E-therapy: More people are turning to instant messaging and online therapy for a range of mental health issues because they’re fast and anonymous
By Andrew Lavallee
Wall Street Journal
Instant messaging, favored by chatting teens and office gossips, is a growing tool for therapists counseling people on everything from smoking cessation to sexual-abuse trauma.
Proponents say the text-based conversations are appealing because they’re fast and anonymous – users can log onto a number of online services and connect with therapists who know them only by screen names. But many in the mental-health community say the format is too impersonal for effective treatment and should be only an adjunct to face-to-face counseling.
In recent years, Web companies including MyThera pyNet, eGetgoing.com and HelpHorizons.com have rolled out services that link consumers with therapists. Patients can browse biographies of participating counselors ranging from social workers and marriage counselors to psychologists and psychiatrists. They can make an appointment for later or chat with whomever is on call at the time. The sites provide the forum for instant messaging, where participants exchange short text messages in real time.
Costs vary by service, ranging from $1.60 a minute for “e-mmediate” sessions on MyTherapyNet.com to $1,200 for a 12-week program on eGetgoing.com, an alcohol and drug treatment site. Some individual therapists, too, offer instant messaging as an additional service for their office-based patients, often using free chat programs like AOL Instant Messenger.
The chief benefit, say proponents, is that IM can provide confidential treatment for people who otherwise might never seek help.
“Frequently, people who contact me are putting their big toe in the water of therapy, so for them, it’s a lot safer than trying to see someone face-to-face,” says Thomas Fransen, a licensed clinical social worker in Chicago who provides therapy for depression and relationship issues and often counsels patients through HelpHorizons.com.
Some mental-health experts warn that the IM format is impersonal and limited, and counselors shouldn’t attempt to treat severely ill or suicidal patients whom they have never met face-to-face. Text messaging, critics say, doesn’t allow therapists to pick up on important visual cues to a patient’s true state of mind.
“What one gleans as a psychiatrist in a clinical assessment is not just from the words one says but from the emotions,” says Paul Appelbaum, a psychiatry professor at Columbia University and past president of the American Psychiatric Association. He says doctors need to assess the way a person walks, sits, smiles or tears up. “Emoticons just don’t get you to the same place,” referring to smiling or frowning faces made with punctuation marks.
Online therapy is essentially unregulated, though the Web sites say participating therapists must be licensed in their own states. Neither the American Psychiatric Association nor the American Psychological Association has a formal position on instant messaging. But the psychiatric association did recently publish a guide about the use of e-mail in psychiatry, suggesting security measures such as encryption and noting topics that may be inappropriate for e-mail, such as suicidal ideation. The consensus within the psychiatric association on online therapy is that practitioners should be licensed in their home state as well as the state their patients reside in, according to Appelbaum.
Online-counseling providers agree that IM isn’t appropriate for suicidal patients. Participating therapists generally advise patients to seek immediate in-person help if they feel they are a danger to themselves or others. The services also say patients won’t get access to drugs inappropriately via online therapy. In their biographies, the psychiatrists who participate say that while they are medical doctors able to prescribe drugs, they won’t provide medication for patients they haven’t met in person.
To address liability issues, the sites include disclaimers that people who are suicidal or think they might harm themselves should call 911 instead of signing up for a chat session, and on HelpHorizons.com, they must indicate they have read this before a chat session can begin.
In many ways, instant messaging is the latest in a range of technologies to link patients remotely with therapists or medical doctors. Some therapists say instant messaging isn’t much different from phone and e-mail-based sessions that are often offered in addition to face-to-face counseling. Doctors and therapists can bill for phone or e-mail consultations, and insurance will often cover them.
MyTherapyNet, eGetgoing and HelpHorizons all say they use secure messaging tools with Secure Sockets Layer encryption technology to help ensure patient privacy. MyTherapyNet and HelpHorizons say they provide customers with invoices and claims information that can be submitted to a health insurer; eGetgoing says it accepts several major insurance plans, including Cigna, and will submit claims for patients.
About 75 people a day use instant messaging to chat with a counselor at eGetgoing’s drug and alcohol programs, according to Barry Karlin, chief executive of CRC Health Group Inc. The Cupertino, Calif., company operates the site as well as 90 treatment facilities and says sessions are led by certified drug-rehabilitation counselors employed by CRC.
Karlin says about 90 percent of those who sign up with eGetgoing complete the program – about 1,000 since the site’s launch in 2003 – compared with far fewer at traditional outpatient clinics. The anonymity of the Internet is part of the reason, he believes, because it reduces the stigma of treatment. “No one can see you, and because they can’t see you, people don’t have the impression that they’re being judged,” he says. People who finish all 12 weeks are less likely to relapse than those who don’t, says Karlin, adding that the site offers a weekly online follow-up chat that is free for up to a year.
At Boston-based HelpHorizons, Fransen says he has treated a variety of people in the six months he has been participating – from relatives of the mentally ill to nursing-home residents. IM therapy can play an important “triage” role, he says. Typically, Fransen says, he chats with patients two or three times online and then helps them locate a therapist in their area if they want to continue treatment.
MyTherapyNet has more than 1,000 therapists in its database, including life coaches, marriage counselors, social workers, psychologists and psychiatrists, according to Greg Palumbo, president of the Woodland Hills, Calif., company. Most of the therapists also offer in-person counseling. The site provides details on each therapist, including professional background, home state and a photograph. Therapists must maintain current licenses with no suspensions, as well as malpractice insurance, says Palumbo. Therapists who are licensed to treat patients in certain states include that in the biographies, and users can search for therapists licensed in their home state.
The site, which began in 2000, has about 5,000 active users a month. Registered users can schedule an online session for fees ranging from $60 to $150, or pay by the minute to chat instantly with whatever counselor is online.