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Psychiatric-Mental Health Nursing

7.5 Online Self-Help and Therapy

Psychiatric-Mental Health Nursing7.5 Online Self-Help and Therapy

Learning Objectives

By the end of this section, you will be able to:

  • Describe the types of online self-help and therapy options and their benefits
  • Describe the special considerations for online platforms for psychiatric-mental health nurses and clients
  • Explain the role of the PMH nurse in promoting online self-help and therapy

Online therapy, also known as teletherapy, has skyrocketed in popularity in recent years as a viable option for mental health treatment. Increased convenience has driven its popularity, as has the COVID-19 pandemic, which accelerated the adoption of online therapy as mental health treatment. Ongoing changes to telehealth policy and reimbursement will address this increased need in the future. The explosion in popularity of online mental health treatment has brought with it special considerations and concerns that professionals must address when using these platforms to work with clients.

Understanding Online Self-Help and Therapy

Online self-help and therapy offer individuals new avenues to address their emotional well-being. These virtual platforms provide a range of resources, tools, and therapeutic interventions that empower users to navigate their mental health challenges from the comfort of their own spaces. Understanding the dynamics and potential benefits of online self-help and therapy is essential for anyone seeking accessible and flexible ways to enhance their mental health resilience and seek support.

Definition and Types

There are several types of online self-help and therapy available today. Here are some common ones:

  • Online support groups are moderated groups where people can come together to discuss common challenges and provide emotional support to each other.
  • Self-guided therapy uses online programs that provide structured activities and exercises to help individuals address specific mental health concerns, such as anxiety or depression.
  • Therapy or counseling that happens remotely instead of in-person, called teletherapy, is performed by licensed therapists and mental health providers who offer treatment for various mental health concerns.
  • Self-help technology, or online self-help, refers to the use of internet-based resources, such as websites, forums, mobile applications, and digital tools, to address personal mental health issues and challenges. These include self-help apps that offer a range of features, including CBT exercises, mindfulness techniques, and guided meditations.
  • Online coaching: These are online sessions with life coaches or other professionals who provide guidance on how to achieve personal or professional goals (APA, 2023).

Benefits of Online Self-Help and Therapy

There are multiple advantages to online self-help and therapy that have helped make it such a popular choice in recent years. One of the biggest advantages is accessibility. Online self-help and therapy are extremely convenient and can be accessed from anywhere and at any time, thereby eliminating the barriers to traditional in-person therapy due to location or scheduling conflicts. As access to care is a challenge in health care in both rural and urban settings, online options are providing services to more individuals.

Another major benefit is affordability: online self-help and therapy can be less costly than traditional in-person therapy, increasing access for clients with lower incomes. Additionally, some self-help materials are available online for free, requiring only an internet connection. Local public libraries are often a great resource for people who need access to free internet.

There are other benefits. For example, some clients believe online therapy offers greater anonymity and privacy and prefer it to discussing their problems face-to-face with a therapist. Additionally, online self-help and therapy can provide access to a wide range of resources, including forums, videos, and articles, that can supplement therapy and help individuals develop coping mechanisms for their mental health issues.

Common Features of Platforms

In today’s digital era, reputable online self-help and therapy platforms have emerged as valuable resources in the realm of mental health and well-being. These platforms offer individuals convenient access to a variety of therapeutic tools, resources, and guidance, providing a means to address their emotional challenges and personal growth at their own pace and on their own terms. Exploring the world of reputable online self-help and therapy platforms opens up opportunities for individuals to engage in evidence-based practices and connect with professional support, all within the comfort and privacy of their digital environments. Reputable online self-help and therapy platforms share several features in common:

  • Accessibility: Online self-help and therapy platforms offer easy access to mental health resources for individuals who may not have access to traditional in-person therapy due to various reasons, such as financial constraints, distance, or scheduling conflicts. They also offer different communication channels, including messaging, videoconferencing, and phone calls, to enable individuals to connect with therapists and access support.
  • Confidentiality: Most online self-help and therapy platforms ensure the privacy and confidentiality of user information and conversations with licensed therapists. Clients should be discouraged from using those that do not.
  • Personalization: These platforms often use algorithms or assessments to match individuals with therapists or self-help resources that are tailored to their specific needs and concerns.

Special Considerations for Online Platforms

Online mental health platforms have several challenges and limitations. To begin with, not everyone has access to reliable internet or possesses the equipment and technical skills required to use online mental health platforms. This can limit the reach and accessibility of these services, particularly for older adults and people in low-income or rural areas. When it comes to client care, online mental health platforms often have a standardized approach to mental health treatment that may not be tailored to the individual needs of the client. This lack of personalization may not be suitable for people with certain complex or severe mental health issues. If someone is expressing thoughts or demonstrating behaviors indicating that they may be a harm to themselves or others, they should be seen in person immediately.

