Could you be an Online Therapist?

Aidan Maloney


The Internet helps to meet all sorts of needs and counselling is no exception. Users 
of the information superhighway through the medium of cyberspace can obtain
 counselling and attend support groups. Currently, counselling services are offered 
by email but they can be offered in real time using chat rooms, or in some cases, 
virtual reality technology. With chat technology, users log on to different chat
rooms and view written dialogue on their monitors. The statements read like 
scripts, with the lines scrolling upward as new conversation is entered by other
 chatters. In the three dimensional world of virtual reality, users possess a body
 (known as an avatar) with written comments appearing in “bubbles” over the 
avatars’ heads.

Types of Online Counselling


The services offered by online therapists fall into two categories:

One Question: therapists who give you an answer to a one-time inquiry. On going: therapists who work with a client in an ongoing series of emails or 
chats.

One-Question

“One-Question” is most often called psychological “advice”. It can be compared to 
an Agony Aunt/Uncle. The client writes to the therapist with a well-defined 
question or problem, and he/she writes back with individualised response or a
 suggested solution to the problem.

Ongoing


Online therapists who offer ongoing interactions are very different from the one-
question “advice” or “information” services. This is about forming a relationship
 with a therapist. 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 will listen and try to help. This 
process doesn’t happen in one email exchange. It takes time, while the therapist 
gets to know the client, and the client has a chance to tell his/her story in some 
depth. This “ongoing” process is closer to what might happen in a therapy session.
 Some people who have worked with online therapists in an ongoing relationship
 say it can be compared to keeping a journal. The client can write at length, and
 explore thoughts and feelings in depth. Of course the difference is someone is
 reading and responding – journals don’t usually talk back!

Like a face-to-face therapist, a therapist who works in this way will work to form 
a “therapeutic alliance” with the client, getting to know the client over time, and
 working with the client on problems, goals and challenges.

Real Life Therapy

In real life, therapy is time-bound. Once a week at a predetermined time, client and 
therapist meet. Even without any explicit statement from the therapist a client has
 a lot of information. The office and how it is decorated offers its own messages as 
well as dress, manner and greeting. These stir up any number of unconscious 
feelings, both positive and negative.

Psychotherapy in person is based on many factors, including facial expressions,
 body posturing, vocal inflection and, importantly, the relationship between 
therapist and client.

“I observe clients’ physical responses, as unspoken signals to their internal life. For 
example, a client walks into the office looking dejected, sits down with a weary 
sigh and proceeds to tell me about the previous wonderful week. Another client
 may use loud, rapid and pressured speech, yet claim to be calm. These clients’ 
affects and words are not congruent. I can see clients in front of me struggle with
 dawning insight, try to hide barely contained rage or make a valiant effort to put
 words to unknown feelings. In real life, clients sometimes change the topic in an 
attempt to ward off uncomfortable feelings. The physical body gives itself away in 
subtle but unmistakable ways.”


Online Psychodynamics


The biggest challenges facing a therapist working online are the lack of both face-
to-face contact and the non-verbal cues on which one ordinarily relies in an
 analogue setting. In a face-to-face communication a counsellor pays attention to 
verbal and physical language, tone, inflection and silences. All of these things are
 absent in a text-based environment in which the written word conveys the message.
”When I am talking to a person in a room, the client can see that I am listening and
 can be encouraged to continue speaking with a mere look or a gesture on my part.
 In the absence of visual cues, how am I to interpret silences when everything is 
silent? I am perceived as absent unless I post something.”¹

It can be more difficult to read sexuality, culture and race from writing style 
compared to face to face communication.

It is quite clear that it is possible to form deep and meaningful relationships even 
on the basis of text-based correspondence, and these relationships can be
 constructive; otherwise why would we write letters, read novels or poetry? On the 
basis of written words, people fall in love even on the Internet.

In some respects, the psychodynamics of therapeutic interaction have been 
enhanced by the realm of cyberspace. For example, transference and 
countertransference are important aspects of psychotherapeutic work in face to
 face interaction and online therapists suggest that they may be even amplified 
online.

“It was easy for members to idealise me or project their fantasies and wishes onto 
me. Because I am unseen and “mysterious,” anger and frustration were taken out
 on me more readily. Conversely, my idealisation of and projection onto clients
 could be difficult as well. Because I often didn’t know what group members looked 
like, it became easy to accept the person as they created as the group continued.”
 Let’s say that online shadows are longer!

