Bad day at the office? Spouse acting unresponsive? Generally feeling bummed? Help is just an e-mail away.
As the Internet becomes an increasingly popular venue for advice-wielding therapists, Web counseling has emerged as one of the hottest debates in psychotherapy.
The dozens of individuals plying their trade online say e-mail counseling is not only convenient and affordable but, for some dTC people, also more conducive to free expression. Skeptics call it an oxymoron.
"You can tell a lot of stuff from someone's voice," notes Dr. Douglas Weiss, owner of the Fort Worth Heart to Heart clinic for sexual addiction. "Whereas if you just wrote me an e-mail, I wouldn't know if you were 50 or 21. It robs you of a large part of that intuitive, interactive part."
Online counselors offer a virtual ear to individuals suffering everything from low self-esteem and sexual addictions to eating disorders and anxiety. They claim professional, confidential and comparatively low-cost treatment, as close as the nearest computer terminal.
Think "modem-as-sofa" and get comfortable.
"Nobody's grandmother will be surprised by the fact that you can create a lot of intimacy through writing letters," says Lawrence Murphy, co-founder of Therapy Online, based in Canada. "All of the clients have been impressed with the connections they've been able to make" with their Web counselor, he adds.
Murphy and partner Dan Mitchell opened their online office two years ago, marrying interests in computers and counseling. They also saw a need not being met.
"There are a lot of people who find it difficult to come into an office and sit in front of another person and disclose their problems," Murphy explains. People in small towns might not have easy access to a therapist. Worse still, the local psychologist might be a relative. And clients who move around a lot don't want to tell their stories to five different psychologists.
With online counseling, "You never miss an appointment," Murphy says, "you don't have to get a baby sitter, you don't have to take an hour off work, you don't have to wait until the appointment to talk about what happened."
The Internet supports about 50 online advice givers, says Dr. John Grohol, director of Mental Health Net. Most of them appropriately refer to themselves as counselors, he says, not therapists.
"Counseling is looked at more as helping the person to determine what the best course of action might be, and it deals generally with much simpler problems," Grohol says. "To actually say that you're doing psychotherapy online is taking a big leap in terms of what has been traditionally known as psychotherapy."
The ethics code of the American Psychological Association states that productive therapy requires a "professional relationship" between psychologist and client. That, says Dr. Stuart Tentoni, coordinator for the Norris Health Center at the University of Wisconsin at Madison, would be extremely difficult to develop without face-to-face contact.
But even Grohol, who studies online behavior and leads mental-health chats on the Internet three times a week, acknowledges the appeal of Web counseling.
"[Online] relationships are very real, and they're just as intense and just as important as they are in the real world," he says. "Whether it's therapy or not, I don't know."
One of the biggest concerns surrounding online therapy is fraud. "The most obvious drawback is you don't know who the heck you're talking to and what their qualifications are," Grohol says. "You could be sending 20 bucks to a 14-year-old kid."
Most Web counselors accept payment by credit card (some accept checks). Fees on average run $20 to $30 per half-hour, compared with $40 to $45 in an office (or around $75 for 50 minutes).
Confidentiality is another major issue. Some counselors will offer an encryption program, but otherwise there is little guarantee that a private e-mail won't fall into the wrong hands. Emergencies also pose a problem for online clients and providers. How does a counselor in Texas help a suddenly suicidal patient in Michigan? Murphy in Saskatchewan and counselor Jeanne Rust in Tucson, Ariz., carefully screen potential clients and will not accept those with severe mental disorders.
Neither will counsel individuals primarily dealing with sexual abuse, for instance, or domestic violence. "I would not be at all comfortable writing to an abused woman whose husband can access her e-mail," Murphy says.
Three months ago, Grohol's Mental Health Net began certifying online therapists. The nonprofit organization will verify the identity and credentials of any counselor who asks (the cost is $19.95) and then give its seal of approval to the site. About 15 therapists, including Rust, have signed up so far.
"I don't think anyone is suggesting this replace traditional therapy," says Rust, an eating-disorders counselor who uses her Web site mainly to disseminate information. "In my mind, it's for people who can't do it otherwise."
Rust's long-distance patients complete a 23-page assessment, and she conducts e-mail sessions only with clients too far away to phone, such as those in Brazil and Singapore. Those exchanges take place in a password-protected chat room.
"The thing is, in a year, this is all going to be moot," Rust says. "We're all going to have video capabilities and be able to see people." In the meantime, the pitfalls of online therapy need to be addressed -- at least, that's the belief of the National Board for Certified Counselors. In June, the NBCC approved a 20-point "Standards for the Ethical Practice of Web Counseling." The American Psychological Association's annual conference last month also addressed the issues of online psychology.
"Because it's so new and because we don't have definitive answers, we feel uncomfortable promoting" online therapy, says Dr. John Bloom, the NBCC board member who headed the Web-counseling committee and wrote the standards. "But nonetheless it's being done, and because of that we feel a responsibility to the public and the profession to see that it's done as professionally and ethically as possible."
Where to look
Using the search engine Yahoo!, we found 38 sites under the heading "online counseling." Here are some specific addresses offering information. All Web site addresses begin with http: //.
* www.apa.org -- The American Psychological Association site contains ethics information as well as journal articles.
* www.nbcc.org -- The 26,000-member National Board for Counselor Certificaion, a nonprofit organization, recently drew up an online ethics code.
* www.grohol.com -- Information from Dr. John Grohol of Mental Health Net.
* www.cmhc.com -- A listing of mental health services online.
* www.deepcove.com/therapy/ services.htm Therapy Online, one of the first and most well-regarded Web counseling sites.
* www.edrecovery.com -- Jeanne Rust's educational information on eating disorders.
* www.csudh.edu/psych/lrosen.htm-- Dr. Larry Rosen offers information about psychotherapy and a link to the article "From the Couch to Cybertherapy."
* www.dcez.com/davids/ pageone.html -- The Mental Health Cyber Clinic.
Fort Worth Star-Telegram
Pub Date: 9/09/97