An E-Patients Story

It was raining the night I reached the end of my rope. Dark, desolate, dismal: mirroring my mood. Rain, like a heavy curtain, creates a barrier of separation. When it rains, we retreat into the shelter of buildings, shutting doors to protect ourselves from the weather. Shutting ourselves away from one another. For some, these shelters may be a warm haven of connectedness, shared with family, colleagues, and friends. But for those who are alone, the curtain of rain magnifies the aloneness, the sense of separation.

As usual, I was alone. In the late afternoon, I had completed one more presentation to one more workshop group that looked like every other workshop group. Temporary relationships, a connection for three hours, and then they were gone, home to their families and friends, shutting their doors against the rain, shutting me away, just a passing memory. I was left behind in one more airport Ramada, one more city like every other city I encountered on that trip. A familiar scenario to be repeated day after day: same script, different people, different city. For several weeks, I could look forward to more of the same.

I needed to talk; there was someone I knew I could call. Late night though it was, compelled and reluctant at the same time, I dialed anyway, awakening him. Sleepily, he did his best to listen as I struggled to find words to express my desolation. After just a few minutes, he apologized; he just couldnt stay awake. He offered to call the next day. The next day, I would be on a plane, one more plane. Resigned, I hung up the phone. Just another disconnection.

Staring silently out my hotel room window at the rain, I found myself contemplating the state of my life, which was not very good. Too much change, too much loss. A midlife career change that had me grieving the loss of my avowed vocation. The new job, though good, was both stressful and isolating. Continuing financial struggles. Old emotional wounds forced their way to the surface: a painful divorce, a sense that I could never get close to anyone. As my mind traveled these haunted corridors, I began to feel overwhelmed by grief, loss, and hopelessness.

There is only one thing worse than hopelessness: being alone with it. Turning away from the rain-sodden world in the window, I went to my laptop-and went online.

I went online to cyberspace, to connection. Connection with people. It was an association I had learned in 1982, within hours of buying my first computer. I had imagined that going online meant nothing more than connecting to another computer to play a game with it. It came as a surprise, and ultimately a delight, to discover there were people-hundreds, thousands of real human beings-connecting to each other in cyberspace. I found them in a collectively imagined space called Participate, in an online world called The Source. Before long, I discovered even more cyberspace villages.

Over the next thirteen years, I experienced the power of people-to-people cyberspace connections. I made close friends, many of whom I never met in person. I shared my life with them, and they shared theirs with me; we were part of each others day-to-day lives. Though our bodies were separated by great distances, we were neighbors in the same village, a dynamic community which was always as close to me as my computer.

As the community grew tighter, we began to share more intimate hopes and fears with one another. Soon, we began to form more intentional support groups. Beginning in early 1983, I participated in and led dozens of support groups on a wide variety of topics. A depression support group touched me most. Its members shared deeply with one another and formed an intimate bond that continued for many years. Each person knew that there, in that private cyberspace room, they would find a connection with people who cared. They supported one another through rough times, helped each other cope, bolstered the hope of those whose strength was flagging, and ultimately faced the suicide of one of their own.

Stunned and shaken by that suicide, I realized that as cyberspace continued to expand, similar events would surely follow. I felt compelled to find a way to respond. I immediately set out to learn something about crisis counseling and to adapt it to cyberspace.

People have a tendency to say things online they would never have the courage to say to someones face (disinhibition). In cyberspace, people share intimate details of their lives and hopes and fears with friends they have never seen-precisely because they are unseen. In the privacy of cyberspace, I too could talk more freely about many things. And I witnessed an alarming number of people admit online to despair and suicidal feelings that they would have been embarrassed to acknowledge in person, even to a professional counselor.

As I continued leading support groups, I encountered more and more wounded souls who, freed by the anonymity of online communication, poured forth a seemingly bottomless well of pain. As a compassionate listener, I did the best I could to help, but felt hopelessly inadequate, lacking professional skills and training.

Again and again, my efforts to connect hurting people with psychotherapists were unsuccessful. People seemed to be separated from the help they needed by barriers-misconceptions about psychotherapy, financial and geographic limitations, and most of all, embarrassment. So many people either could not or would not contact a professional psychotherapist. The intransigence of this gap nagged at me. Psychotherapists know the pain of those who come to them. But the shielding of cyberspace communication was beginning to open a window onto the alarmingly huge population of walking wounded who never made it to psychotherapists offices.

