Online psychotherapy is here.

Actually, it has been here for a few months, but its presence can be imperceptible in the vast expanse of the online world. Hundreds of people have already taken advantage of such services and it is likely that many of them have found them advantageous and useful. Whether such services are legal or not, and to what extent they are as equally powerful (or more so) than traditional forms of psychotherapy, remains to be seen. For instance, a law which goes into effect this summer in the State of California restricts psychotherapists practicing "telemedicine" (which includes psychotherapy services) to only those individuals within the state boundaries.

What is most interesting about online psychotherapy or "e-therapy" (no matter what its providers actually call the services they offer) is the wide variety of online modalities it is offered in. By far the most common modality is via e-mail. E-mail allows what is called asynchronous communication to take place. That is, neither person has to be online at the exact same time to carry on a conversation. In this manner an online client can write their online therapist whenever they need to, and the therapist can respond appropriately within a given time frame.

E-mail is the most widely used form of e-therapy because it is the most widely available to people and the easiest to use. A client can often write a great deal more, and can be much more open and expressive with their thoughts and feelings through a well-written letter than they ever could in person or through other modalities. The one major and oft-overlooked drawback to this format is that e-mail is not a secure communication online. Unlike regular mail, where it is a federal felony to tamper or read other people's mail, electronic mail can be somewhat easily tapped into and read by unauthorized individuals (such as the system technical people at your Internet service provider).

Despite this drawback, e-mail has advantages over other online modalities available. Many are excited about the advent of audio and eventually, video transmission online. However, such new modalities bring with them the same problems which accompany real-life psychotherapy. Namely that those who seek psychotherapeutic services online probably do so because of reasons which prevent them from seeking real-world services. For many people, those reasons may include cost, but also social stigma and social awkwardness in seeking help for their problems. E-mail is easier to use for many people because there is no direct social interaction with another. There is no or little perceived judgment of one's behaviors or feelings. And the most distressing memories and histories can be written and explained more clearly and with less confusion than talking about the same things.

Audio and video communication require a person to interact and effectively communicate with another. People who are good writers, though, may not feel as comfortable in sharing their innermost thoughts and feelings through audio or video online. An invisible social barrier or mask goes up once these new modalities are put into use. The client once again is reminded of the awkwardness of talking to a stranger about their problems. It is likely, therefore, that such a modality will not be widely used, even when available, in the online world because it brings with it these kinds of additional social and interpersonal burdens on the client.

One example which comes to mind is an experience we had when testing various online telephone products. These products allow individuals to talk to one another via audio, much like a telephone, using the Internet as the transmission media, therefore reducing long-distance costs. Many of these pieces of software come with a "chat" window where you can type comments to one another, individually or in a group of people. In our testing online, we would often randomly call people to test the audio capabilities of the software. More often than not, people either didn't have the audio capability to talk with the software or made a conscious decision not to use it. This latter point surprised us. When we actually did talk with people using the audio capability, we often found that the conversations we had were much shallower ("How's the weather there?") than conversations we would have with the same people in the chat window. Text seems to offer a powerful medium in itself. The inherent power of text and its preference over audio online is often overlooked or dismissed. Yet the fact remains that people seem to choose text over audio for more "real" conversations. (While we might chalk up some preferences to the poor audio quality most products offer today, even on high-quality audio connections we still observed the same behaviors taking place.)

The type of client who seeks therapy online likely differs in significant factors from the person who seeks therapy in the real world. Research needs to be conducted in this area to determine what these factors are and how they impact the services offered online. It is clear to us, though, from conversations had with many online therapists that e-mail-based psychotherapy is here and is likely here to stay for the future.

Reference
Grohol, J.M. (Apr 1997). Psychotherapy online. [Online].

Last reviewed: By John M. Grohol, Psy.D. on 27 Jan 2007