Have you tried therapy-by-email? Would you recommend it?

November 2, 2009 7:31 PM

Have you tried therapy-by-email? Would you recommend it?

I'm interested in trying therapy (for depression, social anxiety, and related concerns).

I'm considering therapy-by-email, for a few reasons:

• It's generally a bit cheaper than face-to-face therapy (and I'm strapped for cash at the moment, and that's not likely to change unless my mental health improves).
• In my limited past experience with therapy, I've been frustrated by the format. An hour a week doesn't feel substantial enough to me. With email, I could take as long as I like to consider the therapist's comments and compose my reply, without needing any more of his (expensive) time. I would be glad to put several hours a week into this.
• Similarly, I'm an intensely private person, and it takes me a long, long, long time to feel comfortable enough to open up to anyone, let alone a stranger, about my inner life. However, I seem to have no problem spilling my business semi-anonymously on the Intertubes. I think the detachment of the email format might actually help me develop a more productive relationship with a therapist.
• I'm much more comfortable and capable expressing myself in writing anyway.
• I live in a rural area, and there aren't many therapists around here. Email would broaden my options significantly.

I realize that everyone's experiences will be different, and that finding the right email therapist may take as much trial-and-error as finding the right face-to-face therapist. I'm just trying to get a sense for whether this is a wholly bad idea (or maybe a super-fantastic idea).

If you can recommend a specific email therapist, well that'd be great. I might ask you a few (not too probing) questions about your experience, in that case.

posted by ixohoxi to Health & Fitness (13 answers total)

I'm not a fan. Therapy is about building trust with someone who needs to get to know you, and it's tough to read body language, tone of voice, and other responses via interwebs. I think email therapy is good for regular, ordinary advice, but not for helping recognize and strategically change thought patterns, emotional response, etc. I know it takes a long time to open up, but that's part of the point: the therapist is getting a gauge on you long before you think you've even started opening up, and that's a nearly impossible task without being face to face. I know that there are a lot of constraints prohibiting you from getting therapy, but it is worth the drive, and there are facilities that have a sliding payment scale if you are financially strapped.

On the writing note, my therapist suggested that I write for 20 minutes before I go to bed - everything, including fears, anxieties, stress, observations, etc. I do not have to ever read what I write again, and I can even throw it out, but it's a good exercise in articulating things differently and sort of organizing my thoughts. It has been helpful as a cathartic exercise.

Maybe try some yoga, too. The breathing part is pretty good for a lot of things. Not necessarily a solution to what ails you, but at least it gets more oxygen to the brain and gives you time to stretch and just be.
posted by cachondeo45 at 7:41 PM on November 2, 2009 [1 favorite]

Yes, but I call it "online dating" ... there are even free services.

(note: This is, unfortunately, half serious.)
posted by SpecialK at 8:21 PM on November 2, 2009 [1 favorite]

For a therapist, having the connection to a person's emotional and physical presentation is VITAL in being able to accurately assess her or him, especially with things like depression and anxiety.

It's also a vital part of treatment for things like anxiety and especially social anxiety that the person is physically present in the therapy office and conversing with said therapist the way that they are likely to have to converse with others in their life. Doing therapy over email means you are going to lose a huge chunk of the benefits of therapy in the first place, and I would venture that you are not likely to see meaningful results particularly with the social anxiety. You say it will be easier for you to develop the relationship, but the treatment will more than likely not be as effective.
posted by so_gracefully at 8:52 PM on November 2, 2009

I completely agree with cachondeo45. Once you get to know a therapist over an extended period of time, I could see supplementing face-to-face sessions with email exchanges, but without tone of voice, body language, and so on, I think your therapist would have a severely limited perception of who you are, which would hinder their ability to help you.

