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Interviewed By Juan Moisés De LaSerna
- What is an online psychological consultation and how is it structured?
An online psychological consultation or e-consultation is a classic consultation done via the internet using a specific digital platform and sometimes several ones at the same time. This can be done by email (asynchronous contact), or by instant messaging (synchronous contact) which must both be secured. The choice of an audio-visual platform online or only audio one can
be chosen as well (Via micro-computer or Smartphone). The e-psychotherapist follows a well-defined protocol which he draws first carefully. He reads or listens to his patient via the internet, asks pertinent questions, sends his questionnaire, assessment grids and psychological tests by secure email and then analyzes the data to define his diagnosis. Lastly, he proposes to his patient a therapeutic protocol by setting the objectives, date and time of session, the digital means to be used as well as the appropriate communication platforms which arrange his way of operating.
Thus, the online consultation makes it possible to diagnose a case with a view to following a procedure. It is thanks to the online consultation that the relationship between the psychologist and the user is defined. The psychologist then decides if a support cybertherapy is necessary or if it is necessary to go to a deep cybertherapy. In both cases, he draws up a therapeutic protocol and proposes it to the surfer who, from the moment of acceptance of the therapeutic relationship, becomes a cyber patient. From there, a program is traced (Date and time and duration of cybersessions, material means, the number of emails per week or per day etc.) Moreover, the psychological preparation of the patient is imperative for him to commit fully in the therapeutic relationship. The payment in this kind of contract is done electronically following the fees of the psychologist and on the professional tools used (tests, questionnaires, evaluation grids etc.)
Thus, the duration of instant messaging (professional chat) varies according to the case and the way of doing and the objectives per session. This duration ranges from 60 to 90 minutes. Psychotherapy ends as soon as the patient improves and the disorder or problem disappears. A check is important depending on the case and goes from each week, to each month then every three months and after that, every 6 months. This follow-up is essential to control the new behaviors and cognitions put in place during online psychotherapy. However, it varies in duration and in frequency depending on the disorder treated and the psychotherapy used.
Here, I open an important parenthesis that conventional methods of therapy can be transposed in the virtual space but not all methods are transposable. In addition, self-assessment of the patient is very important to follow offline the evolution of his case. In this context and during my cybertherapeutic interventions, I noticed that the resistance to change is less important than this in face-to-face therapy , this because of defense mechanisms which are minimal thanks to cyberspace specificities. These ones are to be taken into consideration by any cybertherapist so that he/she can conduct his therapy correctly and effectively. Indeed, the patient behind his screen and also at home, has the impression that he is free to stop the therapeutic relationship when he wants, just by turning off the computer or out of the medium therapy platform. This impression is one of the psychological specificities of the cybernetic therapeutic relationship and provides some flexibility in the therapeutic relationship, except that the psychotherapist must be vigilant and minimize or avoid what would stop or hinder the therapeutic relationship. The results obtained via the Internet are sometimes just extraordinary in the absence of psychological barriers in some categories of people especially those who are shy or with significant psychological sequelae for examples those who had traumatic situations such as rape, natural disasters, parental maltreatment, disorders following manipulation of narcissistic perverts etc.
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What technological requirements does an online psychological consultation require?
First of all, before any care, we must make sure of some elements and put them in place before engaging in e-psychotherapy or cyberpsychotherapy which is very flexible online and where we should have plan B and C. This implies the existence of an adapted logistics, a psychological contract, technical means and an adequate real environment to the setting up of the therapeutic situation online. The technical means vary according to the type of e-therapy chosen. I'm talking about platforms. There are psychotherapists who use texting, those who use audio or video or both, and those who use them all in the same time. So, on both sides (therapist and patient), the minimum required is to have a PC or tablet or Smartphone connected to the internet with a good connection flow to avoid connection breaks in full sessions. Also, an alternative of communicational platform should exist in case that connection interruption happens ( i.e. a phone number through both parties can agree for a new cyber appointment). There are also other ways to provide therapy, some for examples require a headset for better verbal comprehension. However, it should be noted that we must be very vigilant about the confidentiality of exchanges between psychotherapist and patient and therefore choose communication applications or software where the conversation should be protected from end to end (encrypted) . The psychotherapist must encourage his patient to exchange encrypted emails. This regarding technical side. What concerns the environment conditions, the patient must necessarily choose a suitable place to start and continue his therapy. This place may be a room in his house, his own room, an external place, etc. The therapist should control the parasitic factors that boil down to:
- Technical interruptions (phone, noises, alarm clock etc.)
