Saturday, June 29, 2013

Email Counselling and the Disinhibition Effect: An Interview with Psychologist Caroline Macrory

Psychologist Caroline Macrory is a Therapy Market practitioner offering therapy via email. Email counselling and therapy is becoming more and more popular as a way of engaging with a counsellor. We asked Caroline about her clients and approach and why she decided to offer written word therapy.


Caroline, you offer written word therapy through email. What inspired you to specialise in this written approach to therapy?

During my work as a therapist, I discovered that traditional one-to-one therapy doesn’t work for everyone. I spent many years seeing clients who had experienced trauma and abuse and who struggled to withstand the intensity of a one-on-one therapy situation; I travelled out to rural and regional areas to see people who had no access to other services closer to home; I also saw people with speech or communication difficulties, who found it difficult to express themselves effectively by talking. As a result, I became more and more interested in alternative therapies and exploring ways of supporting people using different techniques and approaches.

I have been drawn to writing since a young age, and journalling has undoubtedly helped me through some difficult periods in my life. So once I became aware of the evidence base that demonstrates the healing power of writing, I was hooked.

My colleague and founding partner, Jenna Mayhew, had experienced similar limitations in traditional therapeutic approaches and also shared my passion for writing. It made sense to us to develop a therapy service where people could be supported and empowered to experience the many benefits of writing from the comfort of their own home. 

Therapy over the Internet and web counselling is becoming increasingly popular. What do you see are the advantages of a text-based approach to therapy?

There are a number of practical benefits to online therapy, for example it is convenient, more affordable and you can do it whenever and from wherever you like. You also avoid waiting rooms, public transport and all the other irritations that accompany attending appointments in person.

There are significant emotional benefits as well. Being online can be empowering, and will often lead to you being able to express yourself more openly and honestly. Researchers call this the ‘disinhibition effect’ and it means that you are likely to be more confident in exploring aspects of your self and identity when online. Being open and honest is crucial for effective therapy, so this is a real plus.

Is it just therapy you offer by email, or do you provide counselling and coaching as well?

Our service is person-centred, meaning that we believe people have a significant capacity for self-understanding, self-healing and personal growth. As such, whilst providing structure, guidance and suggestions in our correspondence, we also aim to support empowerment, and we work from the assumption that the individual needs to maintain control over the therapeutic process at all times.

Counselling and psychotherapy are often used interchangeably, although they are different. Counselling is usually focused on one problem, whilst psychotherapy is for longer-term emotional problems. We use the term ‘therapy’ to cover both of these approaches.

Jenna and myself trained as psychologists, meaning that we can offer both counselling and psychotherapy. We will determine the needs of each client on an individual basis and respond accordingly. There may also be an element of coaching in our approach, although we don’t practice this as a pure modality.

Who are your typical clients and what kinds of concerns do they write to you about?

The wonderful thing about writing is that anyone and everyone can benefit from it. Although our service may have particular appeal to certain people, for example those who find traditional therapeutic approaches uncomfortable or those who find it easier to communicate by writing than face-to-face, we don’t have a ‘typical’ client.

Clients come from a range of backgrounds and write to us about a whole host of of issues, ranging from a recurring dream they have been having to a relationship breakdown or a general feeling of being ‘lost’ in the world.

How many times can clients write to you? Is there a minimum number of emails they can send or a maximum time period you will work with people for?

Clients can write to us as a one-off or on an on-going basis. As with face-to-face therapy, people are likely to experience an increased rapport with the therapist over time, along with a steady progression of their self-development through writing, therefore it is encouraged that clients do write more than once. However, there is no minimum or maximum time period for engagement. 

As with all therapists, we will use our clinical judgement if we feel a client is no longer benefitting from the service or if we think a different type of therapy might be helpful. However, we will never turn a client away as long as they feel they are gaining something from the service and we feel it’s the right support for them.

What kinds of issues or problems interest you most as a therapist? Do you have any special areas of expertise to offer those interested in written word therapy?

A traumatic experience is one that overwhelms an individual’s ability to cope and inhibits their ability to integrate the emotions related to that experience. It can have a lasting negative impact on their lives.

I have worked extensively with people who have experienced trauma of one kind or another. As such, I am particularly interested in supporting people to work through these experiences. James Pennebaker’s original and groundbreaking research into writing focused on people writing about traumatic and emotional events and the results were remarkable.

I certainly believe that where a person has been subjected to an overwhelming experience and is unable to talk about it, writing about it (as long as they are ready) can bridge that gap and begin to make the traumatic event more coherent and subsequently more manageable.

What advice would you have for other therapists thinking about branching out into online therapy or even written word therapy by email?

Online therapy is a powerful tool that is becoming more and more popular. However, it is essential for therapists to be aware of the potential drawbacks to this approach. Most importantly, when individuals reveal their deepest and most painful or emotional secrets when no one is physically present, this can leave them feeling vulnerable and alone. Online therapists need to be aware of this and ensure they provide an appropriate level of support and advice. They also need to be aware of the many legal and ethical requirements of working online.

Finally, what do you think is the future for online therapy in the UK?

It is becoming evident that computers and online environments can have profound implications for therapeutic support. People are becoming more familiar with computers and more comfortable interacting in online environments, and this has become a part of daily life in modern societies.
Online therapy can be extremely effective, and it is also cost-effective and convenient. It makes therapy available to many people who have previously been unable to access it, due to location, time or financial restrictions. It has great potential for reaching out to people who are in need of support, yet are unable to see a therapist face-to-face.

Take a look at Caroline's page on Therapy Market if you would like more information about her services.

If you are interested in becoming a Therapy Market practitioner, you can join Therapy Market or visit to find out more.

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