Is Pakistan Ready for Online Therapy?
Local conditions in Pakistan provide a sufficient basis for online counseling to be a practical and convenient solution
People find it difficult to make a decision when it comes to seeking online or in-person therapy. Thus, the issue of online counseling as opposed to face-to-face counseling is one that most psychotherapists, myself included, are faced with fairly regularly. The core principle of psychotherapy is benevolence and non-harm, which simply means minimizing harm and maximizing benefit to clients. Following this rule, online counseling may prove more convenient than face-to-face counseling in various cases, particularly in less economically developed countries where mental health is often considered a taboo subject.
Many professionals and ordinary people believe that personal advice is superior to online advice. Frankly, the notion that online mental health practice should be looked down on is uninformed and comes from a privileged place, especially when it comes to the realities of developing countries. The realities of Pakistan, for example, provide a sufficient basis for online counseling to be a viable solution. I was browsing my social media the other day and came across a women-only group. The content shared in the group and personal stories only confirmed my stance on telemental health/online counseling.
I have seen victims of violence and injustice supported in online groups in Pakistan. Many women in our country are in a depressing situation and do not have the ability or the strength to escape their abuser or abusers to seek personal counseling for their ongoing trauma. Online counseling offers them the opportunity not only to process the trauma, but also to do so in a protected space. This often results in them having enough coping mechanisms to eventually stand up to the oppressor and exit their respective toxic situations. Unfortunately, these women are not the exception as they would be in economically developed countries. These women are the norm in Pakistan.
Online mental health advocacy is also important in situations where the client cannot trust the psychotherapist because the client’s sexual orientation and/or gender is taboo. There is a general lack of ethical practitioners in Pakistan who are aware of the sensitivity of dealing with LGBTQI+ clients and their families. Much has been written about therapists who have outed their own clients without their consent or harmed others through their unethical practices.
Therefore, online counseling in countries like ours guarantees a sense of security, autonomy and anonymity for clients who identify with vulnerable groups and minorities. Additionally, online counseling is a common preference for Pakistanis abroad facing economic hardships. In such a scenario, psychotherapists from Pakistan offer quality service with cultural understanding at affordable rates.
In addition, there are various cases where physical disabilities become a barrier to face-to-face sessions due to the poor infrastructure for disabled adults in our country. It minimizes the feeling of dependency on a caregiver to accompany the person at in-person sessions, as there is no infrastructure to travel alone in the country.
In addition, Pakistanis have been badly affected by recent increases in petrol prices and travel to and from the consultation session would cost half the session fee for anyone driving around for an in-person consultation. In such cases, online counseling makes sense not only for clients but also for psychotherapists.
A cyber lifestyle is also gaining ground on a global level, especially after Covid-19. People have started to prefer accessing mental health services in the safety of their own homes. For those leading a nomadic lifestyle, this is the only option to ensure they are dealing with their mental health system on a regular basis.
However, a major disadvantage of online therapy is the inability to engage 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 treated and monitored in the best way in a personal mental health facility. In general, adult psychological assessment is something that is difficult to incorporate into an online setup. So it would be useful to make a visit or two for this purpose.
Another inconvenience experienced by mental health practitioners is clients’ lack of understanding when it comes to the logistics of online sessions. For example, it is difficult for an average Pakistani customer to understand that an internet failure on their end is not eligible for a refund. Meeting meeting times and time slots is another issue when it comes to online appointments. Power outages and load shedding in Pakistan are significant inconveniences for anyone attempting to provide or use online mental health services.
The discourse around online therapy is more rooted in a preference for old-school counseling concepts and a resistance to online therapy, especially among the older generation. In Pakistan, it is an extension of the already existing taboo around mental health. There is also an alarming trend of unqualified “therapists” giving misleading advice to clients.
However, according to the American Psychological Association, online therapy is the future and no amount of resistance can change that. Therefore, the few bad apples that commit malpractice under the guise of therapy must be eradicated.
It is imperative that we equip Pakistani mental health professionals and young therapists with the necessary tools to address the blind spots associated with online mental health therapy. We must also help them acquire better skills to handle this growing frontier.