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By Dr Timothy J Sharp, Founder of The Happiness Institute; Clinical Lecturer, University of Sydney and Michelle Pritchard, PhD candidate, University of Sydney

With more than 50 per cent of Australians accessing the internet, many for health care information, practitioners are increasingly incorporating internet-based therapy into their repertoire of services (Newman, 2004). But research regarding internet-based therapy has been sparse, and focused predominantly on the advantages and disadvantages. In summary, internet-based therapy enables more convenient communication for those who lead busy lives or who are geographically disadvantaged (Hunt, 2002). Perceived disadvantages of internet-based therapy include the potential for miscommunication, the risk of breaching of confidentiality with hackers and viruses, and the chance of breakdowns in technology (Barak, 1999).

Despite both the recent surge in internet access for healthcare information and the increase in literature discussing internet-based therapy however, research investigating efficacy is extremely limited. Further, there appears to be no research seeking to understand what the general public's opinion is regarding accessing the internet for psychological therapy and how these attitudes compare to their attitudes to other delivery modalities of psychological therapy.

In an attempt to fill this void the current study seeks to gain an understanding of attitudes towards different delivery modalities, including face-to-face individual and group therapy, telephone therapy, self-help resources, computer-aided technology and internet-based therapy. Specifically, the study addresses how beneficial the public perceives these types of therapy to be in assisting with a problem, how likely it would be that they would engage in each of the therapy types, and what the factors would be that determined the choice of psychological therapy.

The sample included 179 adults with a mean age of 29.5 years. Participants comprised four groups including first-year psychology students, clinical psychologists, current users of internet-based psychological services and clients in face-to-face therapy. Information was gathered via an originally developed questionnaire which participants completed in their own time (and which assessed demographics; attitudes towards different modalities; and computer use behaviour).

Overall, face-to-face individual therapy is perceived as being more beneficial than all other types of therapy, the most likely type of therapy to be engaged in, and also the type of therapy that the public would be more willing to pay a higher amount of money per session for.

Interestingly, the results for other means of service delivery were less consistent. For example, while face-to-face group therapy was considered to be significantly more beneficial than all other forms of therapy other than face-to-face individual, the participants reported they would be less likely to engage in this form of therapy. This finding may be attributed to a reluctance to share personal information with others, an explanation supported by the finding that while participants rated self-help resources to be less beneficial than other modalities, they reported being more likely to utilise them. In addition to a preference for confidentiality, participants may have also preferred self-help resources as something that can be used in their own time.

Notably, internet-based therapy was not rated all that favorably. It was consistently perceived by the respondents as being less beneficial and as being the least likely form of therapy that the participants would engage in.

The three most important factors affecting choice of therapy, as reported by the participants, were (1) how beneficial they believed that the therapy would be in helping them to resolve their problem; (2) how experienced the therapist is; and (3) how comfortable they felt in the engagement of therapy.

While these factors are not surprising in explaining the overall preference for face-to-face individual therapy, they may assist in the understanding of the contributing factors to reluctance to engage in internet-based therapy. In an attempt to improve public motivation for engagement in internet-based therapy (which is important, as this may well prove to be one of the more effective ways to ensure that more people in need access professional resources), researchers should seek to clarify the efficacy of internet-based therapy and assist in the reporting of these results to the public. Practitioners should also seek to clarify the qualifications and experience of the clinician providing the treatment and should assist clients in becoming comfortable with internet-based therapy.

While there is no question that face-to-face individual therapy will (and probably should) remain as a frequently used and preferred method for delivery of psychological therapy, there is considerable reason to motivate clinicians and researchers to boost the reputability of internet-based therapy. Further research may seek to clarify what the public would consider to be helpful in improving levels of personal comfort if engaging in internet-based therapy.


Barak, A. (1999). Psychological applications on the Internet: A discipline on the threshold of a new millennium. Applied and Preventative Psychology, 8, 231-246.

Hunt, S. (2002). In favour of online counselling? Australian Social Work, 55 (4), 260-267.

Newman, M.G. (2004). Technology in psychotherapy: An introduction. Journal of Clinical Psychology, 60 (2), 141-145.

Address for Correspondence: Michelle Pritchard, Clinical Psychology Unit, Transient Building F12, The University of Sydney NSW 2006. Email: ellep@psych.usyd.edu.au