Other limitations relate to communication. Online mental health platforms rely on video, written, or typed communication, which can be limiting in terms of conveying emotions, tone, and nonverbal cues when compared with in-person interactions. This can make it difficult for the therapist and client to build trust and rapport. Also, online mental health platforms may not provide the same level of continuity and follow-up care as traditional in-person therapy. Clients may discontinue treatment or switch to another provider without adequate transition planning, leading to discontinuity of care.

As online mental health platforms have increased in popularity, specific ethical considerations have evolved to protect clients and provide the safest, most secure experience. The top ethical concerns for online platforms are privacy and confidentiality (Stoll et al., 2020). The safeguarding of an individual’s personal and sensitive health information from unauthorized access, use, or disclosure, ensuring confidentiality and maintaining the individual’s control over their health data is called privacy. The ethical obligation to protect and keep private a client’s personal health information, preventing its disclosure to unauthorized individuals or entities, is called confidentiality. Online platforms must ensure the privacy and confidentiality of their users. This includes providing highly secure transmission and storage of personal and sensitive information. Data breaches can occur, however, because of security or technology issues that are beyond the control of the clinician. Clients should read and understand terms and conditions clearly when entering personal information on websites and ensure the site uses appropriate privacy practices. The legal terms and conditions concerning privacy can be long and dense, making it challenging for clients to comprehend.

Another top ethical concern for online platforms is informed consent. Informed consent for online services is slightly different due to different ethical and legal concerns that may vary by service or by state. Users should be informed about the nature and limitations of online mental health services and have the right to give or withhold consent for treatment. It can be difficult, however, for the provider to assess if the client is mentally or legally able to give consent online without first having evaluated the client.

Online mental health providers must have appropriate training, credentials, and licensure to provide services. Therapeutic techniques for online therapy may differ from those that are used for in-person therapy and require special training. Online providers must adhere to the same ethical and professional standards as in-person providers, such as avoiding dual relationships, maintaining appropriate boundaries, and avoiding conflicts of interest. Additionally, online mental health platforms must ensure that their services meet accepted standards of quality of care. This includes regular assessment of client outcomes, ongoing professional development, and adherence to evidence-based practices.

The Role of Nursing Online

As telehealth has expanded, so has the role of the nurse in providing telehealth services for clients with mental health issues. The role of nursing in online self-help and therapy platforms can vary depending on the specific platform and the services it offers. Nevertheless, nurses play valuable roles in supporting individuals who are seeking help or therapy online.

One important role for nurses is providing health education and information to individuals who are using online self-help and therapy platforms. Nurses can use their expertise to help individuals better understand their health conditions, medications, and treatment options. This can be particularly helpful for individuals who are seeking information about mental health conditions, such as depression or anxiety. Nurses can also provide education to clients on how to look for the best online platform to suit their own particular wants and needs.

Ethical and Legal Considerations

It is the nurse’s duty to deliver ethical, evidence-based, high-quality, individualized care that is based on the Code of Ethics for Nurses (American Nurses Association [ANA], 2015). With online platforms, privacy is of the utmost concern. Nurses should have knowledge of the different telehealth technologies that are available—particularly which telehealth platforms are considered secure. For example, no Zoom platform may be entirely HIPAA secure, and FaceTime is not considered secure in most facilities. Organizations often have designated platforms that meet privacy, confidentiality, and security requirements.

Nurses must also be aware of legal and regulatory issues, that vary from state to state, and remain current on applicable laws. For example, licensure requirements for a nurse providing care to clients in other states may differ from requirements in the nurse’s home state and are subject to change at any time (, 2023). The details of telehealth consents vary between states as well. If the nurse is providing care in multiple states, they must follow the Board of Nursing guidelines for each state. The telehealth nurse must also be trained in the proper delegation of non-RN tasks to unlicensed staff and licensed practical nurses (LPNs). For example, an LPN can schedule appointments and referrals to other providers.

Nursing Interventions

Even though telehealth leads to a much more independent, client-driven experience, it is still important to follow up and evaluate the effectiveness of the treatment plan. One important nursing intervention is to educate clients about the benefits and limitations of using online platforms. By discussing the various platforms available and their effectiveness, clients can make informed decisions about which platform would suit them best. Another important intervention is to assess whether clients are suitable candidates for online self-help and therapy platforms. Factors, such as the severity of a client’s mental health condition, their access to technology, and their computer literacy levels, can determine if online self-help and therapy platforms are appropriate.

Nurses also help monitor clients’ progress and adherence to their treatment plan, including their use of online self-help and therapy platforms. By tracking their usage, nurses can identify any issues or barriers to treatment, such as problems with the client navigating the website or difficulties understanding certain concepts. Nurses can also collaborate with other health-care professionals, such as psychologists or psychiatrists, to provide a holistic approach to the client’s mental health. This collaboration can ensure that the client’s treatment plan is comprehensive and that it addresses all aspects of their mental health.

