Is Pakistan ready for online therapy?

People have a hard time making a decision when it comes to seeking online versus in-person therapy. Hence, the question of online counselling as opposed to in-person counselling is one which most psychotherapists, including myself, are faced with quite regularly. The core principle of psychotherapy is beneficence and non-maleficence, which simply means minimising the harm and maximising the benefit for the clients. Going by this rule, online counselling may prove to be more convenient in various instances than in-person counselling, especially in less economically developed countries where mental health is often regarded as a taboo subject.

A lot of professionals and common people hold the idea that face-to-face counselling is superior to online counselling. In all honesty, the notion that online mental health practice should be looked down upon is not an informed one and comes from a place of privilege, especially when it comes to the ground realities of developing countries. The ground realities in Pakistan, for instance, provide a sufficient basis for online counselling to be a viable solution. The other day, I was browsing through my socials and came across a women-only group. The content and personal stories shared in the group only affirmed my stance on tele-mental health/online counselling.

I’ve seen victims of violence and injustices being supported in online groups in Pakistan. A lot of women in our country are stuck in an oppressive situation and don’t have the opportunity or strength to escape their perpetrator(s) in order to seek out in-person counselling for their ongoing trauma. Thus, online counselling provides them the opportunity to not only process the trauma but also to do so in a safe space. This often leads them to having enough coping mechanisms to eventually stand up to the oppressor and leave their respective toxic situation. Unfortunately, these women aren’t the exception, like they would be in more economically developed countries. These women are the norm in Pakistan.

Advocacy of online mental health is also important for situations where the client cannot trust the mental health practitioner due to a taboo being associated with the client’s sexual orientation and/or gender. There is a general lack of ethical practitioners in Pakistan who are aware of the sensitivities of dealing with LGBTQI+ clients and their families. A lot has been written about therapists that outed their own clients without their consent or caused other damage due to their unethical practices.

Hence, in countries like ours, online counselling guarantees a sense of safety, autonomy and anonymity for clients that identify with vulnerable and minority groups. Furthermore, online counselling is a common preference for overseas Pakistanis facing economic difficulties. In such a scenario, mental health practitioners from Pakistan provide quality service with a cultural understanding at affordable rates.

Moreover, there are various instances where physical disability becomes a hurdle for in-person sessions due to poor infrastructure for differently-abled adults in our country. It minimises the feeling of dependency on a caregiver that needs to accompany the person for in-person sessions since no infrastructure is in place for them to travel alone in the country.

Additionally, Pakistanis have been severely impacted by the recent hikes in the price of petrol, and the commute to and from the counselling session would cost half of the session fee for anyone driving around for in-person counselling. Online counselling in such cases is not only viable for clients but also for mental health practitioners.

On a global level too, a cyber lifestyle is taking over, particularly after Covid-19. People have started preferring accessing mental health services in the safety of their own home. For those who lead a nomadic lifestyle, it’s the only option to ensure they are regular with their mental health regime.

However, an important con of online therapy is its inability to incorporate those with severe symptoms, and inpatient care is the only viable option for such individuals. Also, children with neurodevelopment and other issues can only be handled and observed in the best manner in a face-to-face mental health setup. Generally, for adults, psychological assessment is something that would be difficult to incorporate in an online setup. So it would make sense to have a visit or two for this purpose.

Another inconvenience that mental health practitioners experience is the lack of understanding in clients when it comes to logistics of online sessions. For instance, it’s difficult for an average Pakistani client to understand that an internet dysfunction at their end wouldn’t qualify for a refund. Compliance to session timings and slots is another issue when it comes to online appointments. Power cuts and load-shedding in Pakistan are important inconveniences for anyone attempting to offer or use online mental health services.

The discourse around online therapy is more rooted in a preference for old school notions of counselling and a resistance towards online therapy, particularly amongst the older generation. In Pakistan, it’s an extension of the already existing taboo around mental health. This is further added to by an alarming trend of unqualified ‘therapists’ giving clients misleading counselling.

However, according to the American Psychological Association, online therapy is the future, and no amount of resistance can change that. Hence, the few bad apples engaging in malpractice under the guise of therapy must be rooted out.

It is imperative that we equip Pakistani mental health professionals and young therapists with the tools needed to address the blind spots associated with online mental health therapy. We must also help them acquire better skill sets in order to tackle this growing frontier.