Re:E-therapy, what do you think?

I haven't made up my mind on this issue one way or the other, but I think the pro-cybertherapy folks need some agenda reform. If they really wish to establish some legitimacy for what they're doing, they need to reframe their arguments and start with a more modest goal.

Currently, the debate centers around this question: Is cybertherapy as effective as face-to-face therapy? But given the lack of training programs and methodologies designed for the online context, I think it could be a very long time before this question is settled with any degree of certainty. (And while it's up in the air, online practitioners will be seen as illegitimate, regardless of the practice's legal status.)

Instead, cybertherapists should initially focus on underserved populations, such as shut-ins and people in very remote areas. In this way, the new question becomes: Is cybertherapy more effective than doing nothing at all? These populations usually don't have access to face-to-face therapists, after all, and this second question really is more relevant. If it can be demonstrated that cybertherapy would benefit these people more than the alternative (i.e. nothing), then the pro-cybertherapy crowd would have a legitimate issue around which to influence the professional community, the State Boards, and the public in general. (And as long as we're dealing with the political reality as well as the scientific aspects, we might as well point out that very few people are going to stand in the way of help for senior citizens and historically underserved populations.)

After cybertherapy becomes an accepted practice for people who have no alternative, then the cybertherapists can begin serious research dealing with the question of cyber vs. face-to-face effectiveness. An added bonus here is that the research that was conducted during the first phase can provide insights that would prove helpful in designing research for the bigger debate.

But as it stands now, we're basically comparing face-to-face therapy with somewhat lame adaptations of face-to-face therapy using technology (chat rooms that attempt to reproduce the consultation room, for instance)...a fight that the cybertherapists probably can't win. There are ways of using that technology to develop brand new techniques, however, that have nothing to do with weak reproductions of face-to-face interaction. (Scheduling aids, online diagnostic tools, PDA-integration of various "homework" activities...these kinds of things are just starting to be explored.) Going head-to-head right now is like sending a weakling out against a professional boxer...work out, pump up, and condition your "fighter" before you get into the ring. (After all, if you "lose" this first fight, it's going to have a huge impact on how you're viewed by the public at large forever...regardless of how things progress later.)

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