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Use of Online Therapy among Spanish Psychologists | OMICS International
ISSN: 2573-4598
Journal of Patient Care

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Use of Online Therapy among Spanish Psychologists

González-Peña P*, del Barrio V, Olmedo M and Torres R

Department of Online-Psychology Work, Professional Association of Psychologists of Madrid (COPM), Spain

Corresponding Author:
Paloma González-Peña
Psychologists of Madrid (COPM)
Avenida de los Prunos, 11-D3ºD. 28042
Madrid, Spain
Tel: +34677728772
E-mail: [email protected]

Received date: July 06, 2017; Accepted date: August 25, 2017; Published date: August 31, 2017

Citation: González-Peña P, del Barrio V, Olmedo M, Torres R (2017) Use of Online Therapy among Spanish Psychologists. J Pat Care 3:133. doi:10.4172/2573-4598.1000133

Copyright: © 2017 González-Peña P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Teletherapy is the practice of psychology using technology that makes it possible to interact with a client at a distance (telephone, e-mail, Twitter, Internet, WhatsApp, etc.) without face-to-face contact. Online therapy is a part of the widely used online therapy psychology. We try to know the situation in Spanish psychologists. An e-mailed survey was applied to evaluate use that the Spanish psychologists make of information and communication technologies alongside his attitudes. The sample was 486 psychologists who answered a questionnaire we made with previous literture reviews regarding the same topic. Only 26% use teletherapy as other combined modality therapy with face to face. The drawbacks encountered are primarily the limitations of non-verbal communication and the therapeutic alliance, followed by the confidentiality of the data and technical problems in handling them. As has occurred in many other fields, North American psychologists (from both the US and Canada), as well as from other countries like Australia and New Zealand, have been a pioneering force in this field.


The first guide for psychological services available electronically was published in Canada. Online therapy effectiveness has support in the scientific literature on depression and anxiety, which are the most prevalent disorders. It can also be used in the pediatric population with the same success as face-to-face therapy. The behavior and participation of children is the same as in face-to-face visits, but online therapists reduce or control their own stress less than in face-to-face visits. The major concern of therapists using new technologies is to create a good therapeutic relationship. In the study by Rees and Stone, there were no significant differences between therapeutic relationships developed in face-to-face therapy and distance therapy, especially in the case of video conferences [1].

Another successful form of distance therapy is Terapia en Web (Web Therapy), which offers self-applied programs for patients with access to the Internet, who can use the programs without the online mediation of a therapist (automated online therapy) or with timely interventions (Figure 1).

Figure 1: Distance therapy resources.

The primary concerns of professionals who carry out their therapeutic work using distance techniques relate mainly to clinical limitations (the therapeutic relationship, deficient perception of nonverbal information in the interaction and the effectiveness of therapy), and legal and technical aspects [2,3]. Other issues of concern are the confidentiality of client information and legal liability (interstate insurance coverage) [3].



The sample consisted of 486 psychologists registered with the Professional Association of Psychologists of Madrid (COPM, Spanish acronym) out of a total of 16,428 psychologists, representing 3% of the psychologists practicing in the Community of Madrid. Of this sample, 75% were women (80.39% of the total) and 25% were men (19.61% of the total). Their ages ranged from 23 to 74 years. Most of them were licensed in Clinical Psychology with health accreditation. Most of them worked in private practice in Clinical Psychology. The questionnaire was completed in June 2015.


A questionnaire was developed ad hoc consisted of 19 questions to be completed in about 6 min. The response scales were multiple choice and open. The respondent received a link to the questionnaire by e-mail sent by the COPM. The questionnaire was completed and processed directly without identifying the respondent.


We requested authorization from Professional Association of Psychologists of Madrid to send the survey in digitized format with a short presentation to all its members in Madrid via e-mail. The objective was to seek the views of psychologists on using the Internet in their professional practice.

Data analysis

Data processing included a study of the descriptive characteristics of the sample, frequency analysis and qualitative study of the open questions. SPSS 19.0 software was used.


Use of Internet in professional practice

The 26.7% of the psychologists in the health field indicated that they currently conduct therapeutic sessions via videoconference, the 60.5% favored using it in the future and only 12.8% ruled it out. Videoconferencing was the most media used in distance therapy, followed by specific application, telephone communication, e-mail and WhatsApp. The earliest date at which distance therapy was used by psychologists was 2000. In 2010 was a significant increase in the use of distance therapy and it was popular in 2013.

