08/14/97 - 01:15 AM ET
The Princeton, N.J., Internet consultant often travels on business but never loses touch with her therapist because the sessions are conducted in a place where miles don't matter - cyberspace.
Ainsworth is one of a rapidly growing cadre of new therapy clients counseled on line. The sudden explosion of cyberspace therapy is a flash-point trend sparking concern at the American Psychological Association (APA) meeting here.
Experts agree the practice is spreading so quickly that nobody can keep accurate tabs on it. When Ainsworth went looking for a therapist on line a year ago, she found six; now there are about 65 counseling sites, some offering choices of many therapists, her Net searches show.
Most sessions are done by e-mail, though some counselors offer interactive chats. Fees range from a few charging nothing to up to $90 for a 30-minute chat.
But is it therapy?
Definitely not, argues clinical psychologist Leonard Holmes, who does one to three "consultations" a week by e-mail. Holmes tells clients in advance that the genre is not suitable for complex problems. "You can't diagnose and treat disorders by computer contact. Too many powerful nonverbal cues are missing," he says. When clients wince, blush, avoid eye contact, suddenly take a deep breath, hesitate, weep or evince revealing tones of voice, none of that shows up on the computer screen.
He thinks Net sessions can work "if they're problem and solution-focused, for something fairly simple."
Common relationship complaints often can be handled on line, Holmes finds.
For example, he's counseled single people who tend to flee relationships after the initial romantic stage wanes. The first e-mail may depict a client's concern about this troubling pattern, his feelings before leaving and how he creates scenarios to justify breakups. Holmes will ask specific questions about childhood experiences that might prime someone to behave this way or past adult relationships that could stoke distrust. He also may suggest behavioral techniques for coping with self-destructive urges as they arise.
Clients often gain new insights after one or two e-mails. He advises in-person therapy for durable, serious problems. "What we do is similar to the work of radio therapists, but this is more private."
In fact, call-in shows may afford more privacy. E-mail is not secure. New technology allows psychologists to make it harder for aspiring hackers to eavesdrop on therapy, but nothing is foolproof, and many therapists on line don't have the protective software.
Some of them don't even have a license to practice therapy. In a survey conducted by California psychologists Barry Gordon and Marlene Maheu, about 1 out of 5 who chose to respond to an on-line poll admitted they weren't licensed; the true number could be much higher, Gordon says.
And ethical concerns abound. In-person therapists are legally liable if they don't report someone who appears poised to threaten the life of another; are Net counselors bound by the same laws? Also, therapists are licensed to practice only in their own state, so how can they treat clients across state lines?
In the rule-free, Wild West milieu of cybertherapy, nobody knows the answer to these key ethical and legal questions, Gordon says.
There's no evidence so far anyone has been seriously harmed. Still, therapists were appalled at one recent on-line interaction touted at the Web site as a good example of problems that can be tackled on the Net: A worried teen-ager was nervous about her budding attraction to other girls; the therapist advised spending more time with boys, and the "problem" would solve itself.
Even seemingly benign advice can cause trouble if offered generically and cloaked in professional authority. Stanford psychologist Thomas Nagy says he surfed into a well-regarded Web site that offers advice on how to cope with depression. One of the suggestions: Play with a child. "Pedophiles often have symptoms of depression, so that stopped me cold," Nagy says.
An APA task force recently issued a report on the many ethical and legal questions raised by the growth of Net therapy. New guidelines for psychologists may be in the offing soon, says Russ Newman, a lawyer and psychologist who directs the group's professional practice wing.
The report lauds on line's potential for reaching "underserved" people, such as the elderly, handicapped and rural citizens. Ainsworth thinks the medium is a natural for frequent travelers, and for those too busy or timid to get therapy in person.
The quality of video available by computer will improve greatly in the next few years, adding visual cues that will make therapy on line far more effective, says psychologist Marlene Maheu. She's among those who think Net counseling is sure to grow.
"Ultimately, this is going to be a cheaper way of doing therapy," she predicts. "Managed care will want it, it's going to be market-driven."
By Marilyn Elian, USA TODAY