In addition to this some therapists offer what I consider a strange argument that
 reduction of information is in some way conducive to better therapy:

“E-mail counselling allows both the therapist and the client to process actual 
communication more clearly, because there seems to be a relaxing of defence
 mechanisms within this medium. In addition, the information to be processed or 
filtered is greatly reduced…there is no need to process body language, voice
 quality, facial expressions, etc. There is time to digest the message to allow only
 the words to process and reprocess. The resulting effect is like the old adage of 
”sleeping on it” before responding. The focus is more easily centred on the content 
of the communication…on the real “soul” issues needing to be addressed. I have
 experienced online counselling as surprisingly more dynamic and intense…both 
emotionally and intellectually…because all systems are directed to only one source 
of stimuli, which is the written words on the computer screen.”²

Online Therapist ³

The average online counsellor is a 48 year old male (75% were male) and a 
psychologist with 15 years of traditional clinical practice experience. He has been 
in online practice for almost 2 years and calls his service “advice giving”. When 
you visit his website, you’ll find that he uses some sort of encryption software to 
protect your anonymity. In order to reduce fraud and exploitation, in 50% of cases, 
his credentials have been authenticated independently. The composite counsellor
 thinks the availability of online counselling services increases clients’ access to
 counselling professionals, especially clients living in remote areas or suffering
 from disabilities. This profile is changing rapidly because the Internet is becoming
 much more gender balanced.

Online Clients

The average client wants assistance with his/her relationship problems. Based on 
the close ratio of men to women receiving online services (two to three), it would
 seem that men are indeed more likely to seek counselling services on the Internet
 than in face to face settings. The perceived anonymity of cyberspace may permit
 people to engage in freer dialogue about problems and feelings. Online services 
also have the advantage, especially in email, of being quick. Some people may find
 the speed more appealing and the lack of communication intimacy less threatening 
than traditional encounters. Depression ranked high among online client’s
 problems, with over half the respondents reporting depression as a primary
 concern.

Online Services

Many of the online practices are listed at Metanoia (4). Apart from general
 counselling services there are a number of specialised counselling services online. 
Sexual abuse issues, sexual problems, relationship issues, alcohol and other drug 
abuse recovery services, pastoral counselling, eating disorders, and gay/lesbian
 issues all have specialised sites. Caveats at online clinics often prohibit the discussion of suicide with a cybertherapist. Instead, they give instructions how to
 get help elsewhere. There is however, at least one site expressly designed for the 
suicidal client. The title of the service is The Samaritans <jo@samaritans.org>.
 Located in England, all the trained volunteer counsellors use the name “Jo” and
 communicate with clients via email, telephone, or “snail mail”. Response to first
 contact is usually within 36 hours. In just a two year period the number of online
 practitioners almost doubled. The average number of clients per therapist over the
 time period was 72, and 103, respectively. The most contacts reported for any one
 client was 9, the most frequently occurring number was 6 contacts, and the average
 number of contacts per client was 3. The directory at Metanoia contains fee 
information, costs of $65 for a 50 minute private chat session and $20 for a group 
chat session. The average fee ranges from $10 – $20 for an email response with the
 provider spending about fifteen minutes preparing it. Some provide free services.
 However a client if using a fee paying service should never send credit card or 
checking account information over the Internet using e-mail or an unsecured form 
on a website. The information should only be sent by means of:

secure form (the browser (5) will tell if it’s secure), or
 telephone (make sure the number belongs to the therapist), or
 fax (make sure the number belongs to the therapist).


No Soft Touch

Touch is one form of therapy, the oldest form, which Internet technology is not yet 
able to approximate.

“The physician must be experienced in many things, and among others, in friction. 
Friction can bind a joint that is too loose and loosen a joint that is too rigid.”(6)

To the extent that any therapist uses touch, from minimal handshake to hugs, to
 Reiki, to massage, as part of the therapy session then the cyber session fails to 
replicate the live session. So massage and touch therapists can either feel reassured
 that their services are not endangered or feel neglected that technology has
 overlooked them.

Is it Therapy?


