Psychotherapy in the Internet Age

The potential to communicate on-line opens up whole new possibilities for emotional healing. While some decry the use of technology as an intermediary and claim that the artificial, dehumanizing medium is the "message," there is no doubt that the internet will take on a greater and greater role in the therapy/counseling universe. Why is this? For two reasons. First, in people's busy lives, productivity and efficiency are at a premium. Simply stated, it takes too much time to drive (or worse, take public transportation) to the therapist's office. It will not not be long before people say "Do you remember when we spent an hour in the therapy office and an hour in the car?" Second, the internet gives clients extraordinary choice. Rather than being restricted to their own community, clients can pick therapists from anywhere in the world--language replaces locale as the only barrier.

The availability of internet therapies in different modalities, however, is no guarantee of their effectiveness. Do internet therapies (e-mail, icq/chat, and video) work? How do they compare to traditional face-to-face therapy? Because the use of the internet for this purpose is so new, there is little empirical research on this matter, but we can make an educated guess based upon our understanding of the therapy process.

In Psychotherapy: The Restoration of Voice I identified three parts of the therapy process: discovery, broadening and deepening understanding, and developing a strong therapeutic relationship.

If we use these three processes, discovery, broadening and deepening understanding, and developing a strong therapeutic relationship, as criteria, how do internet therapies stack up against traditional face-to-face therapy.

From this table, you can see that both e-mail and ICQ/Chat are adequate for the discovery part of therapy, but they they are less than ideal beyond this function. E-mail suffers because the therapist is unable to interrupt and ask a question in order to better understand what the client is thinking/feeling at the moment. The therapist can send an e-mail, but he or she has to wait for a reply--a thirty second clarification turns into a day's wait. ICQ/Chat solves the immediacy problem, but the mechanics of typing slows the therapy process to a standstill, and keeps the therapist from attending fully to the client. Internet video shows promise. One question remains to be answered: Will the video technology somehow interfere with the human relationship building process? My guess is that it won't. If it did, people would not laugh and cry at movies; rather they would stare, like my dog Watson, blankly at the screen.

Face-to-face therapy remains the ideal mode of treatment, because it offers the fewest obstacles to a genuine therapeutic relationship. But internet video, with its advantages of time efficiency, and almost unlimited choice of therapists will likely grow in popularity as broadband and fast computers become widely available. It remains to be seen whether this technology will somehow dehumanize the therapy process.

Searching On-Line for a Therapist?

It can be a frustrating experience. But, if you are able to get a sense of who the therapist is through his/her web site, it's a good first step.

Every therapist brings their own philosophy of therapy to their work. But just as importantly, they bring their own "self" through which this philosophy is filtered. That "self" is critical to a good therapy match. Unfortunately, that "self" is rarely revealed in a web site. Yes, credentials and experience are important. But as a therapy consumer, I would also want to know what my therapist is like. What issues is s/he sensitive to? Is s/he bright? How "deep" is s/he? How much world experience does s/he bring to the therapy office as opposed to book knowledge? How realistic is s/he? Is s/he pompous or self important? Will s/he be able to sit with me through my blackest moods? Will s/he be honest with me or hide behind a therapist persona? Does s/he have children? (Perhaps the best way of evaluating a new therapist would be to spend an hour with their children!) Does s/he know what it's really like to raise adolescents? How about stepchildren (if this is relevant)? Does s/he have experience with the death of a loved one? Has s/he had enough pain and loss in their life to really know what I'm talking about?

If a therapist is willing to be revealing, a web site offers people an excellent opportunity to "pre-screen" potential candidates. I think all therapists should put them up. Of course, constructing a site that reveals yourself is risky business. If my therapist had revealed himself in this way, I never would have chosen him (see Dreams, Imagined Dreams: Failed Therapy) Indeed, at most therapist sites, the person is hidden behind a sea of credentials, slick graphics, etc. These sites cry out: "I am professional." But being "professional" does not, by itself, make a good therapist. Good therapy is an endeavor that involves two human beings, and the client will and should over time discover who the therapist is. A good web site can help begin this process.

Certainly, perusing a site is no substitute for a face to face meeting, but it can be an excellent first step in determining whether a good match can be made.

Good luck in your search.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: So, You Want to Be a Therapist?