy.

This offers an opportunity to challenge unrealistic expectations and reduce the risk of early termination. If the client’s expectations are managed in this way, there is greater opportunity for success, because there is greater opportunity for engagement and positive change (Tambling et al, 2016).

Therapists have emphasized the importance of getting clients to reflect on both their personal goals and their goals as a couple. It is not uncommon for the two partners to enter therapy with different goals, which presents challenges for the therapeutic journey. Goal setting is an essential ingredient for a successful couple’s therapy.

Email Counseling

Can email counseling really be classified as counseling? While some therapists would argue yes, for the majority, email counseling lacks the necessary relationship building process that is essential for successful counseling.

That is not to say that therapists should dissuade clients from emailing their thoughts between sessions. These thoughts can be useful to explore further in face to face or online sessions. The effectiveness of email counseling remains unproven, and further research is necessary.