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Analyze this: Therapists offer counseling online

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Even advocates of online therapy admit that face-to-face sessions are the better way to treat serious problems. (Courtesy of


Online therapist Shirley Gruen is available for counseling via telephone, e-mail, videoconference and face-to-face sessions. (Photo courtesy of


All online clinicians at are members of the International Society for Mental Health Online. (Photo courtesy of

Let’s quickly do some free association: What comes to mind when you think about seeing a therapist? A couch? A quiet room? A box of Kleenex? If for some reason you thought about a screen, a keyboard and a mouse, you might belong to the growing number of people who seek help from online therapists.,, and are a few of the many Web sites that offer help to patients who--for whatever reason--don’t want to sit down in a real office.

Lying down on a virtual couch is as easy as buying books from “Online therapy can really be used by anyone who’s had some experience being online and feels comfortable communicating in an online environment,” said John M. Grohol, the publisher of, a mental health educational Web site. “People have used it for everything from grappling with depression or anxiety disorders to less serious concerns, such as relationship issues or work and career issues.”

Mental health professionals began offering therapy over the Web around ten years ago, and Grohol estimates there are well over a thousand therapists practice online today. Yet, many psychologists question the functionality and safety of e-therapy.

At most sites, patients can choose how they want to conduct their sessions: by e-mail, instant message or, if they’re less computer-inclined, via telephone. At, a one-hour session--conducted on the phone or on the Web with secure chat software--costs $85. Three sessions go for $245; 10 hours for $800.

About 800 patients a month seek treatment from the 24 therapists affiliated with, according to Judy Gifford, owner and founder of the site. Many clients are in the military and want to avoid going through the military channels, she said. Others live in rural areas, or travel frequently for business or simply are concerned about confidentiality. To work for Gifford, a therapist must have at least 10 years of post-graduate work experience and be licensed in his or her state, she said.

Can therapy work when two people aren’t physically in the same room? Gifford thinks so and says studies have shown that online patients disclose more information more quickly than during face-to-face sessions, she said. “They don’t have the issues of shame or feel that somebody is judging them.”

Likewise, said Grohol of psychcentral, “the original form of psychotherapy, which was widely practiced until the middle of last century, was psychoanalysis, which had the patient out of view of the therapist.” And, Grohol added, the Internet has fostered communication rather than hindered it, especially on sites like Facebook or Myspace. “If talking online would be difficult, or challenging, or somehow didn’t replicate the experience people are looking for in friendships,” he said, “people wouldn’t be doing it to the extremes that they are. Psychotherapy is about communicating with each other, like friends, just in more structured format.”

Some conventional psychologists disagree vehemently. Susan Jaffe, a psychiatrist, psychoanalyst and assistant faculty at the New York Psychoanalytic Society and Institute, for instance, can’t imagine treating patients in any other way than an ordinary conversation. “I don’t think [e-therapy] is a substitute for the intimacy of an analytic session,” she said. “I feel I would miss too much information--intonation, facial expression or hand motions. These are very important.”

Advocates of online shrinks don’t buy this argument. “E-therapists have to work a little harder, ask more often for clarification, because they don’t have the visual clues,” Gifford admitted. Of course it is possible that patients who write to their therapists can choose to keep certain emotions or facts to themselves, she said. “But patients can hide things in an office setting, too.”

Grohol, too, believes physical distance is not necessarily an obstacle to successful psychotherapy. “For anybody who says the written word can’t convey the depths of emotion or experience necessary for psychotherapy to work, I would say: Tell that to William Shakespeare. Because anybody who reads his works is very much aware of the depth of emotion and information conveyed by word,” he said.

Mental health professionals do agree on certain things. E-therapists admit that face-to-face sessions are the better way to treat serious problems. On, a disclaimer warns that, “This service is not appropriate if you are experiencing suicidal thoughts, suffer from a severe mental illness, are in crisis or are under 18 years of age.” Gifford readily admits: “Clearly, we don’t feel our site is appropriate for everybody.”

Critics of online therapy also often cite security and confidentiality risks. Todd Essig, a psychologist and psychoanalyst from New York, once declined to talk to a patient using skype, “because I do not understand it sufficiently, especially how to protect privacy,” he said in an interview.

Essig also thinks e-therapists shouldn’t say they’re practicing psychotherapy. “If they do, it’s professionally problematic.” To do psychotherapy at a distance is to confuse a simulation with an actuality, he said.

“The experience of going to a concert is different than listening to a recording--even a good one--and who would compare the richness of a museum visit with a trip to the local post-card store,” he said during a 2007 talk to New York University’s postdoctoral program. “Reality is just too robust to be fully captured by any simulation and the importance of what’s missing can’t be known in advance.”