Finally, nurses can provide emotional support to clients who are using online self-help and therapy platforms. They can discuss clients’ concerns or fears about using these platforms, address any feelings of isolation or disconnection, and provide reassurance and encouragement.

Real RN Stories

Nurse: Lenore, RN
Years in Practice: 20
Clinical Setting: Community mental health center
Geographic Location: Midwest

In rural areas, there can be a lack of both psychiatrists and psychiatric nurses available to care for clients in the inpatient setting. One thing that hospitals do to combat this is use contract providers through a telehealth company to provide ER psych assessments and to cover daily rounds, especially on weekends. Even though this is provided within the hospital setting, it does require that the client feel comfortable talking to a doctor on a computer screen and the assistance of the RN to bring the clients to the examination room to support both the client and the doctor during the appointment. Sometimes, the clients are hesitant to talk to a doctor who is not physically present, so the nurse can provide the client with support during the intervention. The doctor can also ask the nurse questions after the client has left the room and this helps to facilitate continuity of care. This particular hospital gets admissions from as far away as a five-hour drive. There is an online tracking system used throughout the state to find beds for clients in need. The availability of online providers to support the in-person psychiatrists is beneficial to the department and the clients.

During the pandemic, many therapy offices switched to online appointments with their licensed professional counselors. Clients became comfortable with the convenience and flexibility of this type of service. I am familiar with several local offices that continue to offer online appointments to meet the needs of their clients.

Online Approaches and Theories for Self-Help and Therapy

Several different approaches are well-suited for online self-help and therapy. Here are some of the most commonly utilized.

Cognitive Behavioral Therapy

One of the most widely used and well-known forms of psychotherapy (NAMI, 2017), CBT is based on the idea that thoughts, feelings, and behaviors are interconnected, and that by changing thoughts and behaviors, people can improve their emotional well-being. Research shows that CBT delivered through telehealth can be just as effective as traditional CBT, especially for anxiety and depression (NAMI, 2017).

Mentalization-Based Therapy

Used to treat personality disorders, such as borderline personality disorder, mentalization-based therapy (MBT) encourages clients to consider how their thoughts influence their behaviors and their relationships with others.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is a type of psychotherapy that aims to help individuals develop psychological flexibility and improve their overall well-being. The core principle of ACT is to accept difficult thoughts and feelings, rather than try to avoid or eliminate them, and to focus instead on taking action toward living a meaningful and fulfilling life.

Dialectical Behavioral Therapy

DBT is a form of therapy based in CBT that is meant for clients who have difficulty regulating and expressing their emotions. It was originally designed to assist clients with borderline personality disorder, but is now used to treat a variety of mental illnesses. DBT emphasizes the importance of balancing acceptance of reality and change of unhelpful behaviors in order to improve emotional regulation.

Online Support Groups

In online support groups, clients can find a community of individuals who share similar experiences and can offer advice and support to one another. Examples include groups for individuals with anxiety, depression, or addiction.

Clinical Judgment Measurement Model

Generate Solutions: Helping Clients Find Options for Online Mental Health Assistance

Generating solutions involves the identification of the measures, interventions, or actions necessary to address a particular problem or issue. Part of this process involves differentiating between solutions that are appropriate, and those that are unnecessary, unneeded, or contraindicated (Introduction to Health Assessment for the Nursing Professional—Part I, 2021). When assisting clients with finding the most appropriate forms of online therapy, there are multiple factors that the nurse must take into account:

  • Diagnosis: Consider the client’s specific mental health diagnosis. Certain therapeutic modalities may be more effective for particular issues, such as CBT for anxiety or depression, or DBT for borderline personality disorder.
  • Severity of symptoms: Some individuals may require more intensive support or specialized interventions than may be offered through online care. For example, online therapy would not be appropriate for a client experiencing active suicidal ideation or psychosis.
  • Technological accessibility: Ensure that the client has access to the necessary computer technology and internet connection to participate in online therapy sessions. Determine if they are comfortable enough with technology to effectively participate in regular online treatment.
  • Privacy and security: Ensure that the proposed online therapy platform complies with relevant health-care regulations and provides secure, confidential communication channels to protect the client’s sensitive information.
  • Cost and insurance coverage: Discuss the cost of online therapy sessions and whether they are covered by the client’s insurance. Consider the financial aspects and explore options that are affordable for the client.
  • Client preference: Involve the client in the decision-making process. Understand their preferences regarding the format of therapy, communication style, and therapeutic goals. Some individuals may prefer traditional talk therapy, while others might benefit from approaches like mindfulness-based therapies or dialectical behavior therapy. Others may prefer therapists who specialize in certain culturally sensitive care, such as those who provide therapy specific to LGBTQIA+ individuals.

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