Cybertherapy - is it really therapy?

You've probably seen the sites that offer counseling over the internet. Therapists are hanging out their shingle on the net and offering services directly to the public. Is it really possible to do counseling or psychotherapy over the internet?

There are many answers to this question. Martha Ainsworth is an outspoken client of internet counseling. She found it helpful in her own life, and she has gone public to make people aware of this. Her site at Metanoia.com includes a comprehensive list of providers and gives some excellent background on the issues involved. Her discussion of "Terminology.... Is this 'therapy'?" is another good discussion of the issues involved.

I have a slightly different perspective than Martha on these issues. I have been providing internet consultations at my Shareware Psychological Consultation site since early 1996. I do not believe that internet interactions are therapy, but I do believe that they can legitimately be considered to be a form of "counseling."

What's the difference? Stedman's Medical Dictionary defines psychotherapy as:

treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication with the patient, in contrast to treatments utilizing chemical and physical measures.

Counseling is defined as:

A professional relationship and activity in which one person endeavors to help another to understand and to solve his or her adjustment problems; the giving of advice, opinion, and instruction to direct the judgment or conduct of another.

Notice the difference in emphasis? Psychotherapy is the treatment of a disorder. Verbal and nonverbal communication are both mentioned in the definition, and are both essential. Counseling is defined quite differently. Working from these definitions, some amount of counseling is already occurring on the net. No diagnosis is needed in order to help a person understand and solve a problem. There is a long tradition in our culture of "advice giving" through print media. The internet is simply a logical extension of this tradition.

Is it ethical to make a diagnosis over the net? The current bandwidth means that we only have verbal self report to go on. We generally can't observe the client's speech patterns, affect, nonverbal indicators of anxiety and depression, etc. Internet telephone software gives us a bit more data, but the audio quality is not even equal to that of a real telephone in most cases. Internet video gives us a jerky image the size of a postage stamp. We have a very restricted information base. We might be able to give opinions about possible diagnoses, make suggestions of what information they should give to a health professional, etc., but I do not believe that we should attempt to make a diagnosis over the net.  More information on this point-of-view is available in my 1997 presentation to APA entitled "You Can't do Psychotherapy on the Net (Yet)."

My internet consultations have almost all been brief. The focus is on a problem and possible solutions for the problem. This does not mean online counseling is the same as giving advice. Often what I do is to help someone see things from a different perspective. In discussions with other therapists who provide these services, I hear a similar emphasis from most of them. Many of these discussions take place on the International Society for Mental Health Online mailing list. Professionals interested in these issues can join the discussion. To subscribe, visit the website and follow the instructions. You will be added to the list.

A colleague on a mailing list gave an excellent analogy. He suggested that the therapists on the list imagine conducting a live therapy session in the following manner: Sit with your back to the client, write a sentence on a pad, pass the pad to the client to let them write their response, read their response, and write a reply. Is this therapy? While it might work with some people and some problems, it is certainly not therapy.

Consulting with a mental health professional over the internet can be a convenient way to get help with a focused problem. For background on some of the privacy issues involved, consult the previous feature which addresses these concerns.

Stay tuned as we discuss these issues further. You can contribute to the discussion. Please do not write to The Mining Company for advice or counseling. Our purpose is to explore important issues, and to help you find the best sites on the net.

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