- Human interruptions (Presence of family members in the room, friends, neighbors etc.)
- Environmental interruptions (Ceremony, football match, noisy work etc.)
Concerning the therapy program, the therapist prepares the tests and questionnaires as well as the observation and the self-evaluation grids to be systematically sent to his patient according to the psychotherapeutic sessions and aims.
- Where is the psychologist trained to conduct psychological consultations online?
Currently, psychologists who use the cyber space to do therapies are trained by specialists who had worked as E-therapists. They are usually university professors affiliated to psychology departments. But note that not all universities in the world offer this type of study since e-Psychotherapy itself is recent and was born between 1992 and 1993 in the United States with the studies and practices of Dr. John M. Grohol precursor and pioneer in this area without dispute (@DocJohnG). In Algeria, the first site that offered online consultation was the one I designed myself in 1999 named "Nafsiyat" which has remained, until now, the only website in my country offering online services. . It is on the basis of a six (06) years academic studies of psychological e-consultation and e-counseling that I started my career in the field of cyberpsychology. In 2007, I added an online psychotherapy service (e-therapy or cybertherapy) I called "Nafsiyaty".
Thus, and speaking of what is being done, the new student-research psychologists find the opportunity to better educate themselves in the universities which have been able to open CyberPsychology as a new specialty where is included courses on cyberpsychotherapy in their theoretical and practical fields. Many psychologists gave a definition to cyberPsychology. For my part, I defined it on 2016 as "The discipline that studies the impact of modern technology on the human being by evaluating his behaviors, emotions, cognitions, perceptions, motivations and his evolution in cyberspace in order to encourage best practices and treat any deviance and any psychological or psychopathological disorder that may result from the inadequate contact of humans with machine ".
So, the psychologist can be trained by other psychologists who can guide him/her and give the means and tools necessary to make online consultations by teaching him/her how to transfer his academic know-how in the cyber world by adapting it to the latter, taking into consideration the specificities of cyberspace.
- What are the advantages and disadvantages of the psychological counseling online?
First of all, I will start with the disadvantages since there is only few compared to the advantages. These disadvantages revolve around the confidentiality, the code of ethics to be respected by the patient and his psychologist, data security (content of the messages, audio or video between the patient and his psychologist) as well as the inconvenience of the uncontrolled consultation from interruptions (voluntary or involuntary termination of the therapy) or a failure related to a problem in the tool of communication between the psychologist and the patient (PC, Smartphone, Tablet, headset or virtual reality software).
As far as the benefits are concerned, there are fortunately a lot of them that help us, cyber-psychologists, to make sometimes a better therapy than face-to-face, especially in a few special cases. So these advantages boil down to:
- Mobility: The patient is not obliged to move to the office of his psychologist for consultation or therapy. The category of motor impaired people who suffer from agoraphobia or social phobia, or other problems, those also who are introverts or suffer from psychological trauma - not able to go out from their homes-, the elderly people and so forth can have at their disposal psychological services online .
- The cost: The patient with less mobility will not have to pay the transport expenses but just the psychologist fees), thus after comparing prices and methods of work on the internet which can help the patient to estimate the costs of the service proposed.
- Traceability: The exchanges between the patient and his psychologist can be saved (e-mail, exchanges by synchronous texting, video, audio, etc.) which is very important for monitoring the patient and also for orienting him, if necessary, to a second specialist or a multidisciplinary team. The arrival of the Blockchain for secure backup and mobility of data between professionals, including those living in different countries, far from the one where the patient lives, will contribute to the development of online cyber therapy with maximum efficiency and a minimum of error.
