Disadvantages of Remote Therapy and Online Counseling

While it can be argued that there are plenty of benefits to remote therapy it can also be argued that there are plenty of disadvantages. Some of the disadvantages I’ll discuss in this post are just inherent to the “remote” situation, as it will never be the “same” as in-person.

However, there are still disadvantages to Tele counseling that are worth discussing and bringing attention to. Some of these disadvantages can be “improved”, and are inherent to the therapist’s or client’s “less than optimal” setup. But, as I will discuss, some of them are not.

I’m a big fan of remote work and remote therapy, but I think it’s important to play “devil’s advocate” and discuss some of the potential downsides to remote psychotherapy (maybe that’s my “inner Philosophy” undergrad screaming). Either way, I’m going to break down what can be considered the disadvantages of accessing therapy remotely, because it’s not all “sunshine and roses”, even though Tele counseling research is showing it to be an effective format.

Stuart Cameron MSW, RSW posing for disadvantages of remote therapy featured image

Insurance Companies May Not Remote Therapy

While this is becoming less common, some people’s insurance coverage and employee benefits may not cover services that are remote. COVID-19 has “helped” make this less common, and now, people’s insurance and benefits typically care most about the designations of the service provider, such as:

  • MSW, RSW
  • R.P
  • Psychologist
  • Mental Health Counselor
  • Psychiatrist

But it’s still in your best interest to check with your insurance and benefits provider before booking therapy to see what you are covered for to ensure you will in fact receive reimbursement if it’s available to you.

Some Provinces and States Don’t Allow Out-of-State/Province Providers for Remote Therapy

Remote therapy can still have geographical limitations. For example, I am a Registered Social Worker in Ontario, which means I can only see clients who are living in Ontario.

It’s kind of a weird “beauracratic rule” because I’m actually able to “be anywhere”, so as long as the client is in Ontario, I can be on a beach in Hawaii and it will still be deemed “legal” according to the rules.

Remote therapists do have the ability and opportunity to register themselves with other colleges in other Provinces and States. Sometimes it’s free to do some and a fairly easy process, but other times it might not be worth the time and costs due to the other colleges’ registration requirements.

Issues With Confidentiality, Privacy, and Unreliable Technology

An in-person therapy office allows for a confidential meeting to take place in comfort and safety. If people are in abusive or controlling relationships, remote therapy at home may not be an option. And even if it is an option, people can still have lingering and intrusive thoughts that someone in their house in “listening in”.

Unreliable technology is a big disadvantage of remote therapy. This is especially true when people rely on wireless connections for their online counseling sessions. Few things ruin the therapeutic alliance between a therapist and client than having to constantly deal with “can you hear me now?”.

However, technology is constantly progressing, and we will likely see a surge in satellite internet over the next decade. This will hopefully offer accessible and affordable offer high-speed wireless connections to almost anywhere in the world.

Stuart Cameron MSW, RSW demonstrating his remote therapy internet setup
I run ethernet from my modem outside to directly connect to 1 Gigabit Fibe internet in my detached garage’s router, then run another ethernet cable to my desktop computer (please excuse my cable management, it’s a work in progress).

And when it comes to privacy, it’s best to remember that nothing on the internet is one hundred percent secure. Nothing. Although popular therapy and Tele health platforms like Jane.app use encrypted servers, they will still never be 100% secure.

However, the same can be said for paper notes locked in a therapist’s in-person office.

And almost all of our data these days in different sectors, such as:

  • financial
  • healthcare
  • government
  • legal
  • personal

is stored on digital databases that are technically “at risk”. Of course, extreme efforts and safeguards are put in place to ensure security and confidentiality.

I don’t want to “paint a picture” that our data is easily accessible and always being intruded on. I just like to really stress this point as it’s important to be aware of when consenting to any service.

Countries like Estonia, for example, have actually converted their entire government services onto a cloud-based solution and have yet to be compromised by a security threat since the early 2000s.

The Lack of Response to Crisis Situations in Remote Therapy

With remote therapy, there will be less opportunity for therapists to help their clients during a crisis situation. Something like a client having a sudden health condition (e.g., heart attack) that requires immediate attention for their client will leave the therapist with fewer options to respond.

The best practice for any Tele health situation is for the service provider to confirm the clients’ location as soon as they start their session. This will allow them to be more effective if they need to pass on information to emergency response units.

Remote Therapy Is Not Appropriate for Serious Psychiatric Illnesses & Mental Health Challenges

Online counseling is not ideal, and should not be used, for people experiencing complex and serious psychiatric issues. It can be helpful and appropriate after a client or patient has already received care and made progress and can offer easy and convenient opportunities for “check-ins” on progress. However, remote psychotherapy should not be the first choice for handling complex issues from the beginning.

The ideal situation is that the people who are experiencing these more complex issues and challenges are able to receive immediate and ongoing support until they make progress and recover.

Remote Psychotherapy Overlooks Body Language

Body language is a very important aspect of many therapeutic approaches and is something every therapist pays attention to during a session. Remote therapy, however, typically only displays the top half of our body.

As a remote therapist myself, I look directly into my webcam so that my clients experience a more “in-person feel”. This means, however, there are times when I am not entirely attuned to body language, and it presents opportunities to miss important information during an online counseling session.

There are starting to be solutions to this issues, however, with technology like the “center cam”. It allows a small webcam to be placed at the centre of a person’s computer monitor.

Stuart Cameron MSW, RSW demonstrating using a standing desk for remote therapy
I will point out that I love the benefits of using a standing desk during some of my sessions, but it would be so awkward in person!

Unqualified Providers Are More Prominent With Online Counseling

Every service online has this inherent issue, as the internet makes falling prey to scams and misinformation really easy. When people are looking for remote-only psychotherapists, the number of available counselors goes up exponentially, but so does the opportunity for unqualified “people “scammers”.

By unqualified providers I mean people who are not professionally trained to deliver mental health services and/or who do not have certification. They may also be people who were once qualified but have recently been suspended or “terminated” from being allowed to provide mental health services and the internet allows them to hide this information from the people searching.

This becomes a critical issue for liability and legal reasons, because part of being a qualified mental health service provider means being regulated by something like a college whose job is to protect the public. This is part of every profession, and public citizens have the right and opportunity to “complain” to the regulatory bodies that oversee the profession.

So always do your “due diligence” and look for common qualifications such as:

  • Psychiatrist
  • Canadian Certified Counsellor
  • Registered Psychotherapist (Qualifying)
  • Registered Psychotherapist
  • Registered Social Worker
  • Psychologist

Please note: the above designations are specific to Canada. It is in your best interest to check which designations qualify for and are regulated for mental health services.

Female using virtual reality for psychotherapy exposure therapy

Final Thoughts

Remote therapy has its own unique downsides, there’s no “beating around the bush”. Depending on your goals and intentions with therapy, it may not be the right choice for you, and that’s ok!

Remote work allows for a lot of convenience and flexibility for therapists, and sometimes that pairs well with psychotherapy. But sometimes, sitting down in person next to a real human being is what is needed most, and remote therapy can’t capture that aspect.

Perhaps one day in the next decade or two virtual reality will get to a place where we can almost not tell the difference between in-person and “virtual”, but that will come with a whole host of new problems for how we experience life and our world. But it may also allow for a better remote psychotherapy experience, and that’s my hope as the technology around us continues to improve.

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