Online Consultation

Since offering personal help on the internet is a relatively new development, there is much controversy about it.  Before you decide whether or not this is for you, consider the following pro's and con's.

The Pro's

Online consultation can be a good thing, since it allows more people to have access to professional help.  This is especially true if you live in a rural area, where there aren't many (any?) professionals to consult or in a place where there aren't any professionals who specialize in your particular problem. Online therapy may be better than no therapy at all.  

Online consultations can protect your privacy. If you live in a small town, you may be concerned about gossip, should anyone see you enter a therapy office or ask where you have been for the past hour. In a small town, you also may be concerned that your therapist may turn out to be your child's Girl Scout den mother or someone you are likely to bump into in the supermarket.  When you interact with a helper online, no one has to know.

Even if you live in a big city, you may find it easier to "talk" to someone about something very personal or embarrassing, if you don't have to see that person face-to-face.  You may find it easier to "open up." Communicating online allows you some degree of anonymity, without which you might not seek help at all. And, who knows, maybe after a while, you'll feel courageous enough to switch from online therapy to face-to-face therapy.

If you are physically ill, have no transportation or if being unable to leave your house IS your problem, online consultation might be just the thing for you.

Online consulting may be less expensive than face-to-face appointments.

You can "save" your online therapy "sessions" and view them or read them over and over at your leisure.

Writing--especially writing emails that you can mull over and edit--may help clarify your feelings and thoughts. Writing may help you think through your problem--and maybe some solutions.

Finally, online consulting may be easier to fit into your busy schedule: You retrieve your personally-designed e-mail consultation at your own convenience, even if that means ten o'clock on a Sunday night. You may engage in a real-time consultation without having to get dressed and drive somewhere.

The Con's

Online consultation that involves only written communication gives only a partial picture of who you are. Although you may "tell all" in your written communications, there is still much that is left out since the consultant cannot see you or hear you.  (If you've ever had a pen pal whom you only knew through the mail for a long time, remember how different the person seemed from what you expected, when you finally met, face-to-face!) Without seeing your facial expressions, your body language and your overall appearance, and without hearing the tone of your voice, the speed of your words and the way you talk, the consultant is lacking a lot of information about you. This "non-verbal communication" conveys  as much, if not more, than the words you speak or write.  With only incomplete information, the online consultant may not be able to help you as well as he might if the consultations were face-to-face.

The anonymity of online consulting can work against you too. How can you be sure that the person you are consulting is really who he says he is?  (Click on Credentials to find out about who I am.)  And that works both ways: How can a therapist be sure that you are who you say you are? How can a therapist be sure that the person typing the e-mails or chat room responses is the same person as the one sending in proof of identity?

You also might worry about how private your e-mails or chat room communications are. Do you want to use an encryption code for online consultations?  Are you concerned about hackers? Can anyone else besides yourself access your e-mail, chats, facetime sessions or otherwise get into your computer?  If you are using a computer at your place of employment, realize that your employer has the right to read anything you send out or receive on that machine. If you are using the family computer, can other family members deliberately or accidently access your communications with your online therapist? 

Distance can be a problem too.  If you are having urges to hurt yourself or someone else, there is not much an online consultant can do from five hundred miles away. You must have someone local to call on in case of such serious emergencies.

Some therapists believe that it is the relationship between them and their clients that is the "active ingredient" in helping, moreso than any techniques, information or treatment done "to" the person. It may be harder (some say "impossible") to develop a real relationship with someone you interact with only through a computer.

If you live in a different state from your online therapist, it's unclear "where" the therapy is taking place. Psychologists (and other mental health professionals) are licensed on the state level and are not supposed to practice outside their own state. If you want to register an ethical or legal complaint against a therapist from another state, you may run into problems: Which state do you approach? Yours? Or the therapist's? What if you leave your state, temporarily or permanently, and your therapist stays in that state? Or vice versa: What if your therapist goes on vacation out of state, and you're still in that state? It gets complicated!

And finally, online therapy may or may not be covered by your insurance.  You may have to pay out of your own pocket. (HMSA does have an online therapy component for therapists who have undergone specific training on how to use it. I'm not sure about other insurance companies that serve Hawaii.)

To learn more about the pro's and con's of online consultation, check out the websites listed on my More Links page under "Online Consultation."

You may also ask me for a copy of an article I wrote for Health.Medscape.com in December of 2001: "Does the 'Virtual' Couch (eTherapy) Actually Help?" (Of course, that was then, and this is now!)

Kapolei Counseling & Online Consultations

For these and other reasons, I do not participate in online consultations at this time, nor have I undergone HMSA's special training to conduct online sessions for their members.

Nada Mangialetti, Ph.D.

DrNada@KapoleiCounseling.com

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