I was home, depressed with the flu on New Year’s Eve 1998–and did what many other unfortunates did that holiday: I signed on to an AOL chatroom in search of some therapeutic banter on the crucial inanities of life.
But what I found was “DrMichael”–a therapist with credentials. And he wasn’t asking me my opinion on the Grammys. “How are you really feeling?” he asked.
That was a little more than I was looking for, but the truth is, I had toyed with the idea of counseling for more than a year. Over the next hour, in private “instant messages,” I shared with the Florida-based psychologist the intricacies of my recent breakup with my boyfriend of four years.
When we signed off, he said, “Talk to you tomorrow?” (There was no mention of money.)
DrMichael sent me his resume, and I called his offices in Florida to verify his identity. He passed the test. We ended up chatting about my gripes and goals one evening a week for the next year–for free. At the time, his wife was ill and nearly unconscious. The two were homebound, and he had become lonely and depressed. “Giving therapy online is more gratifying than short-lived Internet frolicking,” he told me. “Anyway, I went into therapy because I like to help people.”
Therapists have flocked to the Web for a whole slew of reasons, resulting in 200 “online therapy” and online counseling sites offering access to about 350 online counselors. Since 1995, psychologists of varying credentials have offered everything from “answers to three questions for free” to “submit a question about sexuality for $75” to private chatroom meetings for $40 an hour, to three months of unlimited e-mail therapy for $300.
In addition, there are thousands of support groups, moderated by some type of therapist, organized around every conceivable need. Most online therapists also maintain conventional, face-to-face practices.
A growing number of people are depending on the Web for emotional support and counseling for bargain-basement prices. And the need is dire, says veteran online counselor David Sommers. Online counselors are reaching victims of abuse and trauma who are too embarrassed to look someone in the eye as they share their struggles. In fact, this text-based, faceless medium tends to put all people at ease. “There’s no eye contact while confessing insecurities or sins,” says Sommers.
Moreover, he adds, online counseling reaches people who can’t afford standard therapy fees.
And because you can save your correspondences, “it’s like having a hug inside your computer that’s waiting for you whenever you need it,” says Martha Ainsworth, an Internet communications specialist and founder of www.metanoia.org, a private, non-profit Web site that explains and celebrates the virtues of online counseling.
Already, experts estimate there are thousands of online support groups attended by tens of thousands of people. And they predict that online counseling will be ubiquitous within five years.
Most therapists and academic institutions remain suspicious of the new field.
The term itself, “online therapy,” is considered inaccurate and offensive by many psychologists. Stuart Tentoni, coordinator of the Norris Health Center at the University of Wisconsin at Madison, says “Internet therapy” is an oxymoron.
“Psychotherapy is based upon both verbal and non-verbal communication,” he says. “Without seeing the person, it is impossible to get a full sense of that person’s situation in order to adequately render therapeutic advice to them.”
Many online providers do, in fact, call themselves counselors rather than therapists, according to John Grohol, director of MentalHealth.Net, one of the most comprehensive guides to mental health online. The most conservative among them say they offer mere “advice,” while others use the weightier, though clunky term “behavioral telehealth.” But from his five years of online counseling experience, Grohol says that “online relationships are just as real and intense as they are in the real world.” But, he adds, “Whether it’s therapy or not, I do not know.”
This issue is not the point, according to Ainsworth, who feels that psychologists should open their minds to the new reality. “It’s time to concentrate on research and begin to train innovative therapists to meet the needs of the next generation,” she says. “We should be looking at the numbers of people who are being helped by online counseling–and how to improve it–rather than getting hung up on terms.”
Ainsworth admits that online counseling is not for everyone. If you’re going to receive counseling by e-mail or chat, she warns, “you should be comfortable expressing yourself in writing.” It is not for people in the midst of a serious crisis–when body language and tone of voice become vital–although it is especially attractive to them. Many online practitioners regularly refer dozens of people in crisis to traditional therapists in their area or to The Samaritans (www.samaritans.org.uk), trained volunteer counselors in England who specialize in handling crises online.
While the professionals behind quality counseling Web sites state their limitations up front, drawbacks to Web “therapy” abound: There is no systematic guarantee that the self-proclaimed therapist is legitimate or licensed to practice in your state; there are possibilities for compromising privacy; there are technological glitches; and there are complicated payment and legal concerns.
There have been no reported arrests for practicing without credentials online, and, so far, there has been no reported litigation against an online-therapy provider. Yet there are no diplomas to review on the office wall. Still, there are private Web sites that will research the background of any person calling him or herself an online therapist (see www.metanoia.org).
