Abstract
BackgroundInternet interventions have been developed and tested for several psychiatric and somatic conditions. Few people with substance use disorders receive treatment and many drug users say that they would prefer getting help from online tools. Internet interventions are effective for reducing alcohol and cannabis use. The aim of the current study is to understand differences between internet-based and face-to-face treatment of problematic substance use. The concept of alliance will be used as a theoretical frame for understanding differences between internet-based treatment and face-to-face treatment, as perceived by therapists.MethodThe study has a qualitative design and is based on 3 focus group interviews with 12 therapists working with internet-based treatment for alcohol or cannabis use problems within five different programs.ResultsThe analysis revealed five themes in the differences between internet-based and face-to-face treatment: communication, anonymity, time, presence and focus. Treatment online in written and asynchronous form creates something qualitatively different from regular face-to-face meetings between patients and therapists. The written form changes the concept of time in treatment, that is, how time can be used and how it affects the therapist’s presence. The asynchronous (i.e. time delayed) form of communication and the lack of facial expressions and body language require special skills.ConclusionsThere are important differences between internet-based treatment and face-to-face treatment. Different aspects of the alliance seem to be important in internet-based treatment compared to face-to-face.
Highlights
Internet interventions have been developed and tested for several psychiatric and somatic conditions
The analysis revealed five themes in the differences between internet-based and face-to-face treatment: communication, anonymity, time, presence and focus
Internet interventions, online treatment, computerassisted therapy, web-based treatment, e-health... there is a plethora of terms for describing interventions which take place online instead of in the more traditional setting, where a counselor or a therapist meets a patient face to face
Summary
Internet interventions have been developed and tested for several psychiatric and somatic conditions. The aim of the current study is to understand differences between internet-based and face-to-face treatment of problematic substance use. The concept of alliance will be used as a theoretical frame for understanding differences between internet-based treatment and face-to-face treatment, as perceived by therapists. In a study that investigated the experiences of users of an internet-based self-help program aimed at reducing alcohol consumption, the perceived privacy of the internet was important in searching for help and to avoid stigma and embarrassment [8]. During the development of the same intervention, users expressed appreciation of the self-help exercises and the non-judgmental tone of texts [9]. A systematic review on expectations and experiences regarding e-health treatment with focus on women [10] provide an overview of perceived disadvantages and advantages of internet-based treatment outside of the substance use field. The relationship with an online therapist is viewed as important and sometimes experienced as just as close as in face-to-face treatment [10]
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