Experience with online counseling/therapy?

January 27, 2006 10:34 AM

Does anyone have experience with online counseling/therapy, either from the giving or receiving end? What was good or bad about your experience?

Was the therapist hosted by a portal site, such as Kasamba.com or HelpHorizons.com? Has anyone found a portal site they just love? Or can't stand? What do you love or hate about it?

Or was it the therapist's own site, and if so, what was good or bad about this? From the therapist's perspective, how do you make people aware of your site? How do you handle the billing part?

From the client's perspective, how did you choose an online therapit? What sort of fee seems fair to you?

I am a psychologist and long-time psychotherapist who is considering providing services online. Before I jump in, I'd like to know what others have learned from experience. If I'm going to do it, I want to make sure I do it well.

posted by lisaj32 to Computers & Internet (3 answers total)

I don't have experience in online counselling, only in-person (as client/patient), but it would seem to me that online counselling is a very bad idea indeed. Isn't a major part of the therapeutic dynamic the personal interaction? It's too easy to lie online, too easy for the shrink to miss all sorts of subtle physical cues that might lead him/her to find fruitful avenues of investigation, etc.

'Course, you're a shrink, so I'm probably saying nothing you don't know.
posted by dirtynumbangelboy at 10:55 AM on January 27, 2006

Response by poster: dirtynumbangelboy, those are good points. But I think there's a trade-off. Online counseling might help someone who would never go to see someone in person, someone who is in a rural area where providers are scarce, someone who doesn't have a car, etc. Also, online tends to be cheaper, so it could help someone who can't afford face-to-face. I do think in-person is a better choice, but I'd rather deal with the limitations of online than not be able to help someone at all. We would both just have to be aware of the limitations.

I appreciate your input, but I want to make sure this thread doesn't get off-topic. I'm really looking for people who can share their experience with me.

Thanks :)
posted by lisaj32 at 11:09 AM on January 27, 2006

I think it's a complicated area that has yet to be fully explored, in terms of professional services, lisaj32. However, that was also true of therapy over the telephone at one time, and that's a modality that seems to be somewhat accepted at this point, especially to help people deal with mobility or access problems.

As far as I've read the literature on this, I think the issue of confidentiality is tremendously important. I don't know if you were thinking of email or chat type sessions, but neither one meets acceptable standards for confidentiality, IMHO, unless you were to work through a secure encrypted modality.

I think there's some reason to believe that the modality could be effective, putting the technical and ethical issues to one side, for the moment. Certainly some people felt helped by Eliza, even some of whom knew it was a computer that was responding to them. I think it's also important to consider the challenges of how people represent themselves online versus face to face. Here are some articles that discuss that, one by Fenichel, and one by Suler that I think capture some of the theoretical dimension of this issue.

Here's a webpage of someone in New Zealand who is doing this. Maybe he could give you some concrete pointers.
posted by jasper411 at 11:50 AM on January 27, 2006