But “licensed” and “licensed to practice in your state” are separate matters. Cyberspace transcends state and international borders, rendering it difficult to apply and impose enforceable codes of conduct. Worse, case law and statutes regarding confidentiality regulations differ from state to state. For now, online counselors and lawyers agree that the online counselors should be held responsible for adhering only to the legal and ethical boundaries of the state in which they are licensed to practice.
The most sticky and ominous issue yet is payment, says Michelle Weil, who conducted research on online counseling three years ago with her colleague Larry Rosen. “Some therapists would tell their clients, `Pay me what you think it’s worth.’ ” Weil reports that therapists then end up trying to prove they’re worth the money. “This creates an unhealthy power structure,” she explains, in which a therapist’s desire to win a client’s approval may affect his or her treatment.
Although the kinks of Internet counseling have yet to be ironed out, it is the very experimental nature of the medium that attracts some therapists, people who sacrifice profit for the discovery of uncharted territory. The sacrifice ultimately proved too great for Sommers, who left the Internet to open a more lucrative, traditional practice.
“Online therapy is as time consuming as face-to-face therapy, but pays substantially less,” he explains. He did most of his online counseling pro-bono or according to a sliding scale.
Sommers went into the field and communicated with at least 350 people via e-mail–some for as long as a year–to “see if online counseling was doable and if it could have had any meaning.” Five years later, “It is viable, but in no way would I make the case that Internet counseling is complete,” he says. “You’re missing the real person.
“The Internet allows those who cannot obtain live therapy, for financial or physical reasons, to seek instant advice or get quick and discreet information,” he adds. And for that, it seems to be working.
THE GOOD AND THE BAD: 5 ONLINE OPTIONS
ASK-A-QUESTION: A client writes to a counselor with a detailed question or problem, and then receives a customized solution.
Good: If you have well-defined problems that can be explained in a few paragraphs or less.
Bad: If the nature of your problem is complex, overwhelming or has persisted for an extended period of time.
ONGOING PRIVATE CHAT: The counselor and client chat privately through instant messaging, usually for hourlong intervals.
Good: If you are struggling with non-traumatic issues, such as job or relationship stress, and if you enjoy writing.
Bad: If you are suffering from severe depression, or substance addiction, when facial cues and body language are vital.
VIA E-MAIL: The counselor and client correspond via e-mail messages.
Good: If you want to unload at any time. E-mail counseling also can complement a traditional therapy relationship.
Bad: If you feel uncomfortable writing about your issues at length.
SUPPORT GROUPS WITH A COUNSELOR: Participants join Thats administered by professionals at mental health-related Web sites.
Good: If you could benefit from immediate feedback from fellow sufferers but are too embarrassed to meet face to face; or if you have little or no access to fellow sufferers.
Bad: Online support groups pose one of the most contentious legal and ethical issues of all online therapies because minors can easily sign on to the free site and lie about their age or situation.
VIDEO-CONFERENCING: Like private chatting, the counselor and client usually meet for hourlong intervals but can actually see and hear each other via cameras (available now for $50 to $200).
Good: If you want the counselor to be able to fully evaluate you– tears, intonation and all.
Bad: Visuals are still poor. Experts anticipate clear communication within one to three years.
THE 10 NET COMMANDMENTS
If you are going to take the leap into online therapy, make sure your online counselor follows these guidelines, adapted from the American Counseling Association, www.counseling.org/gc/cybertx.htm:
1. Counselors must inform clients of the limited security of their correspondences.
2. A client must be informed of all counselors and professionals who have access to the Web site, and whether information is secured by an encryption code.
3. Upon conveying the “risks” of online therapy to a client, the professional counselor should execute a client waiver by which the client acknowledges that he or she has been informed of potential hazards.
4. On the Web site, counselors should state clearly that therapy is impeded by the counselor’s inability to read facial and body-language cues.
5. The emotional and intellectual capability of the client must be a foremost concern when a therapist agrees to counsel a client online.
6. Despite the global reaches of the Internet, counselors may provide services only in states where they are licensed to practice.
7. Legally, the online therapist must confirm that his or her liability insurance covers the services provided over the Internet.
8. The counselor must verify that the potential client is above the age of a minor.
9. If the client is underage, written consent is required from the minor’s legal guardian or representative.
10. Clients should perform a credential check on any therapist found online (consult www.metanoia.org).
