Virtual Shrinks
eTherapy Gains Momentum

Steve Tanner, Special to SF Gate

Tuesday, September 19, 2000

Tuesday, September 19, 2000

Feeling a little blue in this hectic, modern world? Maybe you've considered seeking therapy or joining a support group.

If you cannot afford these services or can't muster the courage to make yourself vulnerable before a perfect stranger, the Internet may provide a sensible solution. With demand on the rise, a growing number of mental health professionals are starting to offer a virtual therapist's couch.

"Generally, people in the mental health field are trying to keep an open mind," said John Grohol, a Massachusetts-based psychologist and CEO of HelpHorizons.com, an online community for mental health professionals and consumers seeking Internet-based psychological help, or eTherapy.

Until quite recently, The therapeutic community has been split on the idea of conducting psychological therapy over the Internet. While a number of psychologists saw online therapy as the next frontier, many more believed there was no acceptable alternative to face-to-face interaction.

eTherapy is generally conducted via email exchange or one-on-one live chat. Opponents say this type of interaction removes the human intimacy between therapist and client, which is conventionally considered to be at the heart of the process.

"One of the criticisms with online therapy is that you have to accept as truthful how (patients) present themselves online, (but) people often assume various different identities," said Robert Bischoff, South Bay psychologist and proprietor of ShrinkTank.com, a psychology and mental health BBS.

Bischoff said that although it is in a client's best interest to be as candid as possible, "there are any number of things that are a crucial part of someone's psychological makeup that are not necessarily brought up," he added.

By concealing personal factors such as race, or problems such as anorexia or a speech impediment, a client may prevent an eTherapist from offering effective help.

However, from a consumer's standpoint, online therapy may be just what the eDoctor ordered. One of the main advantages to consumers is the ability to seek help without having to make that potentially traumatic journey to the therapist.

Storm King, psychologist and former president of the International Society for Mental Health Online (ISMHO.com), insists that "something is better than nothing," especially for people with boundary issues who feel more comfortable at home in front of their computer.

"For somebody who cannot or will not go after regular therapy, the Internet may be the only alternative," King said.

Bischoff -- who is co-creator of Lifehelper.com, an eTherapy site in development

--has observed that people who seek out online therapy often cannot afford conventional visits, which can cost more than $100 per hour. Some eTherapy services cost as little as $30 for an hour of live consultation via chat.

But to be effective, e-therapists need to be aware of the issues inherent in text-based relationships. Although people may be more willing to divulge painful details about themselves through e-mail or chat, they may do so in a more detached way, without the benefit of direct emotional response from a therapist.

The use of eTherapy as a collaborative tool -- rather than as a wholesale replacement -- might be one way to deal with this discrepancy. This method has already made eTherapy's acceptance more widespread. Bischoff, for example, corresponds through e-mail with patients who began treatment face-to-face in his office.

Another obstacle facing eTherapy is the lack of commonly accepted guidelines in the health industry as a whole. Different states have different standards for mental health professionals. Internationally, as well, standards vary.

Because the Internet is a global medium, consumers need to be aware that not all online therapists are equal. In many cases, guarantees of legitimacy are minimal or nonexistent.

"It's all beyond control. There's a tremendous need to establish international, self-regulatory bodies to gain credibility with consumers," King said.

In addition, security is crucial because of the delicate nature of information being exchanged. Bischoff says that the use of secure protocol for both chat groups and e-mail therapy is crucial in protecting patients' privacy.

King feels that many of these disadvantages -- the challenges of text-based relationships, state-by-state legal issues and privacy issues -- have more to do with the learning curve of the new communication platform than inherent problems with the platform itself.

He believes that many of these issues will go away, or at least lessen, with improvements in public policy and the creation of professional standards.

All of this is good news as therapists begin to discover the advantages of eTherapy. A Web site can be an excellent marketing tool and a way for a therapist to access a huge client base.

And consumers seem willing to try this new method of therapy. "I think it's hard to find people who are coming out against it, because there is so much consumer demand," Helphorizons' Grohol said.

Bischoff, who has operated ShrinkTank since the early BBS days of the Internet, claims that half of his "in the flesh" patients come to him first through his Web site. And as he prepares for retirement, he sees online therapy as a way to stay in the profession part-time, without the overhead of keeping a separate office.

Also, the universal nature of the Internet adds a powerful component to therapy, research and academia. Especially in rare fields of psychology, professionals can go online to connect with experts in their field who may otherwise be impossible to reach.

One example is HelpHorizons.com -- the site is a virtual mental health clinic, professional consortium and educational forum. One of its core features is the Virtual Office for mental health professionals only. This inner sanctum offers a diverse think tank for the professional mental health community.

But don't cancel your psychotherapy visits just yet. Mental health professionals unanimously agree that therapy is most productive when conducted face-to-face. Still, online therapy will continue to enjoy a meteoric rise in popularity and is expected to become an integral part of mental health services in the near future.