I’ve heard people say online counseling doesn’t work.
I’ve heard it too—for many years now. In fact, when I got my counseling degree (about 15 years ago) my professors took all of two minutes to dismiss it as “something that will never catch on…” I guess they didn’t anticipate COVID-19. To the larger question, though: does it work? Have there been any scientific studies to actually provide evidence about that? I cannot go into great detail but here are three recent studies: 
A 2014 study published in The Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
A 2018 study published in The Journal of Psychological Disorders found that online cognitive behavioral therapy is, "effective, acceptable, and practical health care." The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
A 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
I could go on with recent research but you get the point. The claim that online counseling doesn’t work is not true. No doubt there have been many who practiced it poorly and even unethically, but that doesn’t mean the method itself is the problem.
I don’t want my personal problems on the internet!
Most of us hear stories all the time of identity theft, of foreign hackers in data bases and social media abuse. Maybe you’ve even been warned, “if you put it on the internet, everyone can see it.” Why would anyone even think about sharing their deepest and often darkest secrets in such a venue? Let’s think about this fear, however. Let’s consider that the actual issue is the security of our information and how protected it is, not just the way it is communicated. So, if online counseling is not digitally secure, it is very correct to worry that anyone could find it.
It is for this reason that special online technologies have been devised. Your mental health is not the only kind of privileged information out there. Consider what banks and financial firms have to protect—not to mention hospitals and insurance companies. Because information security is so important, I’ve developed a whitepaper on the key legal, ethical and practical considerations for online counseling, titled, Protecting Personal Information in Online Counseling.
I want to be with a real counselor not a digital one!
This is probably the problem that ranks highest for me—both as a counselor and even at times a client. You get my point, I’m sure. I was thinking about my birthday during COVID-19. If you asked me last year would I rather have a “real” party with family and friends in the room or a virtual party on Zoom, there would have been no contest! But since my birthday came at the height of the stay-at-home order, that was not an option. And, to be honest with you, I was just happy to have them all in the Zoom gallery that day.
I think this is very comparable to real vs. digital counseling. While most everyone would prefer face-to-face, there are many times circumstances will not permit it and digital options are better than none at all. To make online counseling effective it has to be conducted correctly and respectful of the unique challenges of the medium. I’ll talk about trust in a moment, but let me say here that an effective online experience requires some additional skills not always utilized in face-to-face sessions. For example, both counselor and client need to take more time to communicate clearly and then verify that the other person understands. In my online practice I have adopted some technological features to expedite that, including the use of feedback buttons. I will frequently ask the client to use the buttons and scales to give honest nonverbal feedback during our meetings.
How can I trust a counselor I have never met in person?
Whether you realize it or not, you rely two or three times as much on what a counselor does not say than what he or she does. That is true of the counselor and you also. It’s because we depend so much on what experts call “nonverbal communication.” In other words, we communicate and understand by such nonverbal cues as facial expressions, posture, tone of voice, and other subtle messages. Most of the time we are not even aware we are doing it. I say it this way, 70-80% of conversation is not what we say but who we are. What happens to conversation when we are doing it on a computer screen instead of in an office? This is especially true when we’re trying to determine if we can trust someone. We rely more on these nonverbal cues than even their words.
All this internet stuff stresses me out. I don’t really understand how it works.
During the height of the COVID lockdown I was involved in daily Zoom meetings often lasting several hours. Like the others, I was just sitting in my home office! I hadn’t driven anywhere in my car for a couple weeks and the only people I saw in person were my wife and daughter. So, why, after a Zoom meeting was I so exhausted! I coined the term “Zoom Fatigue” to describe it. Especially in the early days of the pandemic we were being pommeled with fear and bad news every day. I remember my first trip to the bank to make a deposit, worrying about even touching the deposit slip after the teller gave it to me. In other words, there was a lot of stress brought on by all the unknowns. I also remember my first time hosting a Zoom meeting. I had attended them before but never hosted. And some of the people who were attending couldn’t get into the meeting. I found that enormously stressful.
This is the thing: if you are not real comfortable with digital technology anyway, the thought of doing counseling online seems more stressful than just doing nothing. I understand that, believe me. There are lots of biological and psychological reasons I could give you why we react this way, but all I will say now is, “I get it!” However, that reason is not a good excuse, simply because the stress that is burdening you enough to need counseling to begin with is much, much worse than the “internet stuff.” To accommodate online clients who get easily confused or frustrated by all the unknowns of the media I have instituted certain procedures during online sessions—such as talking on the telephone first if necessary so we can talk about how to get into the online appointment not just try to figure it out themselves.
 Retrieved at https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201911/does-online-therapy-work
J.E. Rose, LPC
Jim Rose is an ordained minister, licensed professional counselor and the director of Fortress Institute.