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An Explanation of Online Counseling by Judith L. Allen, Ph.D.

"eTherapy" is a term coined by Dr. John Grohol to identify mental health counseling services provided over the internet. eTherapy can vary between a few brief consultations emails about a specific issue, to more extensive work to change patterns of behavior or thinking. The practice of eTherapy is now more than 10 years old, but it has gained increased visibility and wider acceptance since 1997, as the internet became a more familiar tool to search for needed services and products.

Today, hundreds of therapists, operating from individual and group websites offer email support to their clients, as well as Chats (asynchronous real time typing to one another), video conferencing, using a camera to augment the typing and/or voice chat. Telephone consultations, once highly questioned, are common practice now. eTherapy has been increasingly accepted as the newest addition to the forms of therapeutic communication used by clients and counselors.

eTherapy From the Consumers' Perspective
eTherapy is useful for people who may not otherwise want to make an appointment for face-to-face therapy in an office. There are many reasons for this, including: difficulty in scheduling the time, stigma attached to going to an office of a therapist, shyness, no local treatment available in the area, travel, privacy, convenience and usually lower costs. eTherapy can be used for brief concerns, and even for long-term ongoing therapy and support. The same issues and concerns can be address in writing as they can face-to-face in an office. It's another medium for people to communicate, and after getting accustomed to typing, it feels quite normal to *talk* to your therapist freely.

Many people who use eTherapy are first time users of counseling services, and have never been to traditional therapy. It is their first attempt at getting help from a professional. Others, who have had both office and online therapy experience relate that it is virtually the same, in the work they are able to accomplish, and that they recognize the advantages of convenience and cost savings. There is some concern that someone might see an email, but most internet companies have protections set up that are as safe as the most secure email program sites. The greatest danger of having your email read, is on your own home computer, by another family member. Free, alternate email sites can be used for this.

eTherapy has gained popularity because it has been primarily consumer-driven. Consumers have been overwhelming positive about the benefits they have received. There are many aspects of online eTherapy that make it attractive to consumers. The costs are generally much lower and there is no wait for an appointment. They find that therapy fits into their schedule when it can be at any time of the day or night. Consumers who travel in their work, have found online eTherapy to provide them with a "portable" therapist. When away from home, isolated in a new city, the same therapist can be contacted, and therapy can continue uninterrupted. Whenever advice or guidance is needed, the therapist is as close as the computer. It can be comforting to have someone who knows your history to be available in times of increased stress.

eTherapy From the Therapist's Perspective
For many therapists, the internet is a convenient way to keep in contact with clients. eMail can be answered at scheduled times, between clients in the office, at night at home, or when they are out of town. It allows the therapist time to think more quietly, and to be more focused about their response to a problem. The internet provides resources to share about any issue, by easily attaching the resource material, or by sharing site links for the client to visit. Finding resource materials once took hours of research through books in the office or library. Now this can be accomplished in a matter of minutes. There is a record of every word exchanged for the files. Costs of doing business can be kept at a minimum by using the computer to conduct therapy sessions. This enables a therapist to charge lower fees, and to avoid hours of paperwork generally demanded by managed care and insurance companies.

Early Unfounded Fears of Online Counseling
In the first years of the practice of eTherapy there were many fears which came with the unfamiliar territory. Some professionals had difficulty understanding how therapy could be conducted without the aid of "visual cues" and auditory clues. There are still questions by those who have not integrated the medium into their practice, questioning whether the therapy is as effective, and if there might be unchecked abuse situations. To date, the fears have been more about the fear of change, than actual problems to be addressed. By consumer and therapist reports, eTherapy is filling a need successfully. Sigmund Freud used letters to augment and continue therapy with his patients who were at a distance, so it's not really a new concept.

Large Corporate Ventures See Potential Opportunity
Several large corporations began to predict how popular eTherapy might become, and invested large sums of money in sophisticated technology and personnel to get into the business of therapy. After great expenditures, they soon discovered that online counseling was provided at such low rates, that there was not enough profit to recover their investments, and they folded. A few large groups have fared well, but they are generally those owned and operated by therapists who are involved in the counseling work, or smaller groups such as TheCounselors.com and NetCounselors.com. They provide responsive help at low fees to the consumers. For more on the history of eTherapy, read Martha Ainsworth's History of eTherapy.



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