Many people who shy away from a therapist's office for help with personal problems are finding cyberspace a more comfortable place to let their hair down.
Although one in five Americans has a mental health problem, nearly two-thirds never get help, according to the Surgeon General's Report on Mental Health. This is mostly because people feel embarrassed or ashamed. If you feel that way, typing out your problems to a faceless stranger in the comfort of your home may feel more private and safer than venturing into a therapist's office.
People who support the idea of online therapy say the Internet has changed the field of psychology by bringing mental health resources and services to more people than ever before. The appeal of anonymity, privacy and convenience is breaking down barriers such as accessibility, cost and the stigma of mental illness that keep many people from getting help.
Some say it gives psychotherapy a bad name. Hundreds of therapists are on the Web, but they are all virtually unregulated. Many are unlicensed and, some would say, unethical, depending on what level of service they promise.
So far studies have been limited on just how well online therapy works compared with face-to-face therapy. Some research indicates there may a benefit to online therapy. But like any other evolving treatment in health, it needs much more research before it can be fully accepted and endorsed by the medical community.
What is online therapy?
Online therapy is clinical work done through the Internet. You type out your issues or concerns to a licensed therapist, who reads and responds for a set fee. Online therapy sessions may resemble face-to-face counseling in some of the issues and methods used. However, it is not the same.
This kind of therapy is not meant to diagnose medical or mental disorders. It's meant to help you deal with certain challenges in your life such as how you feel during a divorce or a move to a new house.
Your privacy
Your online therapist must assure you that your communication is to be kept private. Your therapist should not be conversing with you directly through your e-mail provider. This is because anyone - a family member or a hacker - can access your e-mails. Rather, the therapist should be instructing you through a secure Web site - one that provides encryption of data and is accredited by an institution such as URAC. (URAC is a stamp of approval in the Internet world that the information you are reading on a given site is accurate and up-to-date.)
To know if your connection is secure, you should look for verification such as the Web address beginning with "https:" ("s" for secure). You should also see a locked padlocked at the bottom of the window.
The benefits
Along with being anonymous, the main appeal is its convenience: being able to send and receive messages at any time of day or night, never having to leave messages with intermediaries, and avoiding telephone tag.
The patient and the mental health professional are able to fully reflect on issues discussed in a previous correspondence before responding. It also gives both the patient and counselor an ongoing written record of communications. Electronic communication helps you get to the point quicker too.
Many online therapists are skilled, ethical and fully qualified professionals and can do a great deal of good for you.
The downside
While online therapy can be helpful for some people, it's not for everyone. There aren't any social or nonverbal clues. An online therapist may seem less personal, and it may be harder to build a relationship with someone you have never met. There is also the risk of being misunderstood by either patient or therapist - a potential problem for online therapy when communication is so critical.
Online therapy isn't meant for someone who has a serious or chronic mental illness such as major depression. Such a person should see a health care provider for help rather than using an online therapist. You also have to be aware that you may need medication such as an antidepressant or anti-anxiety medication. Often with medication, you need therapy to help you deal with life better. A therapist in person may be best for this kind of treatment.
Face-to-face therapy can also help you deal with changing your behaviors more effectively. Also you may find it easier with an in-person therapist because such as person can work more in conjunction with your other doctors to create a more well-rounded treatment plan.
Ready to discuss your deepest secrets to a stranger?
Online counseling may be right for you if:
You don't have access to a therapist nearby. Transportation is a problem or you are unable to leave your home. You are nervous or embarrassed about counseling (many people are). Your schedule is keeping you from getting help in person. You can't afford to see a counselor in person. You find it easy to express yourself through writing.
Online counseling may not be right for you if:
You are in a serious crisis. There are other, better ways to get immediate crisis help such as hotline numbers, emergency rooms and talking to a mental health professional over the phone or in person. Get help immediately if you are having a serious crisis. You are unable or unwilling to reveal information to the therapist about yourself and your feelings. Your situation is very complex or you're suffering from a serious mental illness like schizophrenia. If you have some really tough problems, online therapy may be a short-term solution at best. If a therapist feels you need more help, then he or she will tell you so, and refer you to another source for help. If you feel the therapy isn't helping, talk to a health care provider. For some people a few sessions with a therapist online are enough. But if it's appropriate and if it's possible, most therapists would like to see you in person.
The cost of online therapy
Fees vary, depending on the therapist, the type of service you want and how much time you would like. You might be charged by minute, by the word or by the number of e-mails. Online therapists generally charge about $30 to $40 to respond to a single message. That depends on how thorough your therapist is with responses. If it's by the minute, it may be around $1.50 a minute. By the word may be $40 for 1,000 words, for example.
Some therapists offer real-time counseling - you can have a private online chat with your therapist. If you chose this, it may run you about $1 a minute. This would probably be by the minute.
Many insurance plans don't cover this kind of therapy so be sure to check with yours before starting down the online treatment path.
Buyer beware
What do you need to know before looking for an online therapist?
Don't assume that anyone offering counseling and accepts credit cards is a licensed professional. Take time to view the prospective provider's Web site and check credentials.
Don't assume that just because a therapist says he or she is credentialed that it is so. There should be a link from the provider's site back to another Web site where you can confirm licensing information. Ideally a person providing mental health guidance should have a doctorate (Ph.D. or M.D.) or master's degree (M.A., M.S.) in psychology or social work, and hold required state licensing.
Regulating online therapy
One of the biggest problems with the Internet is that there are plenty of robbers and too few cops. Organizations such as the American Counseling Association and the International Society for Mental Health Online (ISMHO) set guidelines for therapists to follow. Guidelines help therapists and patients understand how online therapy should be used.
There is currently no accreditation or regulatory group that approves or monitors online mental health providers or the Web sites that host them.
Here's a summary of some of the ISMHO suggested guidelines for what any online therapy arrangement needs to address:
Structure of the online services. Before beginning, the counselor and the client should agree on the frequency and mode of communication, the expected turnaround time for responses, the method for determining the fee, the estimated cost to the client and the method of payment.
Possible misunderstandings. The counselor should discuss possible misunderstandings due to text-based communications (since nonverbal cues are relatively lacking), and even with videoconferencing since bandwidth is always limited.
The counselor's name and qualifications. The use of pseudonyms is common online, but you should know the name of your counselor. And you should ask for qualifications such as a degree, a license, proper certification and special training or experience. The counselor should provide the telephone numbers or Web site addresses of the relevant institutions where qualifications can be confirmed.
Privacy safeguards. To protect your privacy, a password can be required for access. For further security, although more difficult to set up, encryption can be used. Information about you can only be released if you grant permission, and you should be informed of any exceptions to this general rule.
Contingencies. An issue specific to online mental health services is that the counselor can be a great distance from the client, making it difficult to respond to an emergency. The counselor may want to obtain the name and telephone number of a qualified local mental health care provider or primary care physician who already knows the client.
Online therapy is a new and evolving field, which continues to have a certain amount of risk. It is also not a cure-all. If you don't think it's working or your situation worsens, you must get medical help. An antidepressant or other medications may be necessary. Major depression and other mental illnesses are very serious and must be treated.
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