ABCs of Internet Mental Health Services

What is e-therapy?


THE ISSUES: What you need to know about e-therapy




Copyright 1995-2001 Martha Ainsworth. All rights reserved.


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Types of Online Counseling Services

  • E-Therapy: therapists work with you in ongoing relationship
  • Advice: therapists respond in-depth to a one-time inquiry
  • Private Practices: Independent sites, where one or a few therapists offer services; personalized and highly individual
  • E-Clinics: Large group practice sites, where many therapists offer services; less individualized but good security

What do you get when you interact with a therapist online? You may get a "Dear Abby" type response to one question; or you may be invited to have an ongoing series of private online conversations. It's important to know.

E-Therapy vs. Mental Health Advice

E-therapy is a term that has been coined to describe the process of interacting with a therapist online in an ongoing series of conversations over time. E-therapists are very different from one-question "advice" or "information" services. E-therapy is about forming a relationship with someone who is trained to help. It can cover anything from simple befriending, to a much more intense and directed way of interacting. It means deciding to explore deep thoughts and feelings, and share them with someone who cares and who will listen and try to help. This process doesnt happen in one e-mail exchange. It takes time, while the therapist gets to know you, and you have a chance to tell your story in some depth. This e-therapy process is closer to what might happen if you met with a psychotherapist in an office.

Some people who have tried e-therapy say its a little like keeping a journal. You can write at length, and explore your thoughts and feelings in depth. Of course the difference is that a trained professional is reading and responding to you - most journals dont talk back!

Like a face-to-face therapist, an e-therapist will work to form a "therapeutic alliance" with you, getting to know you over time, and working with you on the problems, goals and challenges you define.

  E-therapists might be able to help you if...
  • you are comfortable using the Internet;
  • you like to write;
  • you are willing to be honest with yourself and the therapist;
  • you are willing and eager to enter into a process of growth and change, and take responsibility for participating in the process.
  E-therapists probably cannot help you if...
  • you are not comfortable using the Internet;
  • you dont like to write (unless you use video or Internet phone);
  • you conceal important information from the therapist;
  • you are not willing to fully embrace the process of growth and change.

[See also Page 6: Who Should Not Use E-Therapy]

You might write to an e-therapist if you would like to work on resolving a more complex life problem but:

  • you are reluctant or afraid, for one reason or another, to see a therapist in an office, or
  • you have financial barriers to getting help, or
  • you live in a remote area where a therapist is not available, or
  • you are prevented, for whatever reason, from getting to a therapists office.

Its not as good as face-to-face therapy, but you can find some help by working with a psychotherapist on the Internet. If you cannot see a face-to-face therapist, you might choose e-therapy if:

  • you have a more complex problem than a single e-mail can solve;
  • you want to do more in-depth self-exploration.

If you are suicidal or in crisis, read this page now.

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Mental Health Advice

Sites which offer psychological "advice" can be compared to a psychological Ann Landers: you write to the therapist with a well-defined question or problem, and he/she writes back to you with "individualized information" or a suggested solution to your problem. These services could be characterized as "education" about psychology and mental health... or an Internet Frasier Crane Show.

  Advice services might be able to help you if...

  • you can clearly explain the whole issue in a few paragraphs;
  • your problem can be addressed with concrete advice or specific information.


  Advice services probably cannot help you if...
  • you are not sure exactly what the problem is;
  • your problems are complex;
  • your problems have persisted for a long time;
  • your problems are causing you great distress.
If you have a clearly-defined problem in your life which is troubling or vexing but not overwhelming, the "Advice" services can be helpful. If you write to them, be sure to describe your situation as thoroughly as you can, including background information about yourself, your life and relationships, which will enable the therapist to respond more appropriately. The therapist may sense deeper underlying issues, and recommend consultation with a face-to-face therapist. If thats the advice you get, please, strongly consider following it if at all possible.

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Private Practices vs. Large Clinics

Since 1995, most e-therapists have been individual private practitioners. The phenomenal growth of the Internet in general, and the e-therapy industry in particular, led to the appearance of large "dot-com" e-therapy sites where many therapists are available. These large e-therapy Clinics all have several characteristics:

  • They use state-of-the-art online security to protect the confidentiality of communication between you and your therapist
  • They have robust e-commerce setups for billing, such as you might see on e-shopping websites
  • All therapists on the site have had their professional credentials thoroughly screened by the e-clinic

The leading e-clinics have literally hundreds of therapists available from which you can choose.

The advantage to consumers is obvious: it's about safety. You can be assured of the best in online privacy, and you can be assured that the therapist you talk to has been screened to guarantee that he/she has adequate professional credentials. And with many therapists available on one site, they may offer one-stop shopping.

A disadvantage of the large e-clinics is that it's a little harder for you to differentiate between therapists. All the therapists' pages are similar, according to a site-wide template; this may make it harder for you to get a feel for the therapist's personal style, before you start working with them. In some cases it's like trying to pick a therapist from a stack of rsums. And web messaging, while more secure, is not quite so convenient to use. But if guaranteed safety is important to you, e-clinics are a good choice.

It is worth noting that some private practitioners also offer excellent levels of security and privacy, good e-commerce setups for payment, and have had their credentials screened by a third party.

Next: How does e-therapy work?>>

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