Often, I wished that all those people who found it so much easier to speak their innermost thoughts online could have had someone to listen who could actually have helped. I prayed for the day when professional psychotherapists would cross the barrier, venture into cyberspace, and take a step closer to those isolated, hurting people who could not come to them.

I had to wait thirteen years.

By 1995, the old online services were giving way to e-mail and the Web. And now I was myself one of those wounded souls, looking for someone who could hear my pain, accept me, care about me and for me. I was looking for this person in the middle of the night, and I was not looking for an office. I wanted to find this person in cyberspace, where I knew it would be safe to talk.

With the help of a search engine, I began to find Web pages on which psychotherapists advertised their office practices. No, I thought to myself, thats not what I need. I want to work with someone here, wherever here happened to be for me from one day to the next. Dig deeper.

I found the page of a psychotherapist who offered to respond to one question for a small fee, sort of a psychological Ann Landers. But nowhere on the Web site did the therapist reveal his or her name or location. That made me very uneasy. How could I know for sure that this was really a competent professional?

Another site seemed promising, but the intake form, which was not secure, demanded my name, credit card number, street address, and phone number, which I was not prepared to surrender to a total stranger. I continued clicking.

I came across a site where, again, psychotherapists offered to answer questions for a small fee. They did give their names and professional qualifications, so I felt more reassured. I clicked to the submission form and began trying to frame my question. After half an hour, I gave up. I didnt have a question. I wasnt looking for an answer. I was looking for a person, a relationship. One e-mail was not going to be enough. I kept searching.

Finally, two hours later, I clicked on a page that began:

WELCOME TO THE MENTAL HEALTH CYBER-CLINIC

Within a paragraph or two, I could see that this place was different. I saw the words ongoing helping dialogue, and my heart leapt. Was this someone who would be there for me, who would be willing to stick with me for awhile?

The therapist had written several pages describing the e-therapy helping process. His tone was informal, but professional. The language was first-second person, I and you; reading his words, I seemed to be in a conversation with him. He quite obviously was an extremely competent psychotherapist who also understood the Internet. He wrote insightfully about e-mail and online communication. From his writing style, I could see that he knew how to communicate in writing; his gentle compassion shone through his words. Best of all, he spoke of forming a relationship. As I read, I began to feel that he would be willing and able to listen to me.

As he described what he could offer, he was thorough and up-front about the limitations and risks as well as the possibilities of working together online. It made me feel that he was responsible, that he cared about my welfare, that he would not try to sell me something. He was not pushing a book or massaging his ego by promoting his own theory of psychotherapy. He wasnt talking about himself, he was talking about me... about us. He was winning my trust before he ever knew of my existence.

I knew enough about cyberspace to be cautious. Things are not always as they seem. But the therapist provided his rsum, complete with license number, office address, and telephone number. My sense of trust began to take hold.

My decision to reach out to him was almost not of my own volition. The pain in my soul was overflowing, and this therapist seemed to have his arms open, waiting to take it from me. I quickly clicked through to the short intake form.

I started to fill out the form... then hesitated. I was about to reveal intimate details about myself to a total stranger. Inside, I felt conflicted. I wanted desperately to connect to this person. Yet at the same time, I was wary and wanted to protect myself. I scanned the form and saw that he did not ask for my name or any other identifying information beyond my e-mail address. Something inside me relaxed. I could reveal to him only as much as I felt comfortable revealing. There was nothing intrusive here; only hospitality and an invitation to talk. He was not demanding anything, only accepting whatever I cared to share. I felt I had some control. I completed the form and sent it off.

We had already had our first session, and the therapist didnt even know it yet.

The next day, my attitude toward physical aloneness had completely reversed. On the plane, I fidgeted, impatient to be alone in my hotel room. I wanted to check my e-mail. I really wanted to check my e-mail. The flight seemed endless. My thoughts kept going to the Mental Health Cyber-Clinic. Was this therapist real? Would he care about me? Would he really be there? Maybe there would be no response at all. Maybe it would be a disappointment. Finally, I reached the hotel and checked in. I hurried to the room, flung the suitcase on the bed, and went directly to the desk and phone. My hands were trembling as I connected the laptop to the phone line. Would I get a response to the cry of pain I had sent off into cyberspace? Would it be human, or would it be a form letter? Could I make a connection with a person who cared?

My heart stopped as my e-mail inbox came up. Yes! There it was:

Subject: 2 e-mails from the cyber-clinic

With some trepidation, I opened the e-mail. I remember scanning the text quickly. Two sentences seemed to leap from the page:

I am here for you and will try only to help.

