Networld Archive: Topics	17.03.98

The Talking Diary

by Gerti Schön

More and more US citizens are taking their keyboards onto the couch: psychotherapists on the Web are no longer a rarity.

It sounds a lot like Dr. Sommer in [the German magazine] Bravo: "Whats wrong with me? Could I be a lesbian?" asks a young woman chatting online who has lost interest in her lover. Dr. Tucker-Ladd answers: "If you like this man, you should try to make your sex life more interesting, too." And finally: "Read something about it. Click on the book icon below to find more on the subject."

But unlike global one-size-fits-all care under the rubric "Ask Dr. So-and-So," online therapy offers a wide variety of different approaches for people with everyday problems. There are now several dozen websites devoted entirely to online care. The hosted chatrooms, in which a psychologist is present as moderator, are especially popular. Many people also use self-help groups, for example for depression or relational problems. Counseling for sexual problems is also available on the Web.

The American Psychological Association (APA) has conducted several studies on the meaning and purpose of online therapy. An observation of an online support group on eating problems revealed that the sessions served mainly to impart information, share experiences, and offer emotional support. Unhealthy postings, such as anonymous tips about laxatives, were the exception. The study reported with some satisfaction that demographic barriers were also being breached: "Teenagers are giving sound advice to 35-year-olds."

Nevertheless, Americas psychological associations are treating this development with caution. They say the two top areas of uncertainty concern whether U.S. therapists are allowed to treat patients outside their own state, and how to protect the exchange of confidential information from being accessed by unauthorized readers.

Americas psychologists keep returning to the discussion of another key disadvantage. "In online therapy, the entire spectrum of nonverbal communication is missing, and that certainly cant be replaced by smileys," says John Grohol, a mental health professional who lives north of Boston, who created the website Psych Central. He maintains that online discussions should be limited to problems like marital crises and common fears, and warns against referring schizophrenics or suicidal patients to an Internet service. Therapists unanimously agree that online counseling cannot replace treatment. But it can be an effective supplement, and much of the material on the Internet, says Grohol, has "educational value." Entire books are published on the Net. Conflicted individuals can, for example, access "Psychological Self-Help", a kind of online advisor for self-diagnosis.

Many "shrinks," as psychotherapists are called in America, are gradually shifting their field of activity into the virtual realm. In the U.S., online one-on-one sessions are now commonplace. Just send an E-mail to the doctor, transfer a tidy sum, and within a few days you have your answer.

The fees charged by these therapists range from 20 to 150 dollars, according to region: in New York City you pay more than, for example, in Nebraska. The advantage: the procedure is simpler than in real life. No appointment, no waiting a week in an urgent situation. And in addition, says therapist John Grohol, the non-visual means of contact allows some people to overcome their inhibitions about seeking therapy.

Sometimes the reasons for switching to the virtual camp are purely pragmatic. New Yorker Martha Ainsworth, for example, missed her weekly therapy sessions on an extended business trip and sought replacement online, "just to deal with stress and work on myself," she says. "It was a kind of diary, but this one talked back."

She has been using online counseling for quite a while, with increasing success. "In the beginning, about two years ago, some E-mails wouldnt even receive an answer. Some providers remained anonymous and you couldnt check who was behind them and what references they had." Thats why Martha Ainsworth created "Metanoia", a Web site providing a long list of online counseling services. The therapists are described and evaluated on the basis of presentation and feedback.

The Web page of psychologist Richard Sansbury is given especially high marks. Among his offerings, he added a link with the title "Playboy mansion." It leads to a picture of a fat baby with the comment, "Hmmm. You were expecting to find a hot babe, right?" Marthas comment: "Certainly the most humorous service. That can be healing in itself."

SPIEGEL ONLINE 12/1998 - Reproduction only with approval of the publisher SPIEGEL