Online therapy, including online drug and alcohol treatment, is not new. It’s been running successfully for decades, including in the USA. As result of Covid-19, people turned to online addiction treatment, as many face-to-face services closed in lockdown. Many clients, and those associated with them, were understandably sceptical at first. However, many have been surprised about how effective online rehab is.
In this blog, Help Me Stop’s Director of Operations, Chris Cordell, writes about the evidence around online rehab, including the pros and cons of this form of treatment. Please call 0208 191 9191 or contact us here to talk about Online Rehab for yourself, a relative, or if you’re a professional who wants to refer.
The Evidence around Online Therapy
Since Help Me Stop rolled out our online addiction treatment programme in 2020, the numbers of clients completing our online programme, (currently 96%), then moving into long term recovery, continues to grow. Recovery is not an easy process, but the option for affordable care online is removing barriers.
And you don’t need to take my word for this. Research is showing that this way of seeking therapeutic interaction is working better than expected. Studies show it is not only as effective as face to face therapies, in some cases it is even better:
- Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care
- A growing wave of online therapy
- Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
- Outcomes of 98,609 U.S. Department of Veterans Affairs Patients Enrolled in Telemental Health Services
- Internet-based versus face-to-face cognitive-behavioural intervention for depression: a randomized controlled non-inferiority trial
You can also read and watch recovery stories from our Online Rehab clients. Hear from them how their lives have changed.
Pros and Cons of Online Rehab for Addiction
At Help Me Stop, Online Rehab is the same intensive integrative addiction psychotherapy treatment programme that is delivered in our face-to-face programme. We provide our online programme by a secure video conferencing platform, Zoom. Although the hours of the programme are reduced from our face-to-face programme, we offer the same types of groups, workshops, lectures, mindfulness and one-to-one therapy sessions online. The programme is delivered live. Our specialist therapists have online therapy expertise.
For therapists, working online requires some different competencies from face-to-face treatment. We follow the BACP updated competence framework which identifies the knowledge, skills and abilities required by practitioners who wish to work with clients online.
Pros of online rehab
- Effectiveness: for clients assessed as suitable for online addiction treatment, the outcomes are as good as face-to-face care.
- Affordability: it’s more affordable than in-person treatment. Our Online Rehab is the best value intensive addiction rehab in the UK.
- Convenience: the time commitment is less intensive than face-to-face care, and with no commute, clients have more time for their family, job, and other roles.
- No geographical barriers: people in rural or remote locations can access the same care as people in cities.
- International access: our Online Rehab has worked very well for many overseas clients, including ex-pats who live where addiction treatment is not available.
- Mobility is no barrier: people who have difficulty moving around can receive treatment at home.
- No commuting: lack of transport is no issue.
- Reduced stigma: by removing the need to go into a physical treatment centre, this can help people who feel shame about addiction, and people who experience social anxiety.
- You choose where you access the service: as long as you have a private room and a secure internet connection, you can access Online Rehab anywhere.
- You can even access online treatment at work, including when your work location is not static: for example, Help Me Stop works with clients in the entertainment industry, who can still access their treatment while on tour. Similarly, we also have a number of clients whose job involves them being on the road.
- Secure: we use Zoom which is an end-to-end encrypted online meeting service, with a low band width requirement. Clients do not need to download any special software or remember a password. At the time of their session, they just click on the link emailed to them to join the meeting. Clients require nothing more than an internet connection and access to a web browser.
But there are some cons
Like any approach there are drawbacks:
- Technology can be problematic: including Internet issues or frozen screens that can interrupt a video session.
- Therapeutic bonding with peers: some people may find it harder to bond and connect when meeting virtually (though it’s surprising how well clients do connect with each other online).
- Distractions and interruptions: unlike coming into a Dayhab or residential rehab, there is the potential for sessions to be interrupted by children, pets, deliveries, visitors, etc.
- Reduced body language: the lack of body language can create issues, particularly if the therapist is not trained to work online.
- Zoom fatigue: being in front of a screen for an extended period of time can create issues. For this reason, we limit daily session times online.
- Reduced social connections: clients may lose out on some of the bonding that takes place after a face-to-face group finishes or the programme finishes for the day. In a face-to-face setting, clients huddle around the kitchen for a cuppa or go out for a coffee. Online, it’s usually a click and goodbye. Many clients will form their own little groups and disappear into WhatsApp groups after before returning to “normal life”, which is great as connection is a big part of recovery. We actively promote clients accessing 12 step groups like Alcoholics Anonymous, Cocaine Anonymous or Narcotics Anonymous.
Expectations of Clients in Online Rehab for Addiction
We encourage all our clients to treat the online sessions as they would in-person sessions, implementing many of the same boundaries. We have created a list of expectations for them to adhere to, some of which are below.
- Find a comfortable space with privacy: confidentiality for the client and others is vital, this means not attending sessions where there are others present in the room. A comfortable space could be an armchair, someone’s home-office desk, or bedroom etc. We suggest sitting on something where the client’s back is supported, and no lying down.
- Technical set up: we recommend the use of PC, laptop, tablet or another device with a webcam and microphone that is connected reliably to the Internet. We do not recommend that a mobile phone is used as someone’s data allowance might compromise the quality of the connection. We also encourage clients to use headphones or earphones with a microphone, even if they have one integrated into their device. This keeps the content of the sessions private, improves sound quality, and minimises distractions for all. We ask clients to close other applications and browser windows on their devices. Phones need to be switched off or put on silent, just as we do in person.
- Good lighting: it’s best to ask clients to set up so they do not have a window behind their device, as this creates a glare and obscures their face.
- Good position: It is also helpful to everyone if the whole of their face is visible, and some of their body. It shouldn’t be a tight close up on their face, nor should it be too far away. We ask clients to adjust their camera and seating to reflect this.
- ‘Do not disturb’: If clients are sharing a space with relatives or colleagues, we ask them to advise people not to interrupt. We also suggest they put a note on the door of the room requesting that people do not come in (unless there is an emergency).
- Protected space: We ask clients to use the toilet before starting each session, and not to get up, walk around, or leave the session to answer the door. Disruptions like this break the flow and are distracting for everyone concerned, especially if the client or someone else in the group are in the middle of discussing something very personal or traumatic.
- Keep to time: Despite not having to travel, clients still need to arrive on time for the sessions and plan for possible delays in connecting online.
- Appropriate clothing: For us, this means not wearing hats or sunglasses during the sessions, and dressing appropriately and respectfully i.e. no pyjamas or very revealing clothing.
- No pets: They are incredibly cute and comforting, but they can be a huge distraction in sessions.
- No food and minimal drinking: No eating in sessions. Of course, it’s fine to have water.
- No smoking or vaping: It’s exactly the same principle as in face-to-face sessions.
- No recording: There is no facility for clients to record the session in Zoom, but it’s made clear that recording the session in any other way, or taking screen shots, is strictly forbidden. By taking part in online sessions, everyone agrees that it is a confidential process.
- Allowing time after the session: We ask clients to give themselves time after the session to process the therapy, before re-joining their family, working, or making other calls.