Our guest writer, Satu Pihlaja from the University of Helsinki, talks about her journey in the forefront of internet therapy services and what it has taught her.

Not at all so popular

To be honest, I wasn’t the most popular psychologist at my workplace when I started in an internet services project at my workplace, University Hospital of Helsinki and Uusimaa (HUS) in Finland, in 2009. We were about to start developing a complete set of internet services for mental health, an online mental health HUB. Internet psychotherapy was something new in Finland. I guess all the clinicians felt threatened, that computers are going to do their work!

Someone asked me recently if I was just the best candidate or terribly lucky to get to work on this project on developing internet services for mental health. I laughed — I was the only volunteer psychologist to respond to a kind request from the chief physician.

Exciting possibilities

I was excited though. First of all, I had already developed an interest in online psychotherapy, since I had held a presentation on the topic in a seminar. Second of all, I had worked as a clinical psychologist for a while and one small thing had started to bother me: It was only very few people I could help in my work since I was meeting individual clients. Time is limited.

A third concern had started to invade my consciousness: Even though we provide some great psychiatric services with some amazing professionals working to help people, the services just can’t reach everyone. Not even half of those in need (Emmelkamp et al., 2014), I have later learned!

Solving serious issues

Internet services for mental health seemed to solve some serious issues. They could reach everyone with a possibility to go online — in Finland that means practically everybody. Finland is also a country of long distances, especially in the north, where your nearest therapist is literally hundreds of kilometers away.

Despite of being a modern northern well-being society, mental illnesses still carry some stigma in our country. Internet could lower the threshold of seeking help (Mechanic, 2007). Especially my research topic, iCBT (internet-based cognitive behavioral therapy) for depression, seemed to have immense demand. If you could find help without having to visit a scary institution, surely that would help depressed people to find therapy approachable.

Furthermore, the on-going change in our culture with digitalization and time-independent internet services is taking weekly therapist appointments further away from our everyday lives. Young people understandably feel odd engaging in such activities. Then there are the issues of cost and availability (Mechanic, 2007). Therapist time is expensive and it seems impossible to provide one to everyone in need.

The art of human touch

Since the beginning, it was clear we would develop internet therapy programs with therapist support. Current research was clear about the fact that human-supported therapy programs reached high-level outcomes, comparable to face-to-face psychotherapies (Andrews et al., 2018)! I think therapists still feel insulted when I talk about this at lectures. But they shouldn’t. Actually, they should be impressed that what they do has such a strong impact that people benefit even if they never actually meet their therapist. Actually, in these days more and more professionals appreciate the possibility of breaking free from time and location constraints.

I first learned about the concepts of therapeutic relationship and therapeutic alliance in my training of integrative psychotherapy. It’s a very important topic of research in the field in traditional face-to-face psychotherapies. Despite years of research on different psychotherapy frameworks, the best is yet to be found (Wampold, 2013). Common factors of psychotherapy, like therapeutic alliance, however, are thriving. This could be one explanation for the huge success of internet psychotherapy programs. It’s amazing to learn about the feelings of online clients, that they feel supported and heard also in an online contact.

Empowerment for people

Despite numerous benefits of offering psychotherapy online, my favorite reasons for appreciating it lies in the client. The feeling of empowerment, while working actively on people’s issues online, without having to wait until the next meeting with the therapist, is touching. Furthermore, many clients feel free online to confess difficulties they would feel too embarrassed to talk about to their therapist face to face. This serves as an immense advantage in many mental health problems, which typically provoke feelings of shame in clients.

My journey continues by studying a group on clients with depression, having difficulties engaging in treatment. It’s not enough to have these great internet-based programs if we still have some clients who don’t benefit from them. We must develop interventions that better match client’s needs, and find ways to support our clients to stay in treatment. I’m currently working on a research paper where telephone support was offered to a group of clients. Unfortunately, the traditional telephone may not be the best way to reach our clients suffering from depression. We have to carefully follow new trends in communication to find ways to better reach our clients. I’m happy to notice it’s not only me anymore who’s interested in this powerful field of research.