Online therapy - effective but risky

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Psychotherapy online instead of in the practice? The internet offers new treatments for mental illness. But it also brings risks.
In fact, his psychotherapy was long since finished when Harry G. * moved to the other half of the globe as a development worker. But then he was ambushed, kidnapped and tortured there. That's why he asked his therapist in Germany to remotely resume therapy for his post-traumatic stress disorder - via Skype.

"Mr G. had no chance of getting qualified treatment in his country of residence," says Dr. Bruno Waldvogel, Vice President of the Chamber of Psychotherapists (PTK) Bavaria. "We could only carry out the therapy on the basis of our trusting relationship and with the help of the new media," he explained.

Because in Germany the PTK only allows treatment without personal contact in exceptional cases. As a result, online therapy is available to very few, although it may be helpful. Experts are currently discussing the benefits and risks of online therapies - and their potential to complement conventional psychotherapy.

High need for therapy

Because the problem is that conventional therapy - with regular, face-to-face meetings - does not currently cover the need. In Germany, more than 30 percent of the population suffer from mental illness. Many of them are not treated therapeutically: some cannot go to a practice for geographical or organizational reasons, others feel too shame. In some places, however, they also have to wait months for a treatment place.

“That not only leads to personal stories of suffering, but also to an economic problem. Because many mentally ill people are unable to work for long periods of time, ”says Dr. Nikolaus Melcop, President of PTK Bavaria. So there is an urgent need for alternatives, such as online therapies.

Bridging bottlenecks

Online therapy has already established itself successfully in many countries, for example America, Australia and the Netherlands. More than 100 studies show that it is effective at least in the short term for certain diseases: "It helps against anxiety disorders, post-traumatic stress disorders, mild depression and body-related disorders," explains Malcop.

The use of the Internet for psychological treatment has many advantages, such as availability: "In some cases, the Internet is the only way to reach people, for example in crisis areas," says Malcop. In addition, the Internet offers more anonymity and could lower the inhibition threshold for many people to seek therapy. Online treatment can also be useful as a supplement to bridging therapy interruptions or as follow-up care after a stay in hospital.

Difficult non-verbal communication

But the internet also carries risks. Data protection is one of them. Because the sensitive data should not fall into the wrong hands. The PTK experts therefore advise against explaining psychological problems online or by e-mail.

In online communication, no or only a few non-verbal features can be perceived. This complicates both diagnosis and treatment. In addition, the addictive potential of the internet must not be ignored. Of course, the professionals want their treatment to avoid causing other mental disorders.

Instructions from the professional

It is precisely because of such disadvantages that it is important that online therapies are carried out under the guidance of trained therapists and that they remain an exception, according to the PTK experts. “From a therapeutic point of view, personal therapy is always preferable. We would only like to offer online therapies if external circumstances such as severe physical illness or extreme agoraphobia prevent someone from leaving the house, ”says Waldvogel. Or for stays abroad like with Harry G.

Personal contact is irreplaceable

He was lucky that he had good contact with his psychotherapist, who was also at his side online. For most people in Germany, on the other hand, it is difficult to get help at the click of a mouse, because online therapies are rarely offered here for legal reasons. If at all, those affected can take part in studies or model projects. Those who are on waiting lists for psychotherapy are often invited as test subjects.

The PTK experts advise anyone with psychological problems to contact a psychotherapist as soon as possible - even if it only works via waiting lists and takes several months. They warn against blindly trusting any offers on the Internet. "Those affected should carefully weigh up which data they want to disclose for which benefit," says Waldvogel.

In Germany, the mills often grind slowly. It is still unclear whether and when a safer and effective online therapy will be available here. At least the PTK now allows unconventional therapy to be carried out without personal contact in exceptional cases. So if you - like Harry G. - already have good contact with a psychotherapist and would like to be treated online, you can discuss this possibility with your therapist.

* Name changed by editorial staff

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