Allowing anonymity: pros and cons

This is a dilemma that does not have a definitive answer. As an e-therapist, you probably want some assurance that the patient is bonafide - is this someone with a real need, or a prankster? Even if it's someone with a real need, can you trust that they've giving you the whole story? Are you missing crucial information?

The trust issue becomes thornier when you take anonymity into account. We know that online anonymity has a disinhibiting effect, and that can be a positive benefit in e-therapy. The more anonymity you allow, the more people will talk freely. If they are allowed to be anonymous, some people will discuss sensitive issues online that they would never talk about in a face to face setting.

How do you strike a balance between anonymity and trust? To what extent do you allow your e-patients to be anonymous?

Many e-therapists, feeling a need for trust, require e-patients to supply their real name, street address and phone number, citing that should there be a crisis they need a way to intervene. A few e-therapists go so far as to require a face to face meeting before beginning e-therapy. Yet the question remains: to what extent is the disinhibiting effect of anonymity lost, when you do that? If you don't allow anonymity, is the e-therapy less effective than it could be?

It's a dilemma -- a case can be made for allowing anonymity, and for not allowing anonymity.

One of the dynamics driving the growth of e-therapy is the issue of stigma. Despite increased awareness, many people are still deeply embarrassed to talk to a counselor or therapist. The Surgeon General's Report on Mental Health tells us that two-thirds of all people who need mental health care don't get it. Fear of stigma is one of the main reasons.

If you allow e-patients to be anonymous, you will have more e-patients. More people will be willing to talk.

But can you be comfortable having less information about them?

Many e-therapists begin by allowing anonymity, and as trust is built up, they gradually convince the patient to supply real-world information. That's one possible compromise. (And of course, if you accept payments by credit card, you will be getting a name and address from your e-patient--although no guarantee that it's their name and address.)

There is no definitive answer. You might like to join ISMHO and talk with other e-therapists about this issue.