On the Virtual Couch

By Anita Hamilton

When Beth Steele's 18-month-old daughter Megan got expelled from day care for ignoring teachers and fighting with other kids, Steele knew it was time to see a professional. But while Megan soon got help from a child psychiatrist, Steele, a single mom and owner of a dog-grooming business in Houston, found the therapists she saw to deal with her own stress either insincere or judgmental. When a friend suggested online therapy, Steele decided to give it a try. Now, each Tuesday night, she logs on to the website concernedcounseling.com for a 50-min. session in a private chat room, typing messages back and forth with a therapist she has never met in person. "He makes himself human," she says, "and he makes me feel human."

Huh? How could the computer screen's cold glare ever replace a therapist's caring gaze? It may be hard to imagine, but for a growing number of people dissatisfied with traditional talk therapy, the convenience and anonymity of the Internet beat $100 sessions on the couch hands down. After all, if people are willing to bare their innermost feelings to a newfound love online, why not discuss deep-seated anxieties that way as well? Some 150 counselors listed on the website metanoia.org/imhs offer online therapy by videoconferencing, e-mail or live chat. Skeptics say the lack of nonverbal cues makes online therapy not only ineffective but unethical and possibly illegal. But two UCLA professors, Marion Jacobs and Andrew Christiansen, plan to publish a study in the journal Professional Psychology this fall showing that at least one kind of computerized counseling may actually work.

Converts find anonymity to be online therapy's greatest selling point. Too embarrassed, ashamed or self-conscious to look a therapist in the eye, some find typing onscreen as direct and honest as writing in a journal. "I've never been good at expressing myself face to face," says Steele, 36, who says she feels less inhibited when typing onscreen. Elizabeth, 27, a graduate student in Southern California who has hidden her eating disorders from her family for more than 14 years, says online therapy helps her think less about her weight and more about the feelings that cause her to binge several times a week. "Right now I feel like I weigh 600 lbs., so seeing someone in person would make me really uncomfortable," she says. "I feel much safer this way."

Convenience and cost are a big part of the appeal. Online therapists charge $60 to $90, less than most in-person therapists. For people in rural areas, those who are housebound and even busy professionals, the ability to go online anytime, anywhere can make the difference between seeking help and not. The ultimate time saver, masteringstress.com doesn't even use a live therapist; it charges $30 for a series of 30-min. online questionnaires aimed at identifying and helping people cope with everything from depression to relationship problems. Nancy, executive producer of a daily cable-TV show in Los Angeles, takes the sessions during long coffee breaks to help her deal with job stress. UCLA's Jacobs and Christiansen studied this program and, surprisingly, found that it helped people nearly as much as sessions with live therapists. "It takes people systematically through problems and helps them organize their thinking," says Jacobs.

Not everyone agrees. "There is no such thing as online therapy," says Dr. Thomas Nagy, a psychologist, Stanford professor and author of two books on ethics. "They're missing the nonverbal clues." For example, someone could claim to feel great but look disheveled and despondent in person. In an extreme case, notes Russ Newman, executive director of the American Psychological Association, a person could be talking to the online therapist while pointing a gun at his head; a dismissive comment from the therapist might just prompt the person to pull the trigger.

Therapists who counsel people online may be playing Russian roulette with their licenses and insurance. Most mental-health professionals are licensed only by the state in which they practice; counseling an online patient who resides elsewhere might be construed as practicing without a license. And while malpractice-insurance providers don't specifically ban online therapy, their coverage is contingent on adherence to state licensing laws.

Yet even these uncertainties haven't dissuaded the online therapists. "You take risks sometimes when you do this kind of work," says Jeanne Rust, who runs the eating-disorder website edrecovery.com "I decided to do that, because some of these people would never get into therapy if I didn't help them."