Internet-based therapy is a form of psychotherapy conducted over the Internet rather than in face-to-face sessions. Therapeutic sessions may be conducted using instant messaging, chat rooms, or e-mail messages. Internet-based therapy is also called on-line therapy or e-therapy.
As the Information Age progresses, more and more services are available over the Internet. We can buy not only books on-line but also electronics, clothes, and even groceries. In the business world, the requirement and expense of traveling to in-person meetings is often negated by the ability to teleconference. College degrees no longer need to be earned in the classroom but can be acquired in the comfort of one’s own home at one’s own pace. The wait for a technician on a manufacturer’s help line is often replaced by the ability to search the company’s database on one’s own or to engage in on-line chat with the same technician to whom one once spoke. Even for medical problems, one can often chat with a physician or nurse practitioner by e-mail rather than going into the office.
There is little wonder, therefore, that there is a demand for psychological services over the Internet. Chatting with one’s therapist on-line is more private than going to an office and waiting in a public waiting room. For those in rural areas where access to a therapist is exceedingly difficult, the Internet can provide a convenient alternative for getting the help that one needs.
There are pros and cons to both sides of the on-line versus face-to-face therapy issue. First, communicating through e-mail, on-line chat, or instant messages has the same drawbacks of any written-only communication: The non-verbal cues such as tone of voice, facial expression, and body language are missing, making interpretation of the message more problematic than in a face-to-face situation. On the other hand, the relative anonymity of on-line interactions make such therapeutic relationships more attractive to those who would hesitate to go into a therapist’s office for fear of being found out by others, fear of embarrassment, or unwillingness or inability to get to the office. In addition, on-line therapy tends to be less expensive than in-office therapy, a consideration for many clients.
There are, of course, some things that cannot be done over the Internet. For example, psychologists and psychiatrists use a variety of tools and techniques to diagnose mental disorders so that they can prescribe the appropriate course of treatment. Some of the tools used in diagnosis include psychometric instruments such as the Minnesota Multiphasic Personality Inventory (MMPI), projective instruments such as the Rorschach test or the Thematic Apperception Test (TAT), and diagnostic interviews. The various tests and instruments used in diagnosis should ethically only be given by a credentialed professional in a controlled situation and cannot be given across the Internet where there is no control over who will see the test, how long the client takes to answer the questions, or even whether it was the client or someone else who took the test. In addition, it would be extremely difficult to diagnose a patient’s problem without a face-to-face meeting for a diagnostic interview.
Research into the effectiveness of on-line therapy is only beginning. However, a number of disorders have been successfully treated electronically. For example, Internet-based therapy has been successful in the treatment of panic disorder, social phobia , child adjustment after traumatic brain injury, and complicated grief , among others.
As with any service provided over the Internet, one must be an informed consumer not only before choosing an e-therapist, but even before deciding to use Internet-based therapy itself. Because Internet-based therapy is an emerging field, there are still many issues to be resolved. Obviously, one must check the professional credentials of a therapist to make sure that he or she is licensed, whether one is choosing a therapist for on-line or in-office therapy. In addition, it is unclear at this time whether it is legal for a therapist licensed in one state to treat a patient in another state. Choosing a therapist in one’s own state makes this issue irrelevant, but requires research.
Client/therapist confidentiality is important in any therapeutic relationship. When choosing an on-line provider of psychological services, one must be certain not only that the therapist subscribes to a professional code of ethics, but also that any information—including personal data about the client—is kept confidential and not sold to or shared with third parties. Similarly, it is important to check that the Web site used in on-line therapy is secure and that conversations, instant messages, and e-mail transmissions between client and therapist are not recorded on the site’s secured host computer.
Internet-based therapy shows promise for helping people who could not or would not otherwise engage in a therapeutic relationship. This potential is beginning to be tested in research. However, much of this research also recommends that Internet-based therapy be used in conjunction with face-to-face sessions. There are still many technical, logistical, and ethical questions to be answered regarding how the Internet best can be used for therapy.
Chat room —A space on a Web site or network server that allows multiple people to communicate by entering text messages at their individual computers. The messages are viewable by all in the virtual “room,” and messages appear almost instantaneously once they are sent.
E-mail —Short for “electronic mail,” a system for sending and receiving messages electronically through personal computers or other computer network. Usually, it takes only a few minutes or even seconds for an e-mail to be sent between computers.
Instant messaging (IM) —A method of electronic communication that allows two or more people to communicate nearly instantaneously without using a chat room. Instant messaging is much like a telephone conversation with text messages. The sender types a message at his or her computer, which is then sent to and received at the other person’s computer. Instant messaging can be used in much the same way as a private chat room.
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Ruth A. Wienclaw, PhD