Although face to face contact is currently the most popular mode of therapy, it isn’t 
the only one. All forms of communication have been, or are currently, used for
 counselling services. Freud used “snail mail” to conduct some of his classic
 diagnosis and treatment. Many claim to be helped by writing to advice columns.
 Phone-in radio and television shows feature counsellors and counselling services.
 Telephone therapy is used on crisis lines.


Online counselling might help if the client is:
 Able to type and has access to a computer; 
comfortable using the Internet;
 enjoys writing and; writes expressively providing the therapist with honest and 
descriptive feedback about feelings and reactions in the moment.


In addition a client may have one or more of the following reasons:


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


However what is being offered cannot yet be considered as therapy although it may
be therapeutic.

“Am I doing psychotherapy or am I just giving directions or advice? In most cases,
 unless you can get a history, come to a diagnosis and really work with a person face 
to face, you’re just giving advice.”

But it would be a very brave counsellor who says that it never will be therapy.

The Future


One technology just getting its start, is called CU-SeeMe. With the appropriate 
camera equipment and software, real time, audio-visual communications can take 
place between up to six persons simultaneously. The technology permits split-
screen images and conference calls. This technology will soon enable live visual
 and voice communications between increasing numbers of clients and counsellors.
 Of course what I have been discussing up till now involves real live humans online.
 There is an apocryphal story about a professor at an American University who
 wrote a programme to demonstrate computer human interaction. The structure of 
the programme was quite simple it used an algorithm to rephrase the statements the
 client made in the form of a question. For example the client says:


”I am feeling depressed”
 and the programme responds:
 “So you are feeling depressed?”


The professor was quite amazed to learn that students were queuing up to use the 
programme on the University computer network. He was even more stunned to
 find out his own secretary who knew it was an algorithm was logging on to the 
programme in her spare time for consultations.

The computer is a prosthetic phenomenon, and when computer (or other forms of 
cyber) counselling are critiqued the arguments for and against them invariably 
revolve around the problem of prosthesis. (7) “Counselling in person” is natural, 
because it requires direct physical presence. Computer or cyber counselling is
 prosthetic, and reflects a technological compensation for a lack. Online counselling
 is either “bad”, because it is less than real, impoverished, or else, online
 counselling is “good” providing, a substitute for those who cannot manage “offline
 counselling” for whatever reason. We could bypass this dichotomy by adopting the 
concept of assemblage proposed by Deleuze and Guttan (8). An assemblage involves
 various kinds of matter, metal, silicon, human beings etc. each acting as 
components according to their ability to form alliances and make connections with 
each other’s particular qualities. Instead of inquiring about the human beings at the 
end of a technology, we should ask instead about the cyborg state bearing in mind 
psychoanalyst Jacques Lacan’s comment that a machine:

“isn’t a simple artifact, as could be said of chairs, tables and of other more or less 
symbolic objects, among which we live without realising that they make for our own portrait. Machines are something else. They go much further in the direction
 of what we are in reality, further even than the people who build them 
suspect….The machine embodies the most radical symbolic activity of man. (9).

Therefore the proper online counselling inquiry is; “Are you pent up today ? or
 “Hi Mac!”

References:


1 Uecker, E., Psychodynamic considerations of online counselling’. Perspectives:
 A Mental Health Magazine. [online serial]. Available: 
http://www.cmhc.com/perspectives/articles/art01971.htm [1997, January 15].

2 Yvette Colun, ACSW Chatter(Er)Ing through the fingertips: Doing Group
 Therapy Online (yvette@echonyc.com)

3 Powell, Terri, Online Counselling: A Profile and Descriptive Analysis, University
 of Kentucky, May 3, 1998

4 http://www.metanoia.org/imhs/

5. Software used to navigate the World Wide Web, a browser allows you to access
 hypertext files and/or web pages.

6 Hippocrates; On Articulations.


7 Boon, Marcus, ‘Phone Sex Is Cool: Chat Lines as Superconductors.’ Women &
 Performance: A Journal Of Feminist Theory, Sexuality & Cyberspace Issue (#17)
http://www.echonyc.com

8 Deleuze, Gilles & Guattari, Felix. 1987. A Thousand Plateaus, trans. Brian
 Massumi. Minneapolis: University of Minnesota Press.

9 Lacan, Jacques. 1988. Seminar: Freud’s Papers on Technique, 1953-4. New
York: Norton.