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Joshua Kates on online therapy
(CNN) -- Joshua Kates is the host of marriagematters.com, an offshoot of his radio talk show "Marriage Matters" and his articles and media appearances talking about relationship counseling. Kates has a practice in New Jersey and is a Licensed Clinical Social Worker. He is a member of the the Academy of Clinical Social Workers (ACSW) and the American Association of Marriage and Family Therapists (AAMFT).
CNN Chat Moderator: Welcome to CNNdotCOM chat, Joshua Kates. What made you think when you started this service that online counseling could be as effective as face-to-face counseling?
Joshua Kates: Well, I did not necessarily think it would be the same or as effective as face-to-face counseling. I thought it would in fact be different. It is very intensive because people seemed to be expressing their most intimate thoughts with complete strangers online, and I felt it could be a valuable experience to speak with someone who had a background in counseling.
From psua1100: What are some of the pros and cons?
Joshua Kates: The pros are that people seem to be getting to the nitty-gritty of what it is they want to know. It is the raw material that they are interested in getting to. They get to find solutions to their problems quickly. A lot of the embarrassment of looking at someone face to face is shed away online. It is a very special connection, and different from face to face. The cons are that for some of the more complex issues, it can be impossible to detect, uncover and keep clients safe. Therefore, most online counselors make very clear and specific disclaimers regarding dangerous situations.
From R_Roque85: Is this service expensive?
Joshua Kates: Generally not. It seems most counselors are in the realm of $50 to $100 per hour. I provide a 45-minute initial consultation for $29.95. I find that often an awful lot can be learned by the client in this initial session, and that often there are only one or two follow-up sessions. However, there are those that I work with on an ongoing basis, but most are short-term interactions. That's the beauty of this work, I believe.
CNN Chat Moderator: How exactly does it work?
Joshua Kates: On my Web site, marriagematters.com, if you choose to work with me, there is an online questionnaire clients fill out. It provides what we call a psychosocial profile and asks the client to spell out questions and concerns, while giving enough background for me to give them some direction. A lot of times, I ask clients one or two follow-up questions before I actually give them a full response to their questionnaire.
From psua1100: Is it better to use chat or e-mail?
Joshua Kates: Personally, I find the e-mail works excellently because it gives us each time to think through what has been said. It is also easier to retain a log of the documents that have gone back and forth. With a chat, the typing sometimes can slow people down. Other technical problems -- I find it interferes.
From Bink: Mr. Kates, what about the nuances of personal interaction, such as inflection and body language? Those play a large part in any counseling.
Joshua Kates: Sometimes they do, I agree. But not always. In fact, sometimes a person's physical discomfort can create nuances that detract from what it is they are really trying to get to. So again, this form of counseling is different from face to face in that you are getting to the heart and core of many issues very quickly. It's fast and it fits with the whole concept of the Internet.
CNN Chat Moderator: Is there a difference in the type of people who seek your help online and those who come to see you?
Joshua Kates: Since my focus is primarily relationships online, it is often one partner or the other that seeks help regarding what they feel is a problem in their marriage. A lot of times, their partner is unwilling to discuss with them or seek counseling with them, so they turn to an advisor like myself. The patients who see me in person often have more significant behavioral health issues. The people online seem to have communication issues that can often be improved through some of the tactics or strategies I explain in my book.
From Guest11744: How do you know you are effective?
Joshua Kates: I have a follow-up questionnaire after each interaction, when it appears our interaction is complete. Over 80 percent of my clients send the questionnaire back, and very few have ever said they were dissatisfied.
From KristenCNN: Have you ever had someone threaten to commit suicide online? If so, how do you handle that since you're not face to face?
Joshua Kates: I never have had that situation. I did have a client with significant psychiatric history, whom I told online counseling was not appropriate. If someone were to make a statement to that effect, I, like any other responsible clinician, would advise that person to immediately call 911. Or go to an emergency room of a hospital. If I was aware of who the person was or where they were, and they had clear intent to harm themselves or someone else, I would have to try to contact local authorities.
From Lemoyne: Would you agree that most people would be more open with an unseen counselor? Will not being face to face perhaps elicit more divulgence?
Joshua Kates: That's a great point and question because I find again that people do reveal an incredible amount of information, right off the bat. Yes, in fact over the two-and-a-half years I have been doing this, I get reminded over and over that people reveal very significant information extremely quickly.
From jack: Which do you prefer doing: online or in-person counseling?
Joshua Kates: I enjoy both. I got into the field because I love working with people, so I suppose my preference is working in person. However, since I have somewhat of a technical background and have always been involved with computers, I find this fascinating and effective.
CNN Chat Moderator: How do your fellow professionals react to your Internet counseling?
Joshua Kates: Some are absolutely horrified. Others are quite curious and neutral. Some immediately see the value. Is that a political enough answer? But it's true. That's the reaction.
From bullmaster: Do you use video conferencing?
Joshua Kates: I never have, and I do not intend to. The jury is still out, by the way, on the efficacy of online counseling. But there are hundreds of online clinicians, and it is definitely here!
From netsnype: Online counseling sounds like a gimmick -- NOT real therapy.
Joshua Kates: Well, people are seeking help online, and it's up to responsible professionals like myself to provide as much valuable information and guidance as we can. Those who might be doing it as a gimmick -- and I don't know of anyone who does that -- but clearly people are seeking help online, and I feel an obligation to provide it.
CNN Moderator: Do you have any final thoughts to share with us today, Joshua Kates?
Joshua Kates: Someone asked or mentioned it might be a gimmick. I feel kind of like a pioneer, in that pioneers don't know exactly where they are going, but they are usually going forward to find a better place. Again, if people are seeking help online, it's up to responsible clinicians to help them get it.
CNN Chat Moderator: Thank you for joining us today, Mr. Joshua Kates.
Joshua Kates joined the chat via telephone from New Jersey. The above is an edited transcript of the chat, which took place on Thursday, November 9, 2000.
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