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Is Online Help Safe?

Consumer beware.

WebMD Feature
Reviewed by Craig H. Kliger, MD

July 24, 2000 -- Eighteen months ago, Beth Steele of Houston was severely depressed. She had long suffered from bipolar disorder, but between caring for a daughter with the same illness and running her dog grooming business, she couldn't find time for therapy. Then a client suggested a solution: Why not seek therapy online?

Hundreds of licensed mental health professionals -- and some unlicensed freelancers -- are offering such services through email and online chat rooms. Even professional associations that once pooh-poohed the practice are now issuing guidelines for online therapy.

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Expect the trend to grow, says Leigh Jerome, PhD, a clinical psychologist who is helping the American Psychological Association develop its online policy. "Within ten years, computers will become so embedded in our lives, we won't even think of this as telehealth," she says. "The housebound patient will be able to receive care on a regular basis. Therapy will be conducted (via email or chat rooms) with remote or extended family members located thousands of miles from each other."

Like Fire

Despite these predictions, online therapy remains controversial. Little research has been done to show its effectiveness or whom it best serves. And many in the field still worry about privacy, liability, and fraud. (To learn more about the benefits -- and dangers -- of online therapy, see Therapy From a Distance and When Cybertherapy Goes Bad)

"It's like fire," says Zebulon Taintor, MD, chair of the American Psychiatric Association's committee on telemedical services. "It can heat your house or burn it down."

For Steele, the advantages clearly outweighed the risks. She found help through a chat room at concernedcounseling.com, where she and her counselor "talked" every Tuesday for a year. "I always had trouble talking about my feelings face to face," she says. "Dr. Stone is the only person I've been able to open up to 100%; he helped me channel my energies in positive ways."

Martha Ainsworth, a Princeton, N.J.-based web page designer, also testifies to the benefits of online therapy -- under the right circumstances. In 1996, Ainsworth found only 12 therapists willing to counsel her online, and felt confident with only one. "It was really convenient doing therapy by email," she says. "And it was one of the most profound relationships I'd ever had. Even though he wasn't physically present, he was a huge presence in my life."

Ainsworth decided to help others locate reputable online therapists, so she created a consumers guide, "ABCs of Internet Therapy" at her web site, www.metanoia.org. The site lists 250 online therapists and provides notes about their credentials.

Checking credentials is essential to finding good counseling online, says Ainsworth. And even then, "Online counseling is not for everyone. You need to be a reasonably good writer. And people who are in the midst of a serious crisis need more immediate help."

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