Email therapy is an asynchronous form of therapy that is conducted via the medium of encrypted emails.
Usually, email therapy works like this: you and your therapist will set a date and time for your email therapy session. You will send an email to your therapist on the agreed day and time. The email may be limited to a certain number of characters - for example, I ask clients to try to keep to 1000 characters per email. You can write about whatever you want in your email and you could also make use of formatting for emphasis and expression. Your therapist will then spend a therapeutic hour (approximately 50 minutes) replying to your email, as they would if you attended in-person. You will receive your therapeutic reply within a certain time frame - usually about 48 hours after you send your email. And then the cycle repeats.
Due to the format of emailing, the client and therapist rely on the written word rather than the spoken word. In this way, it has a lot of features that may differ from synchronous forms of therapy and other forms of therapy that rely on spoken word.
While it’s great that there are so many different forms of therapy, I can imagine it might feel overwhelming knowing what kind of therapy might suit you. So, the aim of this blog is to explore some of the benefits of email therapy and to discuss the kinds of clients who might find this form of therapy helpful. I will also therefore be highlighting some of the qualities of email therapy that may not be desirable to some people. Since everyone is different, it’s important to think about your needs and preferences and how this may factor into what mode of therapy you might like to try.
Asynchronous vs Synchronous
The difference between email therapy and some other forms of therapy is that it occurs via an exchange of emails with a certain amount of time between each exchange. The benefit of an asynchronous form of therapy is that you can take as much time as you need before the deadline to draft and edit what you’d like to say. This means that you can carefully craft what you’ve written and make sure that it expresses exactly what you want.
Whereas, in synchronous forms of therapy like face-to-face, videoconferencing, or chat, you are limited to the therapeutic hour and it can be difficult to think on the spot what you want to bring to the session. Additionally, sometimes things can pop up between sessions and you cannot share with your therapist until the next session. That could also mean that you might not be able to recall and/or express the thoughts and feelings of something that happened two weeks ago, for example.
With email therapy, if something comes up before the deadline you can add that to your email and share your thoughts and feelings at the time when you are thinking and feeling it.
The Power of Written Word
Language is the bread and butter of therapy. That is why it is often known as ‘talk therapy’ because shifts and changes occur through talking to a trained professional. In the case of email therapy, we communicate in a different way - through writing. There is evidence to show how therapeutic writing can be in general but it is also utilised in therapeutic modalities like Narrative Therapy. Despite research in the area of email and other written forms of therapy being fairly recent, one thing that the research does seem to agree upon is that the written word can be a tool for healing (Wright & Cheung Chung, 2001; Wright, 2002; Lynn Haertl & Ero-Phillips, 2019)
“Writing itself is a powerful therapeutic technique”
- Esterling et al., 1999
On top of the therapeutic effects of written communication, email therapy increases the accessibility of therapy. For example, neurodivergent or disabled clients might struggle with traditional forms of talk therapy - and this could be for a variety of reasons depending on the individual. For example, someone who struggles with verbal processing, or someone who has a lack of accessible options may benefit from alternative modes of therapy. So, email therapy could allow more people to access therapy in a way that might suit them and their needs.
Anonymity
One potential benefit of email therapy is anonymity. While of course your therapist will know several details about you, they may not know what you look like or might not have access to as much information as they would in a face-to-face appointment. This may allow you to feel a bit more in control of what information you share. Additionally, it can be hard talking to a relative stranger about your most intimate thoughts, feelings and experiences so it can make it easier to open up to someone by remaining anonymous.
On the other hand, there could be a downside to the aspect of anonymity called the ‘Online Disinhibition Effect’ (Suler, 2004). This means that while it may be easier to open up to someone online - it can actually be quite intense and the pace of getting into deeper topics may be faster compared to other forms of therapy. It’s important to be mindful to take therapy at your own pace and make sure you are sharing information with your therapist when you feel comfortable doing so.
Mindfulness
All therapies aim to increase mindfulness - the present awareness of thoughts and feelings. There are a variety of ways that therapists help clients to increase their self-awareness. However, it can be difficult to practice mindfulness and everyone is different. One technique may work for your friend but not for you. So, one way that we can increase mindfulness is through things like journaling - writing down and expressing our thoughts and feelings. While email therapy is very different from a journal - especially the audience and the fact you will get a reply - it can work in a similar way by asking you to sit down and really think about what you are experiencing. If you struggle with things like guided mindfulness meditations then something like email therapy might be a helpful way for you to increase your self-awareness and understanding of your experience. Additionally, your therapist can assist with this as they would in any other kind of therapy. But, in this case, rather than having to remember what your therapist told you, you have a record of it in front of you that you can revisit when you want to. Having the ability to revisit previous emails could be useful not only for increasing your mindfulness skills but you can also see your progress on the page.
Hybrid Therapy
Another benefit of email therapy is that it can be quite easily used in conjunction with other forms of therapy. For example, you might see your therapist online via videoconferencing or in-person for a traditional ‘talk therapy’ session and you might have an email therapy session in between appointments or once a month. This could be beneficial in several ways: firstly, it allows for two different forms of communication which can bring out different ways of reflecting on and understanding your experiences. It allows for flexibility and space to create a unique therapeutic experience that is tailored to you and your needs. For example, you could agree on topics for email therapy in your in-person appointment and use email therapy like a reflective practice. Lastly, if you want to increase frequency of therapy but you can’t make it in-person or can’t find a safe space to talk multiple times a week or multiples times a month - email therapy could be a great addition so you are still getting your therapy needs met with the limitations you might have on time and resources.
The possibilities are endless and you and your therapist can collaborate in many ways when using a variety of therapeutic modes.
Summary
To sum it up, I think there are so many wonderful benefits to email therapy. Some of these include the increase in accessibility, the ability to use the written word as a form of communication and the versatility of email therapy.
Some things that you might want to consider before you try email therapy are:
The appropriateness of email therapy for your concerns e.g. if you feel at risk of self-harm or are struggling with active suicide ideation then email therapy would not be appropriate
Whether you are OK with not seeing your therapist and having a reduced level of visual and verbal cues
Whether you like to communicate using written word or whether it’s easier for you to use spoken word to express yourself
And lastly, whether you have the time, space and privacy that might be required for email therapy e.g. do you use a shared computer? do you have time to sit down for at least 50 minutes to write your emails?
So, if email therapy sounds appealing to you, why not give it a try? You never know what you might learn about yourself!
As a Certified Cyber Therapist, I'm able to offer email therapy and I’d be happy to answer any questions you might have about how that works. I’d be happy to work with you so please do not hesitate to contact me.
References
Esterling, B. A., L’Abate, L., Murray, E. J., & Pennebaker, J. W. (1999). Empirical foundations for writing in prevention and psychotherapy: Mental and physical health outcomes. Clinical psychology review, 19(1), 79-96.
Jeannie Wright & Man Cheung Chung (2001) Mastery or mystery? Therapeutic writing: A review of the literature, British Journal of Guidance & Counselling, 29:3, 277-291, DOI: 10.1080/03069880120073003
Jeannie Wright (2002) Online counselling: Learning from writing therapy, British Journal of Guidance & Counselling, 30:3, 285-298, DOI: 10.1080/030698802100002326
Suler, J. (2004). The online disinhibition effect. Cyberpsychology & behavior, 7(3), 321-326.
Kristine Lynn Haertl & Adrienne Maiers Ero-Phillips (2019) The healing properties of writing for persons with mental health conditions, Arts & Health, 11:1, 15-25, DOI: 10.1080/17533015.2017.1413400
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