Martha Ainsworth, a Princeton, N.J. Internet communications consultant and an expert on the emerging field of Internet therapy, won’t say online counseling services can replace traditional, face-to-face therapy. But in some instances, she says, the Internet is the only way that someone who needs help can get it.
“My favorite example is a psychologist in Maryland (who had) a client in the Arctic circle,” she said.
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The ability to reach people anywhere in the world, while counseling them at a time convenient for both client and therapist, is the reason more and more psychologists and counselors have begun to offer their services online, providing ‘therapy’ via email or in live chat rooms.
Such online services have jumped in number from 12 in 1996 to 162 today, Ainsworth says. And she expects that number to keep growing.
“Every day I get three or four emails from therapists saying, ‘I want to try this,'” she said.
But those who do try it are venturing into largely unexplored territory. Counselors and therapists have been working online for about three years, but experts say the practice is still too new to have gained widespread acceptance from the U.S. community of psychotherapists at large. The American Psychological Association, for instance, is cautious in its endorsement, saying it supports the “appropriate and ethical” use of what it calls “tele-health.”
Questions about the practice of offering such services abound. Some therapists maintain that counseling online is unethical, while others point to legal problems that could arise if something goes wrong between a patient and a client located in different parts of the world.
Internet counselors, such as online-counseling.com, ask prospective clients to fill out an email form describing their condition. In the case of online-counseling.com, clients have the choice of being treated in a private chat room for a 45 minute session for $30, a personal 45-minute phone conversation for $40, or a personal email response, for $20.
The page includes a disclaimer, however, warning patients that the service is made for people who might otherwise not seek assistance – because of the cost or stigma of seeking help, for example. People whom the online-counseling counselors determine to be in need of serious or long-term care are referred to a mental health provider or counselor in his or her area.
Indeed, experts agree that online therapy or counseling is not appropriate for someone in the midst of a crisis or for someone feeling suicidal. Those cases are best handled in person.
But for more easily-identified problems that interfere with daily living, such as troubles in relationships or on the job, online therapy seems to work for certain people, especially those who express themselves better in writing than in conversation, Ainsworth said.
She discovered as much during a six-week business trip in 1996. During the trip she decided that she wanted to see a therapist, but had no way to do so. So, she searched the Internet and found 12 counselors who were offering services online. After researching them, she selected one and began what she describes as a “one of the most profound relationships I’ve ever had.”
During their two-year correspondence, Ainsworth writes on her Web site that her counselor was “profoundly present in my life, listening, caring, challenging.” Her experience prompted her to launch an Internet guide to online counseling. The ABCs of Internet Therapy, as it’s called, provides a service in which people may check the credentials of an online counselors and therapists whom they’re considering.
Since such therapy involves no in-person contact, however, some argue that the practice cannot actually be accurately called therapy. Ainsworth herself prefers the vague term ‘interaction.’ But she is less concerned with the semantics of the issue than its actual impact. Some people will disclose more about themselves online than they will to an interviewer, she says.
What’s most important, Ainsworth argues, is that many people form relationships with therapists or counselors online that help them in their daily lives.
“I don’t think anybody really believes it’s therapy,” she said. “(But) whatever it is, it’s helpful.”
Online counseling is not without risk. In a paper outlining potential problems and benefits of the practice published on the Internet Society for Mental Health Online Web site, it is pointed out that the therapist’s inability to see the patient, and thus his or her inability to catch the patient’s various audible and physical clues, may restrict the therapist or counselor’s ability to diagnosis the patient properly.
Other potential problems include: the difficulty in determining the identity of the patient, miscommunication, breaches in confidentiality, and problems that arise when the therapist is unaware of the legal requirements and community resources in the area in which his or her client lives.
That’s why online counselors must be careful about how they advertise themselves and practice online, said John Grohol, a past president of the Internet Society for Mental Health Online.
“I think most therapists are being pretty careful about how they label what they do and what they actually do,” Grohol said, noting that some states, such as California, have laws that prohibit therapists from accepting online clients who live out of state.
The practice, he added, will not gain widespread acceptance until studies concerning the safety and effectiveness of online therapy – which are currently underway – have been completed, Grohol said.
“One of the biggest problems is we don’t have a whole lot of research on what it’s good for and what it’s not good for,” he said. “My own experience is that it is safe and effective, but (that) means more when there’s a research paper behind it.”
David Nickelson, a psychologist and lawyer with the American Psychological Association in Washington, D.C., said online services seem to work best when they’re used to educate people on ways to improve their lives or reduce stress, as opposed to actual psychotherapy, which requires the interaction of an in-person meeting.
While some health insurance providers now pay for online services for those who live in rural areas, he said, coverage for people who live in more metropolitan areas is less common, he indicated.
So far, Nickelson added, the federal government has yet to pass laws governing online counseling services, allowing states to manage the practices on their own. The problem, however, is that there is currently no case law to guide people who might want to take legal action against an online therapist who works in a different state. And since such cases typically have a two-year statute of limitations, “It could be three, four, five years before we actually see these cases come to bear,” he said.
