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.
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 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."
One advantage to cybertherapy is convenience; it's as close as your computer, available seven days a week, 24 hours a day, and you don't have to worry about how you look or what you wear. You can also keep a written record of your therapist's advice for future reference by saving copies of the messages you exchange.
It may be less expensive, too; most therapists charge about a dollar a minute for email consultations -- slightly less than the $80 and up they might charge for a 50-minute online chat or office visit.
The anonymity of the Internet is also sometimes cited as an advantage by people who don't want others to know they are seeing a therapist. But "it is folly to think anything going into a computer is anonymous," warns Taintor. "It is all electronically retrievable data."
For some people, the nonvisual nature of cybertherapy is what appeals. Ken Evans of Russelville, Ark., did not want to be seen by anyone. Since undergoing brain surgery in 1994, the one-time personnel manager has been paralyzed on the left side of his face. He became seriously depressed, but was too self-conscious about his appearance to open up in therapy. His turning point came when he found the web site of California-based psychologist Julie Keck, PhD, www.counselingcafe.com.
"With the Internet, I don't have to worry about how I look or driving the car," Evans says. "I can talk to Dr. Keck any time day or night and have an answer within 24 hours."
On the other hand, the most common criticism of online therapy is that the therapist misses nonverbal clues. A person's body language reveals a lot about mood, Taintor says. And the way a patient reacts to a therapist's comments -- perhaps tensing when a sensitive issue is raised -- offers insight into problems. (See Why Counsel Online?)
Another drawback to cybertherapy is that doctors usually won't prescribe medication online. Following her online therapist's advice, Beth Steele saw a psychiatrist once every three months through her county's mental health agency, which provided her with medication.
That ultimately may be the role of online therapy -- to break down the barriers to getting treatment started. Cybertherapy, says Taintor, "is not a substitute for in-person therapy. But it is better than seeing no one at all."
Barbara Burgower Hordern is a freelance writer based in Missouri City, Texas, a Houston suburb. Her work appears in publications ranging from Money to Biography to Ladies Home Journal.