Modes of Delivering Psychotherapy: Investigating Technology

Introduction: Historical Background And Telephony-Based Applications

Counselling services traditionally offer ‘treatment’ in a private, face-to-face setting (e.g., an office or clinic). Technology-based counselling services, however, have surfaced as an alternative means of therapy where patients do not have access to in-person services. These services have been available for several decades. For example, the Australian Royal Flying Doctor Service (RFDS) used the Morse Code, a coding system to transmit messages via the electromagnetic telegraph, was used in 1928-1929 by the Royal Flying Doctor Service (RFDS) in Australia to provide telehealth to remote areas (Margolis & Ypinazar, 2008; Persson, 2010). It was in the 1930s that the service called ‘Voice Radio Therapy’ was introduced and serviced remote areas of Australia by telephone. The use of telephone technology in psychotherapy continued in later years. For example, in an attempt to prevent suicides, the Samaritans¹ began the first telephone counselling service (called Lifeline) in London in 1953 (Hornblow, 1986) and four years later in 1957, three telephone counselling providers were established in the United States of America (Hornblow, 1986). In Australia, the first Lifeline service was officially introduced in 1963 (Coman, Burrows, & Evans, 2001), but it was during the 1970s that telephone technology services have provided psychotherapy services (see Lester, 1974 and Regan, 1997).

Since the 1980s, telephone psychotherapy has been recognised as a valued alternative to traditional face-to-face therapy and has been used to deliver various mental health services (Reese, Conoley, & Brossart, 2006; Robinson, 2009b), for instance, to provide care for obsessive-compulsive disorder (OCD) and depression (Lam, Lutz, Preece, Cayley, & Walker, 2011; Lerman et al., 1992; Marcus et al., 1993; Turner et al., 2014). Telephone counselling has also been effective in helping clients with the psychological issues associated with cancer (Badger, Segrin, Pasvogel, & Lopez, 2013; Bastian et al., 2013), with disability as an adult (Evans, Halar, & Smith, 1985), with smoking cessation (Bastian et al., 2013; Stead, Hartmann‐Boyce, Perera, & Lancaster, 2013; Zhu et al., 1996), and with HIV infection (Velthoven, Brusamento, Majeed, & Car, 2013).

Given the success of telephone counselling, it is not surprising that the usefulness and appropriateness of other technologies for therapeutic purposes has been assessed. Several studies have identified the benefits or disadvantageous of those services, ethical and organizational issues, and the therapeutic outcomes achieved using differing technologies (see Haberstroh, Parr, Bradley, Morgan‐Fleming, & Gee, 2008; Lovejoy, Demireva, Grayson, & McNamara, 2009; Richards & Viganó, 2013a; Schultze, 2006). For example, instant messaging, chatting, and video conferencing facilitate a person’s ability to access services in spite of one’s geographical distance from the service. These telecommunication systems open up new possibilities for communication between therapists and clients. This was the reason the current article outlines the story of use of technology in psychotherapy. The review will classify the technologies that have been used in psychotherapy and will also discuss some of the advantageous and disadvantageous that relate to the use of these technologies.