- Discretion: The patient will feel better in the discretion because no one will see him go to the psychologist’s office which gives him a better self-confidence and allows him to cooperate better, without experiencing any gene in front of his friends, his family, his neighbors etc.
- Alternation: The psychologist can take two to three people in consultation, at the same time, but in different platforms. This is , only possible, via synchronous or asynchronous texting (email, platform etc.). This kind of alternations saves time and money.
What other technological tools does a psychologist currently have?
the era of the democratization of tablets and especially Smartphone, the psychologist was content to have a website and worked through his personal computer in his office or elsewhere to be in contact with his patient. With the advent of tablets, this platform was favored because it gave a little more flexibility in mobility for both, psychologist and patient. They could still be in contact even when moving out of their usual workplaces. As a result, this mobility has opened the door to behavioral therapies, those using in vivo exposure or systematic desensitization in the case of CBT (cognitive-behavioral therapy) techniques as in the case of aircraft phobia, spider phobia, claustrophobia etc. With the spread of
therapies have also evolved, especially with this great flexibility in applications and audio, video and chat devices. Psychologists were delighted to be able to use multiple connection platforms between them and their patients. Also, psychologists find themselves more and more challenged via the internet and are able to take care of several patients, at the same time , and more easily since they can alternate between written e-consultations.
What are the advantages and disadvantages of using psychotherapy through virtual reality?
reality has opened big doors in psychotherapy specially that it allows in vivo exposure and systematic desensitization when using CBT techniques (Cognitive-Behavioral Therapies) in therapy. Thanks to virtual reality, the psychotherapist is no longer obliged to look for therapeutic situations elsewhere or devices to help him as main therapy tools ( i.e for some phobias like snakes phobia, spiders phobia, planes phobia , without virtual reality, the psychotherapist was generally obliged to choose as therapy tools pictures, videos and sometimes even to bring his patient in a real situation such as accompanying him to the airport and follow him throughout the flight to block his avoidance reactions (leakage behavior, loss of consciousness, etc.) as well as his psycho-physiological reactions such as shouting, tremors due to high stress and so forth. The immersion in the virtual reality makes it possible to reproduce, in details, movements, sounds and even sensations related to the situation the patient fears. The psychologist accompany the patient to desensitize him/her or to immerse him/her until extinction of the anxiety. Everything depends on the therapy chosen after consent and commitment of the patient (psychological contract). This type of therapy was a great success first in Canada with the creation of the first cyber-psychology laboratory that offered patients this second state of being able to move and feel in a cyberspace like the patient does in reality.
is it convenient to use online psychology? and when virtual reality?
psychology, from counseling to psychotherapy, can be used for everyone. E-consultation and e-orientation being the strongest services in terms of importance and frequency. While psychotherapy via virtual reality, it is more effective when it comes to changing behaviors such as cases of phobias (agoraphobia, social phobia, claustrophobia, phobia of insects or animals or others), or to teach new behaviors to patients by making them passing through interaction situations (professional or social or familial) that they did not respond to adequately. But, in the case of virtual reality , we cannot use it all cases (i.e for people who have pathologies such as heart problems, hypertension or those who lose consciousness after exposure to the subject of their phobia or anxiety. At this level, psychotherapy using virtual reality is not suitable and we return to therapy via internet (cybertherapy) or to conventional psychotherapy (face-to-face). Thus, the clinical psychologist is the only one who decides about the methods and tools he should use to have good results. That’s why, the psychologist is led to be very vigilant , doing deep interviews face to face or via the internet before exposing his patient to psychotherapy via virtual reality.
https://juanmoisesdelaserna.es/en/psicologia/interview-with-dr-djalila-rahali-for-psychological-therapy-online
Rahali
Psychologist specialized in CyberPsychology
minister advisor in e-communication
in cyberbehaviors of cyberdelinquents and cybercriminels
é d’Oran 2 – Mohamed Ben Ahmed- Oran – Algeria
@DrRahali_CybPsy