I am very concerned about you.

With those two sentences, he completed the circle. He had heard me and grasped my pain; he had responded with caring. My human need cried out, and his human compassion responded. It was connection. Physically, we were separated by five states; but psychically, we were more connected than if we been in the same room. In that moment, a relationship came into being that became one of the most profound I have ever known.

I read the remainder of the e-mail more carefully. He established the therapeutic frame, explaining ground rules and procedures, and offered a few gently probing questions, based on the form I had completed, about my family, my history, and so on, to help me start telling my story. Mostly questions to start with, he said, as I need to know you better, and you need to know me too. The e-mail ended,

Lets try to keep the dialogue going so that not too much time elapses between our e-mails.

Is telephone therapy a possibility?

Can I have at least a first name?

I hope to hear from you soon.

I felt an enormous sense of relief. Not only was he caring and willing to help, but the fact that we were meeting through the anonymity shield of cyberspace made me feel free to tell him everything. I started composing my response right away. I wrote, and wrote, and wrote some more, ending with:

Have I scared you off yet?

I find myself stranded and feeling extremely reluctant about entering into a therapy relationship. I am feeling timid about you. The thought of going through that is overwhelming right now. I am of uncertain hope about whether it can be helpful. And the recent feelings I have been having is stuff I never could talk about to anyone. I write better than I talk. The anonymity of online communication, etc., etc. You know all that. I do not talk well at all.

Im not quite ready for the telephone. Im really not good at talking on the phone, it makes me very self conscious. Can we just keep writing?

I am scheduled to be traveling for the next several weeks. I have a laptop that I take with me. I envision being in my hotel room at night, alone and isolated, far from home. I envision e-mail as a potential lifeline.

Once again I hit the send button, as I had done 24 hours before. But now it was a very different experience. No longer was I sending my innermost thoughts into a black hole in cyberspace. I felt a living strand of connection between myself and another human being who, though he was several states away, was beginning to create a presence as close as my own thoughts. Since I had no physical manifestation to relate to, he existed inside my own head, to be carried around with me throughout the day.

Day by day, he drew me out, helping me talk about the pain. Within a few days, I had told him my whole life story (or so I thought). Late at night, when I felt most alone, I sat down at the computer to write. Sometimes, I wrote again early in the morning. During the day, he always responded within a few hours. It became apparent that just as I held him in my mind, the same was true for him; he held me in his thoughts. I felt totally connected to him-to this caring presence I had never seen in person.

His questions gradually got deeper and more difficult, as did my responses. Little by little, as my trust deepened, I yielded up more information about myself-the city and state where I lived, my last name. I still didnt give up my telephone number. I felt I needed that distance to enable me to continue talking. He was gentle but persistent.

Perhaps a short-term goal should be to say hello on the phone even for a minute.

---

No, Im really resistant about talking on the phone. I have a sort of phone phobia. Talking is really hard for me. Everyone says that I am a very quiet person. Whats going on in my mind is not quiet, but getting it from my brain out of my mouth is exceedingly difficult, for a whole variety of historical reasons. I always found it very tough to talk on the phone. So, maybe sometime we will talk on the phone, but not yet. The thought scares me a lot.

As the weeks went on, the closeness deepened. As is often the case in cyberspace relationships, we began to fantasize about what it would be like to meet for a therapy session in person.

I feel a desire to sit down in my office with you, and I recognize that this is not possible. I feel a need to "embrace" you (figuratively) and stand with you through all your struggles.

---

I feel that too. I found myself looking at a map to find out how long it takes to drive to your city. But the thing is, there are things I can talk about in this way that I cant approach face to face. What I write to you is much more "inner" than what I would probably tell you in person. So lets continue trailblazing here in e-mail.

My e-therapist had two outstanding qualities that never ceased to amaze me: intuition and strength. To this day, I am not sure how he did it; but he was nearly always able to sense my moods accurately, just from my writing. I went through a dizzying range of emotions: depression, playfulness, rage, despair, terror. He always knew.

This day started bad and got worse. The constant ache at the center of my soul. Now it feels like a searing pain. I fear I will always feel this way. I am so tired... If you are the one who is so hopeful then give me a reason to keep this up, to keep corresponding with you. Why I am doing this? Why am I trying at all?