Also, I can understand being frustrated by the format, but please keep in mind that most of your work does not happen in that one hour session. Rather, it happens in the time between sessions as you reflect, notice patterns in your behavior, and deal with daily life. Keeping a journal may be a good way for you to organize your thoughts so that you can make the most of each session. Whether you use writing as a tool or not, it is really helpful to have a basic agenda in mind for your appointment, while still allowing the conversation develop organically and shift as is necessary. Best of luck!
posted by katemcd at 9:01 PM on November 2, 2009

I'm with you on this, ixohoxi, I think it's a good idea. My suggestion is to find a therapist in a nearby town and call ahead and see if you can go to a few sessions in person and then progress to just email.
posted by cda at 9:02 PM on November 2, 2009

If you're already considering therapy by email and are worrying about cost, I would consider picking up a book by Dr. David Burns, most notably "Feeling Good Handbook" or "When Panic Attacks!". He was the student of Dr. Aaron Beck, who was one of the primary founders of cognitive behavioral therapy, and therefore his books don't read like the typical self help book. He is basically teaching you how to utilize CBT techniques as a therapist would. He emphasizes that bibliotherapy often needs to be supplemented with a therapist, but studies have suggested that for a great deal of people only a book is needed to dispel a period of depression or extinguish a distressing anxiety.
posted by Defenestrator at 10:14 PM on November 2, 2009

My only concern would be the long detailed permanent record of your emails and their relative security from becoming more public than just between the two of you. But I am a privacy freak and those sort of things cause worry in me. On the one hand you are opening up in relative anonymity, but on the other hand you risk being exposed to a much greater universe.
posted by JohnnyGunn at 10:22 PM on November 2, 2009

I agree with the comments about the limitations of the medium, but even so, I don't see why you shouldn't just try it if it sounds interesting to you (assuming, of course, your problems aren't so severe that your life is in danger or something like that). It's probably neither a wholly bad idea nor a super-awesome idea, but somewhere in between.

Of course, there's always the opportunity cost of not having chosen something else that would have worked better, etc. But I'm assuming you can make that judgment over time and decide to change things if necessary.
posted by dixie flatline at 12:51 AM on November 3, 2009

Yes, this is possible. There has been research recently in Australia that says that this works as well, if not better than, regular face to face therapy. Catalyst did a story on it, transcript here.

How it works:
You sign up for the website, fill in the questionnaires. Then there is a telephone interview to diagnose you properly.

It's for mild depression, anxiety, etc, not for people who are feeling suicidal.

Hope this helps for you, and that you can access it if you aren't in Australia.

CBT has worked well for me to lessen the crippling anxiety. Therapist helped me to see that fear is normal, but how to deal with irrational fear. How to conquer procrastination. Exercise is positive. The best bit is talking through stuff, being able to just dump stuff out because the person doesn't know me personally.
posted by titanium_geek at 1:12 AM on November 3, 2009

In my experience, therapists will be very insistent about seeing you in person. I have an arrangement with mine after 2+ years (and her moving her office out of my town to somewhere I can't to via public transport) to do in-person every other week and phone the other weeks, and e-mail. But what it boils down to is I e-mail stuff periodically, but she doesn't really write back/respond much unless it's urgent. She specifically does not want to do long, drawn-out, extended dialoguing over e-mail.

I really doubt you'll be able to find a therapist who would do e-mail only, and it probably wouldn't be "cheaper" either.
posted by jenfullmoon at 7:33 AM on November 3, 2009

Many workplace-funded "family assistance" programs offer this for short-term counselling. I tried is a few years back and it was .... OK. I didn't feel like I got good advice or that the therapist really "got" what I was asking but I felt the same way when I tried short-term face to face counselling, either.

In the end, we're kind of just using these people as sounding boards to work out our problems on our own. I discovered that a journal accomplishes this just as well for me, minus the awkwardness and frustration of hearing total non-sequitors from the therapist.
posted by Kurichina at 7:59 AM on November 3, 2009

I'm in the "Try it and see how it works for you" camp. If you have a therapist who is highly intuitive, that might be a good fit. For whatever reason, I can often sense what's going on with someone by the tone of their email. I know it sounds odd but as an emotional empath, I can sense what someone is feeling at that time as if it were my own. That kind of therapist (or coach perhaps) might work for you given your limitations at present.

As I've experienced it, therapy (and coaching) has helped me see patterns where I'm stuck and given me a nudge to move forward - they certainly didn't do the work but they helped me place my attention on it so I could.

Good luck and feel free to MeMail me if you have any questions. I give you lots of props for thinking outside the box and finding a fit that works FOR YOU.

Peace
posted by Mysticalchick at 8:11 AM on November 3, 2009

What several said above about the superiority of face to face and of the inportance of the relationship. However, if such relationships make you too anxious, online could be better until you reach the stage where face to face is tolerable.
posted by Obscure Reference at 12:28 PM on November 15, 2009