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Cybertherapy: Ready for prime time?

June 10, 1999
Web posted at: 9:56 AM EDT (1356 GMT)

In this story:

What about the credentials?

Missing the cues


By Anne-Marie Brauner

(WebMD) -- It's late at night and you're online. Newly divorced, you've been cruising the Web looking for compatible singles to chat with. No one, however, seems to want to discuss your previous marriage or any of the issues you've managed to resolve in your past relationships. You wonder if you might be more in need of therapy than an Internet connection.

Well, don't despair -- there is a new trend waiting in cyberspace. Cybertherapy is available to you 24 hours a day, seven days a week, at a minimal cost. All you have to do is send an email. But is it really something worth doing?

What about the credentials?

You might wonder how easy it is to verify the credentials of an online therapist -- aren't counselors typically licensed to practice only in the state where they've passed a board exam? What if you live in New Hampshire and your therapist lives in California? Is such treatment ethical? Is online therapy something you should even consider?

Well, it depends. According to Leonard Holmes, Ph.D., a pioneer of cybertherapy, online therapy is more akin to emotional consulting than traditional therapy. No diagnosis is made and no "treatment" is given.

Holmes runs a service called and deals most frequently with issues involving relationships or typical, day-to-day stresses. "Online issues seen by cybertherapists are more general in nature and have a different dynamic than face-to-face therapy," he says.

Holmes asks patients to pay if they find his advice useful; about 50 percent actually pay him. He admits that a long-term therapist-patient relationship is difficult to establish over cyberspace.

Larry Rosen, Ph.D., professor of psychology at California State University, Dominguez Hills, agrees that this is a problem.

Missing the cues

"At this time, the negatives outweigh the positives with regard to cybercounseling," says Rosen. "When all you have to work with is a text-based message, you miss many of the vital cues available in face-to-face interactions. That is antithetical to doing good therapy."

Counseling over the Internet can, however, be helpful in certain situations. Cyberpatient Martha Ainsworth had such a positive experience with online counseling that she decided to establish an informational Web site for others in the hopes that they might find the same benefits as she has from cybertherapy.

Ainsworth and her therapist corresponded over a two-year period and discussed issues concerning self-analysis. "Cybertherapy is not appropriate for patients dealing with severe depression or situations that require medication," she says. "But for self-exploration issues, it can be very enlightening."

"What we can do over the Net is much better characterized as creating an interactive self-help book," says Richard Sansbury, Ph.D., an online therapist and an advocate of cybercounseling. "To be honest, I have been pleasantly surprised at how powerful online therapy can be," he says.

What does the American Psychological Association have to say about cybertherapy? "The American Psychological Association supports and encourages the ethical use of tele-health," says David Nicholson, special assistant to the executive director in the Practice Directorate of the APA. "However, there is not yet a good body of research on the topic; psychologists are still pulling out what does and doesn't work. Email is fine for exchanging information, but seems to break down where it becomes necessary to make decisions around contentious issues."

Will cybertherapy become the wave of the future? There is not much danger of that happening today, although the landscape is changing somewhat with the use of videoconferencing software that enables cybertherapists to pick up on the nonverbal cues that are essential to therapy. "Without these cues," says Rosen, "it is very difficult to do anything more than provide an informational resource to patients."

Copyright 1999 by WebMD, Inc. All rights reserved.

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