Is online psychotherapy beneficial or desirable?

I would like to share a few thoughts on the subject of "online therapy", as proposed by certain specialized sites.

I'd like to make it clear that what I'm saying here does not apply to psychotherapists who offer their patients online sessions on an ad hoc basis when they are unable to travel.

Many different activities can bring healing, support and growth: time spent with friends, family and lovers; exercise; mindfulness practice such as yoga or meditation; religious practice; service to others; gratitude work; art; journaling. Life is full of options that can help solve life's problems.

As different as these experiences are, and they are fundamentally different in many ways, they can all be therapeutic, meaningful and valuable; moreover, what they have in common is that they are not psychotherapies. What I mean is that "online therapy" is not psychotherapy either.

I know everyone has to make a living, it's not easy to find a niche in the crowded mental health market, but some "online therapy" practitioners have gone too far in targeting vulnerable people who need help by overselling the practical and economic aspects.

Some people have undoubtedly been helped, especially in difficult periods of confinement. But having satisfied clients doesn't automatically entitle us to call these new technology-mediated practices "psychotherapy" and thus associate them with clinical experience. Doing so diminishes the value of psychotherapy and increases the stigma of seeking help from another human being in search of support. Imagine the absurdity of yoga teachers touting the value of the courses they offer by referring to research documenting the safety and efficacy of various psychotherapies, from CBT to psychoanalytic psychotherapy. All they'd have to do is call it "yoga therapy" and then say that "yoga therapy" isn't exactly like traditional psychotherapy, although it can be used for the same purpose and can in fact be just as effective. We're not far off...

Online therapy" is not a new form of psychotherapy; it's a technological simulation of psychotherapy. And like all simulations, it has its own limitations and is based on processes that differ from those of traditional simulated reality.

Countries such as the UK, where the public health system is on the verge of asphyxiation, are praising the economic benefits of online therapy, which is hardly surprising in a country where a patient may have to wait weeks or even months to consult a psychotherapist. The studies demonstrating the efficacy of these new methods specify, however, that they apply only to cognitive-behavioural therapies (CBT), and remain vague about the subjective methodology (questionnaire) used to assess results. We can sense the cognitive bias that allows us to validate and promote a method that we are obliged to use for want of anything better, and which above all allows the government to save on costs and achieve quantitative objectives.

I have no problem with a person deciding to pay for a video exchange with someone else. On the other hand, I find it very difficult to pass off this exchange as psychotherapy. Here are a few concrete examples which show that the simulations provided by "online therapy" are fundamentally different from real psychotherapy.

• Safety and risk: One of the frequently observed characteristics of effective psychotherapy in many different techniques and schools is the existence of a positive "therapeutic alliance". In the alliance built by the participants, patients/clients must feel safe enough to do the often difficult work; there must be what Winnicott, the British psychoanalyst, called a "holding environment". But in the absence of physical co-presence (the fancy term for being in a room with someone), there's an artificial limit to the sense of security one can feel. When there is no possibility of being let go - that is, all the carnal consequences of the meeting of two bodies that therapists limit - there is no possibility of feeling held. Instead of comfort and security, most of what is possible online is an absence of consequences, and the absence of consequences is not the same as the presence of security.
• Empathy and emotional connection: Knowing the mind and heart of another person is neither magic nor purely linguistic. Since the late 1990s, neuroscientists have been studying "mirror neurons", brain systems that provide a kind of direct access to another person's mind. For example, when you watch someone grimace, the neurons you would use to perform the same action are activated, generating a direct experience of what's going on in the other person's mind because the same thing is happening in yours. Even online therapies based on videoconferencing cannot compensate for the loss of physical co-presence, at least not today, because it's impossible to look someone in the eye and look at the camera at the same time. Yet the experience of empathy depends in part on such correctly synchronized mutual gaze behavior and on the quality of listening. While online interactions can give the feeling of being understood, this is not at all the same as the messy, carnal process of actually being understood.

So, if you're a consumer/client/patient considering getting help solving your life problems from this seemingly wise and kind person behind this interesting website, perhaps you should take a deep breath and ask yourself if a simulation is what you want? What you need? Even if it's a first step towards a real journey, is the simulation enough for now? If not, and if you have access to a real therapist, someone you can sit down and talk to, I hope you'll reconsider the seductions of technology.

And for my colleagues pushing this new frontier, perhaps you should tone down the evangelical fervor, maybe even consider making it clear that what you're offering is a simulation, not the actual journey that's been the subject of decades of research and study.