Video Capabilities

One of the newest players is LetsTalkCoun-seling (http://www.letstalkcounseling.com), which employs secure, Web-facilitated video links between therapists and clients. The company essentially connects independent therapists it lists (currently more than 340) with interested clients, and leaves them alone. Founder Arthur F. Cooksey III says that his firm has no interest in managing payment transactions, leaving them to therapists and clients to work out.

Michael Simpson, PhD, a psychologist who works in a five-psychologist private practice in Sunrise, Florida, is providing treatment online to two clients via LetsTalkCounseling. Dr. Simpson had long-term therapist-client relationships with the clients before they moved out of state. “My experience has been excellent,” he says, “and I like the fact that with the video technology they offer, it's very real time. Also, the issue of being HIPAA-compliant was a major factor in why I went with LetsTalkCounseling. It's secure.”

So secure, in fact, that Cooksey notes that the company's services run at an encryption level “four times more powerful than the Department of Defense's standard” (The parent company, Let's Talk Interactive, Inc., is a vendor to the department, among other organizations).

Text-Based Services

MyTherapyNet (http://www.mytherapynet.com) operates quite differently. The company logs hundreds of sessions a day using Internet messaging (IM) as the primary online chat modality. “We have introduced videoconferencing, but not only did most not want to do it, some had technical problems,” cofounder Greg Palumbo explains. “The technology hasn't quite caught up to people yet.” Live audio is available, but Palumbo says that “The majority of clients really gravitate to [our service] because of the written word.”

Cofounder Kathleene Derrig-Palumbo, PhD, adds that “When I first started this company, I really wanted to reach a greater number of people who either wouldn't go to therapy, because they wouldn't have access to it, or who were fearful of it. Because when we look at the number of people in this country who have disorders and issues, and the number who actually go—they're just not going. So I started to think about reaching those people through the Internet.”

MyTherapyNet verifies therapists' licensure and requires that current licensure be documented and kept up-to-date. The company conducts background checks on all therapists.

Group Therapy Online

Having been around for several years, eGetgoing (http://www.egetgoing.com) uses Web technology to provide online group counseling for chemical dependency and addictions issues. Unlike other online services, eGetgoing works with clients who already have been assessed in person and referred to eGetgoing for treatment. “We also do our own internal assessment” of clients, notes Cynthia Reinbach, MS, the company's vice-president of clinical services and operations.

Clients using eGetgoing commit to 24 60-minute sessions (twice a week for 12 weeks) led by a therapist-moderator. Participants can hear each others' voices and use a headphone/microphone setup to talk to the group, but they see only the moderator, who is able to shut off individuals' contributions if they become disruptive.

Reinbach reports that a SAMHSA-funded study found that 85% of clients have freedom from addiction one year after online group treatment. The company also is launching a five-year study to track the results of patient treatment and measure treatment efficacy.

Some Concerns

Entrepreneurs say their services will attract individuals who either are too distant from mainstream mental health services or who might not otherwise seek them out, such as high-profile celebrities and business executives, people with agoraphobia, and those with highly stigmatized problems like postpartum depression. Yet some experts question the logic of this thinking and have concerns about online therapy in general, although no one seems to completely rule out its possible efficacy.

Linda Rosenberg, MSW, CSW, president and CEO of the National Council for Community Behavioral Healthcare, notes that “The Internet is bringing us a whole new world of communicating, marketing, and interacting. And it's natural that it would also affect therapy. But I hope that people are being careful, that they're ‘seeing’ highly trained, reputable people, and are not being exploited in any way.”

Rosenberg also isn't sure if online therapy will really help those its proponents say it will. For example, “Successful agoraphobia treatment may require some medication, but it also requires successive desensitization training, and that poses a problem” when the therapist and client can't interact in person, she explains. In addition, Rosenberg stresses the importance of having local resources in place on the ground for individuals who might have a crisis or become suicidal, for example.

Russ Newman, PhD, JD, executive director for professional practice at the American Psychological Association, shares Rosenberg's concerns. He adds that client assessments are at issue, as well. “There are ways that you can collect a meaningful assessment online,” Dr. Newman says. “But a survey published in the Journal of Counseling and Development found that a good percentage of people providing therapy and counseling online weren't collecting the necessary information that would enable them to get the person emergency help.” Other issues Dr. Newman raises include licensure issues for professionals treating clients across state lines, and that there is really no substitute for certain aspects of face-to-face treatment, such as detecting subtle body language or even overt characteristics like alcohol on the breath.

Positive Research

D'Arcy Reynolds, MA, a PhD candidate in clinical psychology at Miami University (Ohio), has found positive results for online therapy. Reynolds studied the interactions and treatment experiences of therapists and clients based on their impressions of e-mail–based treatment. Based on preliminary findings (to be published in the journal Counselling and Psychotherapy Research later this year), Reynolds reports that, “On average, both therapists and their clients are evaluating the quality of their online sessions as higher” than average ratings in the literature for face-to-face sessions. He found similarly high scores from clients on the depth of sessions and on confidence in their therapists. “This way of doing therapy, using the Internet, is at the very least promising, because it's showing that people can establish relationships that are therapeutic, and that they experience these relationships in similar ways to face-to-face therapists and clients,” Reynolds says.

Final Thoughts

Only time will tell whether the promises of online therapy are realized for both clients and therapists. Industry experts continue to caution that those who would provide online therapy need to put in place all the safeguards and resources that face-to-face therapy should have. But, everyone agrees, something new is happening. And online therapy will be of great interest to behavioral healthcare professionals and consumers alike as it evolves in the coming months and years.