Online therapy (also referred to as Internet therapy, distance therapy, cyber therapy or e-therapy) is used to describe the variety of ways a professional counselor or psychotherapist can communicate with you over the Internet or telephone. It may consist of emotional support, mental health advice or the same professional services clients receive in face-to-face therapy. It could be as brief as one question, or an ongoing conversation. It may take the form of e-mail, chat, video or even Internet phone (voice-over-IP).

Online therapy is not the same as traditional face-to-face psychotherapy. There are some people it will not work as well for. However, there is mounting evidence that it is very effective for some. An Australian researcher, Gavin Andrews, recently published a study in Australian and New Zealand Journal of Psychiatry that indicates that Internet-based therapies are as successful as traditional approaches in treating depression.

Also significant is the fact that many more people need therapy than those who are already receiving it. For many the stigma associated with seeking mental health treatment still gets in the way, or trust issues make it difficult to sit with someone in person while revealing personal information. Online therapy can also feel safer or like a good first step for those who feel overwhelmed at the prospect of seeking help and the trust risks involved. For example, many sexual abuse survivors report that they feel too frightened to see a therapist in person, at least in the initial stages of their healing. It may be much less frightening for them to receive therapy online from the safety and familiarity of their own home.

In considering the possibility of Online Therapy it is important to consider the potential benefits and areas of concern. The following lists are not all inclusive but hopefully give you a starting point.

When might Online Therapy be a good choice for you?

• You are struggling with an anxiety disorder, agoraphobia or other issues that make it difficult to attend traditional therapy
• You live in a rural area
• It is hard to find therapists with the expertise you seek in your area (LGBT affirming therapists or those with expertise in complex trauma might be examples)
• You are busy, travel out of town for work, have a schedule that conflicts with typical office hours available: email therapy would let you compose your message at your own pace and send it at any time.
• You feel concerned about issues of trust, privacy, disclosure, being seen
• You a physical disability or mobility issues which makes getting to traditional therapy too difficult
• You have an easier time writing rather than speaking certain issues. This is often the case for trauma survivors
• You have never tried therapy and feel this would be an easier way to start
• You'd like a written record (with email or chat forms of therapy) to review as needed. This can be especially useful if memory issues are present, for example with dissociative amnesia.

What should you consider before starting Online Therapy?

• Online Therapy is not the best resource for people in immediate crisis. Crisis lines, a local walk-in clinic or emergency room may be better options. If you or someone else is actively suicidal, you can call 1-800-SUICIDE.
• Online Therapy is still a relatively new field. Make sure you seek out a practitioner who is experienced in general and aware of the specific risks as well as the advantages.
• Match the form of Online Therapy to your strengths: If you're going to work with a therapist by e-mail or chat, you must be comfortable writing expressively, informally, and in some detail. If you don't like to write, or if you tend to misinterpret written communication, videoconferencing or Internet phone would be better options.
• As in any form of therapy, you must be willing to share your thoughts, feelings and self for therapy to really work. This may be even more the case when your therapiust does not have nonverbal information to draw from.
• How comfortable/familiar are you with technology? Those new to email, chat or video conferencing may have a harder adjustment.
• You should have a way to contact the therapist in case technology fails. For example, if your computer crashes in the middle of a session, do you have the therapist's phone number?
• Think about additional privacy/confidentiality issues specific to these formats: others' having access to your computer or email accounts (using a work computer is never a good idea), accidentally sending email to the wrong address, encryption and storage issues.
• Be sure that the online therapist clearly identifies their credentials, areas of expertise. Ideally, you should be able to verify these, for example through a licensing board.
• Potential miscommunications given different communication means. It can be hard to read tone in email or chat! Can you be prepared to elaborate or ask for clarification rather than assuming the worst?

Feel free to contact me with your questions about Online Therapy.

Kathleen Young, Psy.D.