More threads by David Baxter PhD

David Baxter PhD

Late Founder
7 Things To Know Before Logging on for Counseling
By Lindsay Lyon, US News
September 22, 2009

Websites offering counseling are springing up, but ask some questions before signing on

Therapy from afar. While the very notion of it makes some queasy, a growing number of people are seeking?and providing?mental-health help through nontraditional means, such as by telephone or videoconferencing or via E-mail or online chat. E-therapy petered out somewhat after the dot-com bubble burst, when several online "clinics" went bankrupt, but there's been a resurgence as technology has advanced, says John Grohol, a psychologist and founder of

Online counseling holds tremendous promise, advocates say, because it bulldozes the barriers that bar people from face-to-face treatment, such as disability, distance, or hectic schedules. The anonymity also is alluring. But even staunch proponents of telemental health say that tapping into online therapy through E-mail and instant messaging requires caution. It may take just a few keystrokes to find a individual practitioner's website or sites that feature a menu of professionals, but there are several things you should consider before clicking "Pay." "It's really buyer beware," warns Patricia Recupero, a clinical professor of psychiatry at Brown University who chairs the American Psychiatric Association's Council on Psychiatry and Law. Here are seven areas to consider:

1. Licensing.
Online counseling websites may advertise chat sessions with a "licensed professional." Sounds great, but what does it mean? "Normally, psychologists are required by law to be licensed in the states in which they practice," says Roberta Nutt, director of professional affairs for the Association of State and Provincial Psychology Boards, to which all the psychology licensing boards in the United States and Canada belong. In this context, that means the state where the patient resides, says Marlene Maheu, a California-based clinical psychologist and executive director of the Center for Online Counseling and Therapy, a professional training program for therapists wanting to use technology in their practices. If your therapist is licensed only in California and you live in Delaware, he or she could technically be practicing without a license, which is illegal, notes Maheu. That could leave you with little legal recourse if something goes wrong, she says. She suggests asking yourself: Is this professional licensed in my state of residence so that if I have a problem, I will know which licensing board to send my complaint to? Check other credentials, such as expertise in what the therapist purports to offer, too. A "substantial" number of people offering therapy online don't disclose such information, says Recupero, whose findings after surveying 55 E-therapy sites were published in the Journal of Clinical Psychiatry in 2006.

2. Short cuts.
What concerns psychologist and ethics expert Thomas Nagy, an adjunct clinical assistant professor at the Stanford University School of Medicine, is that therapists offering services online might take short cuts. A crucial part of face-to-face therapy is informing patients about confidentiality and privacy up front, which includes addressing the exceptions to confidentiality?such as if a patient divulges that he has abused a child or elder at home. "Those are reportable offenses in most states," says Nagy, "and patients don't know that unless we tell them ahead of time." That discussion, he worries, might be omitted in the interest of time when communicating via E-mail or instant messaging. To make sure it doesn't, Maheu advises asking yourself: Is the therapist telling me everything I need to know regarding confidentiality? For example, isn't he or she supposed to report me if I do something against the law? What are those things? What's going to happen with that information? Who can get it under what circumstances (perhaps with a subpoena)? Will he or she tell me ahead of time in a written agreement? What else should I know ahead of time?

3. Privacy.
Similarly, it's important to ensure privacy on the therapist's end by understanding who else has access to his or her computer, where and how records are kept, etc. If the counselor ever stepped away from his or her desk midsession, would a secretary take over? You'll want to insure privacy on your end, too. If you share a computer with your family, for example, it's possible that someone could catch a glimpse of your E-mail divulging details of that regrettable affair. And experts advise never conducting a session on your workplace computer.

4. Technological reliability.
Despite rapidly advancing technology, the Internet still has its shortcomings. Though websites can be made "secure," says Maheu, E-mails can be intercepted and chat sessions hijacked unless they are protected by both parties with encryption. Moreover, the connection can be spotty. Imagine if the moment after you divulge your deepest secret during a chat session, service drops. What would you think as your cursor blinks?

5. Lack of nonverbal cues.
During face-to-face sessions, therapists have access to an array of nonverbal cues: whether a patient becomes tearful or blushes, say, or fidgets, bristles, or avoids eye contact. "These things make a difference," says Nagy. Even videoconferencing doesn't allow for the same clarity of signals that therapists normally get to help them understand their patients. Ask yourself if you're comfortable with that.

6. Backup.
Issues that arise during therapy often are being explored for the first time, and emotions can spill forth unexpectedly. Maheu advises asking: What does the online therapist do if I get emotional during a session? What if we get disconnected at those times? Does he or she call my house or just forget about me? How does the therapist know where to send me in my local community? A therapist is supposed to have some ability to respond to your acute needs.

7. Training.
Finally, it's fair to ask if the therapist has had any training in web therapy, says Grohol. "I would be looking for people who had taken courses and really gone out of their way to try and be an expert?a specialist in this field." The American Psychological Association stipulates in its ethics code that professionals provide services "within the boundaries of their competence or undertake relevant education, training, supervised experience, consultation, or study," says Maheu. Yet, many professionals who offer therapy online can't document that they've undergone such training, she says. "Rather, they are just Dr. Pete or Dr. Sally, who might have had a practice for a while down the street and now decides to open a website and start delivering services to the world."

Though Maheu is an advocate of telemental health, she doesn't believe that therapy delivered over the Internet is quite ready for prime time. "Much better technologies exist than the Internet alone at this point," she says. An example, she says, is the videoconferencing system in use by the military worldwide. But she's training professionals in how to best use technology in practice now?and in the not-so-far-off day when the Internet can be unleashed in full force to counsel patients. Says Maheu: "It's so ready to explode."

