Online Therapy Here to Stay

Those are difficult words for me to write. While I do provide services directly to clients over the Internet, I have taken great pains to distinguish what I do from therapy. Not everybody does the same.

Martha Ainsworth’s Internet Mental Health Services site lists many different mental health providers currently providing services. The site Concerned Counseling alone claims to have 150 counselors working online and by telephone with clients. Their unique method of marketing promises a free chat room to sites which advertise Concerned Counseling. This approach (along with a now-abandoned fee-splitting arrangement) has resulted in their banners appearing widely on the net.

Why is online therapy here to stay? The incentives are such that mental health professionals have little to lose by going online. Managed care is crunching mental health practices all over the United States. It can cost almost nothing for a therapist to set up shop on the Internet. Do you have an AOL account? You automatically have 10 megabytes of web space (2 megs per screen name). Just throw together some HTML and you have a website. Degree? Who said you have to have a degree. License? Who said anything about a license.

It’s actually not quite that bad. Martha Ainsworth and John Grohol have worked together to form the “Credential Check” site. While Martha’s other site listed 70 providers or groups (as of 11/2/97) and Concerned Counseling claims to have 150 professionals, only 13 providers have voluntarily listed themselves with the credential check service (with 5 additional professionals pending).

What are people doing online? Is this really therapy? I’ve made my views on this subject clear on many occasions. It is not therapy. I call my interactions “consultations”, others call it counseling or advice or education; and a few brave souls actually use the term “therapy” or “psychotherapy.” Whatever you call it, people continue to do it. Consumers seem to be receiving value, and they find it convenient. My own consultations are done on a “pay if it helps” basis, and about half of my “clients” do pay.

It is important to be aware of the unique characteristics of written communication. The discussion forums here at Behavior Online are excellent examples of the richness of plain text. Occasionally we also see some of the problems. Subtle nuances are lost, and posts are sometimes misinterpreted. Much has already been written about the impact of the absence of nonverbal cues and tone-of-voice. I believe that this makes diagnosis and treatment of mental disorders impossible at this time. This is beginning to change, however.

The new “Internet-2” is already being constructed to connect research institutions in the United States. This network will allow high-speed and high-bandwidth information transfer including real-time audio and video. Telehealth projects using similar networks are already including mental health services as one component of their networks. These projects are experimental, and the current focus is on extending services to under-served populations such as rural areas and prisons. As the Internet itself begins to take on some of the high-speed characteristics of Internet-2 we should see online interactions to take on more of the characteristics of therapy.