Skype hypnotherapy – Does online hypnotherapy work ?
In the last few years lots of hypnotherapist have gone online to offer treatments. This has been a controversial area. Some therapists and societies are resisting the move, citing the problems of dropped calls and broken connection. Equally, some prestigious establishments like the world-renowned centre of hypnotherapy research, the South Manchester Neurogastroenterology service, are starting to employ skype in their work (Pilcher 2016). I resisted doing online therapy myself for many years. Eventually, an existing (in-person) client asked to carry on our work even after she moved to another part of the country and I ventured online. I was soon convinced it had merits, but not without reservations. Since then I have conducted lots of skype sessions with. Hypnotherapy by Skype has obvious benefits for people who are cut off in some way. Perhaps because they are housebound or live in a foreign country. I have experienced some great results … and some moderate ones. Ultimately I want to know does online hypnotherapy work ?
Skype hypnotherapy – Does online hypnotherapy work – the hypnosis research
Almost nothing has been published in academic journals on the effectiveness of hypnotherapy via video calling. This of course means nothing. Gravity existed long before Newton formally described it. What we do know is that successful hypnotherapy treatments have been conducted via Skype (Sidman 2015). Sadly, this just confirms what I already knew, that hypnotherapy by Skype can work. What I want to really know is how good that therapy is?
Skype hypnotherapy – Does online hypnotherapy work – insights from other therapies
Is hypnotherapy by Skype better, worse or as effective as in-person therapy? To answer this question, we need to turn to other forms of therapy. Cognitive Behavioural Therapy (CBT) is probably the most well researched online therapy. A lot of online CBT research has used specially designed online programmes, which are often designed to minimise the need for a therapist. This is unfortunate for our purposes as this is not the same as therapy through skype. However, CBT has proven successful over video conferencing platforms (Bouchard et al 2004, Choi et al 2014). Significantly, this has been with larger groups than the hypnosis work. This suggests that the success of hypnosis over skype is no fluke but part of a pattern of success for therapy in general. However, in these studies comparison groups are absent so we don’t know how they hold up against in-person work.
Coming away from CBT we have randomised controlled trials of other online treatments working (Vincent & Lewycky 2009). Unfortunately, this is of recorded therapies, such as guided meditation, rather than interactions. How generalisable the results are we cannot say, but once more we see a picture of online therapy working. However, one early piece of work comes to our aid, back in 2007 Paxton et al conducted small group therapy to help with body image issues amongst a total of 114 women. The women were split into 3 groups
1. An in-person group
2. An on-line group (same treatment as in-person but delivered through video calling)
3. A delayed treatment control.
After the treatment it was found that both interventions (online and in-person) produced beneficial effects. However, at post treatment follow up, the effect size for the in-person was substantially greater (often double) that of the video group. The authors concluded that in-person should be the preferred approach where possible. This is the only evidence that I have been able to find which compares in-person therapy with video calling therapy.
Skype hypnotherapy – Does online hypnotherapy work- therapeutic alliance
This raises the question of what is the differences between skype therapy and in-person. One suggested mechanism is alterations in therapeutic alliance. Therapeutic alliance is the strength of the relationship between the therapist and their client towards the desired goal. Evidence exits to suggest that therapeutic alliance can be established perfectly well via the internet (Cook & Doyle 2002, Hanley 2009). However, on line therapeutic alliance may not be such a good predictor of the efficacy of treatment as it is in in-person therapy (Knaevelsrud & Maercker 2006). Which doesn’t help.
It is possible that despite the presence of good therapeutic alliance that other factors get in the way. Factors such as
1. Dropped calls – I’ve certainly had this happen in skype sessions.
2. Difficulty seeing the client – camera’s rarely pick up the whole body, which limits observations of body language.
3. Interruptions at the client’s end – when you do therapy in a special environment (i.e therapy centre) interruptions are usually rare. When a person does them at home sometimes the need to minimise distractions is not grasped, pets can interrupt, family members (especially children) accidently walk in.
You may well be able to come up with more.
Skype hypnotherapy – Does online hypnotherapy work – conclusion
It seems that online therapy does work. But, not necessarily as well as in-person therapy. Time and evidence may prove otherwise but currently I would recommend that therapy by video calling is used only when in-person sessions are not practical. Practical reasons may include cost, time and travel issues and clients. Skype sessions may be particular good for clients in remote areas, or who are disabled for whom such therapy may otherwise be impractical. There may even be an argument for clients in high cost areas (The US) using skype therapists in other, less expensive, parts of the world or there own country, if therapy would otherwise be prohibitively expensive. Another possible time is when supporting an existing (in-person) therapeutic relationship who moves away or is out of the country working.
Bouchard, S., Paquin, B., Payeur, R., Allard, M., Rivard, V., Fournier, T., … & Lapierre, J. (2004). Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference. Telemedicine Journal and E-health, 10(1), 13-25.
Choi, N. G., Hegel, M. T., Marti, C. N., Marinucci, M. L., Sirrianni, L., & Bruce, M. L. (2014). Telehealth problem-solving therapy for depressed low-income homebound older adults. The American Journal of Geriatric Psychiatry, 22(3), 263-271.
Cook, J. E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. CyberPsychology & Behavior, 5(2), 95-105.
Hanley, T. (2009). The working alliance in online therapy with young people: Preliminary findings. British Journal of Guidance & Counselling, 37(3), 257-269.
Knaevelsrud, C., & Maercker, A. (2006). Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients?. Journal of Medical Internet Research, 8(4).
Paxton, S. J., McLean, S. A., Gollings, E. K., Faulkner, C., & Wertheim, E. H. (2007). Comparison of face‐to‐face and internet interventions for body image and eating problems in adult women: An RCT. International Journal of Eating Disorders, 40(8), 692-704.
Pilcher, H. (2016). Q&A: Peter Whorwell. Nature, 533(7603), S112-S113.
Sidman, J. (2015) Case Study: Interstitial Cystitis Patient (CC) Treated with STSH over Skype.
Vincent, N., & Lewycky, S. (2009). Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep, 32(6), 807-815.