David Baxter PhD

Late Founder
it's fair to ask if the therapist has had any training in web therapy, says Grohol. "I would be looking for people who had taken courses and really gone out of their way to try and be an expert—a specialist in this field."

This last point is more than a little dumb, in my opinion. What courses? Who offers such courses? I've never heard of one. It seems to me that what's important is to determine (a) that your online therapist is a competent therapist, i.e., one who is licensed to practice in the areas in which s/he offers therapy; and (b) that s/he is technically competent and can actually manage an online service (of any kind).

Daniel E.
I guess they think people with masters degrees and PhDs don't know how to use MSN Instant Messenger :D
I would say that number 5 is a big one on that list.
I was seeing a therapist for nearly a year back home, and now that I've moved, I'm only able to do 'phone therapy' with her.
Not even 5 minutes into our session, the first thing I noticed was how hard it was not to be face to face. For me...I have trouble expressing my thoughts when I'm face to face with someone, so most of the time, my body movements and facial expressions where crucial for my therapist to know exactly how I was responding/thinking.
I don't know if I could handle "msn" therapy or even just emailing back and forth!
I had no idea how different it would not being face to face.
But I think whatever works for! Just sharing my thoughts! ;)


After five years of face-to-face therapy, I made the switch to online counselling. I like to write, so when I write my therapist I am usually quite specific in what I'm thinking and feeling, in part because of the lack of visual cues, and in part because I feel like I can be alot more honest and open hiding behind a computer screen than I could sitting in an office.

We've talked about switching to some sort of video-conferencing in the future, and while I would really like that to happen, especially as things progress, I wonder too if it will change our relationship and my ability to be as open as I am with him.

Online counselling isn't for everyone - there still has to be a good relationship between the client and therapist, but I'm finding it to be immensely helpful.
online wouldn't work for me, i value what i get out of the face to face sessions, my psychologist picks up a lot from my body language and will respond to seeing me getting distressed. i like that i then don't have to verbalize or say anything, and that she just knows.

i do write things i can't say out loud and give those to her on paper, and that combination works really well for me.
I do the same thing too sometimes...well I used to when I was seeing her face to face...if I was too ashamed or couldn't say the words I would write them down or draw what I was feeling and it was really helpful....It's hard only being able to do phone therapy because I actually have to "use my words" now...haha

I think it's great if online counselling works, sometimes it is easier to verbalize things or write things without feeling the pressure from the person sitting across from you. And in my opinion, I'd say why bother switching to video-conferencing if you're even worried it would change the relationship! Save yourself the grief of "shutting doors" and having to find a new therapist all over again. If instant chat or emailing works then that's fantastic! Glad to hear online therapy works for some of you :D :D


It's not about shutting doors or having to find a new therapist. I would hope that since I'm working with a professional, if there is an issue or discomfort he would help me work through that. That's what therapy is about, whether it's in person or online. I couldn't imagine leaving a therapist I had a trusted relationship with over something like that.

And I would still have the option of the written medium as well.


Resident Canuck
I have been putting a lot of thought into online therapy, (if I can afford it and find one) the past few months.

I have the one on one with my psychiatrist, so he can monitor my facial expressions, hand gestures, tics and such. Although my psychiatrist and I have a decent lenght session (he doesn't just say "how you doing, here is your prescription) I sometimes think it might be good to try therapy. I think I would find online therapy to be less intimidating, I think.



We've talked about switching to some sort of video-conferencing in the future, and while I would really like that to happen, especially as things progress, I wonder too if it will change our relationship and my ability to be as open as I am with him.

Online counselling isn't for everyone - there still has to be a good relationship between the client and therapist, but I'm finding it to be immensely helpful.

I have been providing on-line therapy with just voice or voice and video for some years now, I was one of the first and had to learn from scratch, my clients tend to be mainly ex-pats living overseas or people who are Internet orientated, as you say its not for everyone and yet there are for some people a distinct advantages in using on-line therapy services.

It can with some people provide a means to interact with a therapist in a way that suites them better.
As you say its not for everyone but is fast becoming popular with some people
After many years of doing traditional face to face therapy, I have slowly transformed my interactions to online counseling. The speed of progress is far superior to face to face (provided the client is prepared to work, of course!) and have even shifted some of my face to face clients to online and found that they too, improved in terms of speed of insights and ability to really focus and think about their problem situation. Yes, there are no visual cues, but strangely that has been offset by an inability to time waste, improved focus through having to write thoughts and beleifs down and an inabilty to slide sideways out of the difficult questions. All this has resulted in shorter therpay times in most cases. I know that there is research backing this up, but my own experience and feedback from clients who have been in therapy, often for years, assures me that for many people, online counseling is the way to go. I have also been told by many clients that they could not speak about certain issues but could write about them. So anonimity is also a factor for many clients. All of my clients can see what I look like, but I can't see them, and surprisingly I have found this also to be an interesting phenomenon, since I spend years looking for visual cues, but now I must read between the lines. And it's amazing what does come out between the lines when a client has no distractions, such as the paintings in my consulting rooms. My overall aim is to convert entirely to online counseling because, comparing the two, online is superior in most cases. There is always a place for face to face, and sometimes face to face is essential, such as when dealing with a suicidal patient. You can check out my website at Your Online Counselor - Beth McHugh - Online Psychological & Relationship Counseling and read hundreds of articles on various aspects of mental illness.
Best wishes,
Replying is not possible. This forum is only available as an archive.