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.
Behavioral addictions - to shopping, sex, even e-mail - trigger the same rush of feel-good dopamine to the brain as drugs and alcohol. Since these "fixes" aren't formally recognized by the medical establishment, insurance won't pony up for treatment. But that doesn't mean they can't undo your life.
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."
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
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."