Counselors are Going Online

There is a multitude of websites devoted to mental health. Some of these sites offer information or assistance in finding a therapist. But something new has entered the world of Internet psychology. This new phenomenon is online counseling.

Why have therapists begun offering their services through the Internet? "I think people have seen there is a niche in the marketplace," explains Dr. Shirley Vandersteen. Vandersteen has noted the popularity of chat rooms where people commonly discuss problems in love and life.

Dr. Sandra Levy Ceren has definitely recognized an increase in the number of sites offering information in psychological matters. But she doesn't feel that counseling plays that big a part. "There is more access to finding a therapist online, but not necessarily doing therapy online," says Ceren.

But there are enough people who seek therapy from their home computer that there are plenty of sites that do offer online counseling. Now patients and doctors can have a therapy session via e-mail or a chat room. In fact, patients may even take part in group therapy.

But like many new ideas, online therapy has met with its share of accolades and criticism.


As for the patients, the prospect of visiting a doctor's office and speaking face-to-face is difficult. "People who are concerned that seeking counseling seems like an admission of frailty may find it easier to find help on the Net than in person due to the sense of anonymity afforded them." That's according to Therapy Online, an Internet site offering online counseling.

Dr. Todd Kettner agrees that a computer therapy session enables those who are homebound to receive the attention of a doctor.

The thought of going to an office is hard for some. But it is absolutely impossible for those who seek treatment but live too far away from medical help. "It is especially difficult to get psychological help in rural areas," explains Kettner.

Through his schooling in the U.S. and his current practice in Canada, Kettner views this lack of access as a common problem. "Tele-sessions, or phone sessions, and online sessions would eliminate the difficulties."

Affordability is another big issue for many when contemplating whether to see a mental health professional. For those who can't pay the hourly rate to go to the doctor's office, online counseling is an alternative. Many Internet sessions cost about $30, whereas a visit to an office can cost upwards of $100. That's according to an article by Steve Tanner called Virtual Shrinks: eTherapy Gains Momentum.

For the therapist, online counseling offers the opportunity to earn some extra money from home without taking up so much office time. The number of mental health practitioners going online is growing, says Larry Freeman. He is the ethics and professional standards director of the American Counseling Association.

Yet few therapists rely only on online counseling to earn a living. Instead, online counseling is often used in combination with the traditional therapy session, says Vandersteen.


"There are a lot of hazards to online therapy because there has been so little research," says Vandersteen. "We don't know if the services provided are effective."

Vandersteen is very concerned when it comes down to location. For example, an online therapist may be working from New York and the patient with whom they are communicating may live in Toronto. This difference in locale can cause a lack of information, such as names of family or physical access to the patient themselves, that may result in inadequate care.

"If a person is at risk, there is a legislative requirement to intervene," explains Vandersteen. "If I'm talking to someone in a small town in Sweden, I have no way of helping them."

This lack of person-to-person contact is a major concern for many psychologists. "Certainly with text-based chat formats, you lose information through the processing," says Kettner. "The doctor can't pick up on emotions such as tone of voice and facial expression. You lose some of that."

Ceren also regards this as a problem and hopes that it can be remedied. "Video therapy with audio might be better, so we can see the facial expressions and body movements."

Another issue doctors face is in taking the word of their patients. "People use code names for anonymity," says Vandersteen. "There is opportunity for distortion. Having an Internet therapeutic relationship is very limited."

Ethical and Security Issues

Could a third party break the patient-doctor bond of secrecy? Psychologists in general are very wary of the confidentiality of the Internet. This factor keeps many psychologists from pursuing online counseling. "This is a primary concern," says Kettner. He recommends that patients do not include confidential material when they e-mail him.

"There are no boundaries," says Vandersteen. "You are leaving a communication record on the computer. Anyone in your household can look at it."

Vandersteen says that distance between patient and doctor is also a problem where ethical matters are concerned. "You may be violating ethical standards where that person is residing."

Other standards that are at risk, according to Vandersteen, are standards of practice and the fact that there is no screening. "Anyone can call themselves a therapist and go online," Vandersteen says.

"There is difficulty in verifying the licenser of the mental health provider," says Freeman. "We, at the American Counseling Association, have separate ethics pertaining to online counseling and we hope that each member will adhere to those ethics."

Online Therapy and the Mental Health Practitioner

Currently, most doctors and counselors who practice online also maintain a separate office outside of the computer. According to Psychology Information Online, a therapist can expect to pay about $200 to get a basic website up and running. This is a cost many are willing to pay in order to get their name out there and enable them to reach more clients.

Also, online therapy is so new and there are enough office therapists going online that it has not yet caused an increase in the demand for those in psychological professions. However, Freeman feels that the popularity for online therapy will continue to grow, particularly when certain criteria are met.

"Once it's been clearly defined, and stipulations such as special training are required. It's a new frontier," says Freeman. "It still has its quirks, but through time, those quirks will be worked out."


Psychology Information Online
Offers counseling services and other information concerning psychology

Therapy Online
Explore a detailed outline of the benefits of online counseling

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