July 24, 2000 -- After Julie Keck, PhD, a clinical psychologist in Newport Beach, Calif., had surgery recently, she couldn't make it to her office for six weeks. But unlike most therapists in that position, she did not have to shut down her practice -- 40% of it is now online.
After nine years of offering therapy the conventional way, Keck began her Internet practice at the request of a student in Michigan, who found her through America Online's Members Profiles. "Joseph," she says, "was shy and withdrawn and feared the stigma of seeing a psychologist. He was afraid his parents would find out."
Keck worked with Joseph via email for several months. Then, at her urging, he got additional therapy in person and medication for what turned out to be social phobia. In turn, he urged her to launch her web site, www.counselingcafe.com.
Keck is one of a growing number of mental health professionals offering Internet counseling, despite serious obstacles that put off many therapists. (See Is Online Help Safe?). The California Telecommunications Act of 1996 specifically bars therapists there from "treating" patients outside the state, so Keck calls her online work "email counseling."
For those who express themselves well in writing, this is an effective way to work through problems, she says. Most who come to her are depressed and don't know what will make them happy. She has them answer questions about what they believe and how people perceive them.
The approach differs significantly from what she does in face-to-face therapy, she says. "I think of it as directed advice," she says, " 'Dear Abby' with a professional. In therapy, I guide people more into their own insights; there is a lot of silence on my part. In email, you can't do that."
Keck also misses the clues revealed by body language and tone of voice that in-person therapists rely on to reveal depth of emotion. She is careful to get names and addresses in case clients get so depressed she fears for their safety. (Once she actually called the police to check on a client's well-being.)
But online counseling has its advantages, too. One is that her clients can write to her at 2 a.m. instead of doing something impulsive. There is also a written record of the conversation, which can help sort out misunderstandings later.
Another attraction is that working online can be lucrative. Keck charges a dollar a minute to read and respond to emails from as far away as China, India, and Israel. This is roughly the same as what she charges in her regular practice, but involves significantly lower overhead. There is no commute, and she doesn't have to dress for success.
Many of Keck's colleagues have mixed feelings about working online. Offering referrals and general information on the Internet might be helpful, says Leigh Jerome, PhD, who is helping develop online therapy guidelines for the American Psychological Association. But counseling a mentally disturbed person online is risky.
"I don't think online therapy is a real good idea right now," she says, "because of the many unanswered questions about it. Research is just starting." On the other hand, she adds, there can't be any research if there are no therapists online. "Somebody has to be first."
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.