---

I feel your pain and anger to the extent possible over our connection. You know I am here. I dont want to be completely quiet because I dont want you to think I am stuck. So what to do? I am going to trust your inner strength and Gods will that there is a way out of this mess for you. I will stand by your side as you travel that way, respecting your silence as needed.

---

No! Now I *am* angry. I *dont* want you to "respect" my silence, dammit, I want you to break into it. And no, *I* dont know what that means, I need *you* to know. You say you will "stand by"?? I dont know what I want from you, but please dont abandon me here, dont stand by and watch.

You said, "I dont want to be completely quiet because I dont want you to think I am stuck. So what to do?"

I dont know, but figure it out, okay?

---

Im sorry I yelled at you earlier. I hope you are not angry at me. The last thing I need right now is to be abandoned. I imagine that you are having second thoughts about having gotten involved with me.

---

Please know and trust that I am not angry with you.

It is noteworthy, the quickness with which you seemed to assume I would somehow reject you. I will not deny that I wish I could do more for you and am thus a little frustrated, but the thought of bailing out never crossed my mind. We are in the present, not your past.

The strength of our therapeutic frame was unwavering. No matter what I threw at him, he was rock-solid, firmly optimistic, gentle, and loving. I told him horrible things from the depths of my depression, and he was not horrified; he accepted them calmly. I raged, and he accepted it calmly. I transferred onto him the abandonment, abuse, neglect, and incomprehension I had suffered from others. Knowing it for what it was, he accepted it calmly, and responded with caring and warmth. No matter how hard I slammed into the frame, it was always strong enough to hold me. Our relationship was a well of caring that to this day has never run dry.

You have been on my mind since yesterday. I am wondering, how are you doing today? Do you have any periods of respite from your feelings? What are your thoughts like at the best times? The worst?

---

In the moment, when you asked, "how are you feeling today?" I honestly couldnt answer because on the spot in that moment I truly didnt know. It took a long time, thinking about it, before I could say, yes, I feel... like crying. Sad. Hopeless. So I suppose that asynchronous therapy works for me in one sense, because my feelings are usually asynchronous to the event with which theyre supposed to be associated. E-mail gives me a chance to catch up.

What I am feeling is loss, or maybe its just an aching loneliness. Writing to you opened a wound. As if your kindness made me realize fully how bad I feel. The fact that you asked--that one person on this planet wants to know how I feel--took a cork off a bottle somewhere inside, and Ive spent the last couple of hours crying. My feelings were frozen, and you made them melt, and now instead of ice I have this lake of emotions filling up again.

My feelings seem toxic. Its like a lake that keeps filling, threatening to overflow. There is no way to drain the lake. The toxic thoughts and feelings are trapped and have no outlet, because no one really wants to hear me talk about it. Except you.

---

The metaphor of the lake is interesting--lets work with that. First lets stem the springs that feed the lake from the inside. Then lets spill some of the toxic "water" off the top, so that the lakes level is well below the overflow mark. You must be able to talk about your life in your protected space, and you need to not be alone there.

You know, as I sit here and think about you, I find myself wanting to go into that lake with you, swim around awhile, check out all its features, see how clean the water is, or isnt, and then maybe call the Army Corps of Engineers and tell them the lake is a flood hazard, so we need to build some drainage. Real good drainage, bomb proof and all that. Let the water drain into the vastness of Gods oceans which can easily absorb the water. Then in the dry land which remains plant flowers and fruit trees. They would grow slowly in the lush soil, but fully. Bearing beautiful blossoms and petals each year, forever.

You are a kind person, whose woundedness helps her to feel compassion for others and whose life work is meaningful. Write with you tomorrow.

Eventually, we did speak on the phone. Nine months later, we met in person, and have done so perhaps a half dozen times in five years. Strangely, when I finally did sit down with him in his therapy office, it wasnt the same. He was just as caring, just as warm, just as insightful. But because he was there in person, I found that there were things I could not say. And predictably, when I got home from that visit, all the things I had been unable to say in person came out in e-mail.

Our correspondence continued for over two years. My e-therapist was faithful, and his caring for me has never wavered. I was challenged, comforted, and empowered. The experience was profoundly healing, and my life changed for the better.

I now have a wonderful, deep, trusting relationship with another very gifted, loving therapist, with whom I meet in the traditional way, in an office for weekly sessions. But as close as I am to him, there are still things I cannot say when I am in his presence. When I have something very difficult to talk about, I return to the private, shielded, non-visual connection of e-mail.