Online therapy represented 10% of all sessions for 17% of psychologists. Four are the highest number of distance therapy sessions a month per therapist, with 21% of therapists having this number of sessions. The 86% of psychologists combined face-to-face therapy with online therapy with the same clients. The respondents reported that they started using distance therapy at the request of the client.

The 68% of psychologists applied the same fees for distance therapy as for face-to-face therapy. For 24% of psychologists acknowledged that distance therapy was up to 20% cheaper than face-to-face therapy; 8% claimed that it was more than 20% less expensive that face-to-face therapy. When the psychologists wants to advertise on the Internet, among all the media used by respondents to promote their professional services, websites were most used.

Professional concerns regarding distance therapy

The diminished ability to collect information from the immediate client interaction (verbal and non verbal) that occurs when therapy is conducted online, and the greater difficulty of achieving good rapport with this form of therapy were the two main concerns of professionals were. These were followed by technical concerns, such as the risk of breaching confidentiality, inadequate transmission speeds or interruptions in transmission, scientific evidence supporting the validity of online therapy, legal coverage, the therapist’s lack of technical or clinical knowledge, the patient’s lack of technical knowledge, legal problems with working with clients abroad, payment systems, unauthorized practice, the use of questionnaires, or the weakening of the patient’s link to therapy.

Professional requirements for distance therapy

At this point the psychologists referred to previously mentioned subjects to topics already addressed in previous points of the survey: legal issues, confidentiality, professional ethics, forms of payment, technical particulars, the ability to access foreign markets, working with children and adolescents, obtaining feed-back from psychologists experienced with distance therapy, better understanding of the applications and the possibility that the Professional Association of Psychologists of Madrid might make a platform available for conducting distance therapy sessions for members who need it and a ranking of psychologists conducting such sessions.

Discussion and Conclusion

Our study examined for the first time, in Spain, the attitudes of psychologists towards the use of Internet and new technologies in professional practice. This happened by the rapid introduction of computer use and access to the Internet of most of the Spanish population, which reached more than 36 million homes in 2015.

In our sample, psychologists registered with the Professional Association of Psychologists of Madrid, we observed more participation by men than women in proportion to the total number of registered COPM members, which may reflect greater approval of distance therapy by men than women, although, gender did not affect the results that predicted therapy.

Spanish psychologists younger predominated in the online therapy use, the ages the sample were concentrated in the range of 27 to 54 years. The 2000 year was the first moment to use the new kind of therapy, with 5,488,520 home Internet users in Spain, the earliest date at which distance therapy was used by respondents was 2000, powered for 5,488,520 home Internet users in Spain. By 2010, there had been a significant increase on line therapy, coinciding with a raise to 30,387,781 in the number of home Internet users. The demand by clients as a supplement to faceto- face sessions when the patient had to travel or move was the reason for starting distance therapy was. Although the use of distance therapy in the Community of Madrid is low compared to countries like the United States and Canada, it is recognized this therapy is developing as an emergent option. Economic questions have not been a driving force in the implementation of distance therapy because the fees are the same or lower, never higher, than for face-to-face sessions.

The attitude of psychologists in Madrid is favorable, because although therapy is currently conducted via videoconference is only 26% of psychologists, the 60% are to favor using it in the future (60%), indicating a favorable attitude of psychologists in Madrid forward this new way of therapy

A specific application (e.g. Skype) is the media currently used for videoconferencing, 91% of respondents use it. As this application allows synchronous communication, the real-time flow of communication and tracking of the patient’s behavior are better, but the medium does not encourage deeper reflection in the course of assessing serious issues. In our sample, 37% communicated by telephone (audio) and 31% used deferred written communication via e-mail or WhatsApp.

The average of online sessions for each psychologist is (21%), which indicates that the psychologists in in our sample still make limited use of this medium.

In terms of the main concerns reported, were differentiate those that refer to psychologists who already use online therapy and those who want to do in the future. Psychologists who are currently using online therapy are less concerned with rapport and deficiencies in the collection of verbal and nonverbal information, which is an important factor in establishing a good therapeutic relationship, than those who have not yet started. On the other hand, the psychologists who already use the online therapy are more concerned with the technological and confidentiality problems. Reliability in the communication, problems in the speed or in the cuts in the connection, constitutes a greater difficulty for the using online therapy psychologists.

Spanish psychologists have expressed some needs in relation to online therapy: legal coverage was recognized from the very first investigations, whereas concerns about confidentiality have since been mitigated by better knowledge of the technical concepts of data storage and Internet infrastructure.


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