More therapists are hanging out shingles online. But who are they? Who's logging on? And does it work? These are just some of the important questions addressed in "Seeing a Visual Shrink," an article featured in the January 22, 2001 edition of Newsweek.

It had to happen someday. Buy online. Date online. Visit the shrink online. Everything, it seems, is a virtual commodity, writes Newsweek. An estimated 250 to 300 counseling sites currently exist, charging up to $1 a minute to $150 and up for a month of e-mail. In the age of the Prozac fix, more will likely emerge as therapists seek new ways to market their trade.

However, as clients begin to log on to online counseling sites, concerns amongst health professionals nationwide are mounting: Is therapy via the Internet ethical? Legal? Even dangerous? It's clearly gaining attention, says Newsweek. Some groups, like the American Counseling Association, have issued guidelines for online practice. Others are taking note from a distance. Recognizing that online therapy is an emerging area with potential pluses and minuses, the American Psychological Association is assuming a watchful, interested, wait and see stance.

Talking To Computers

According to Newsweek, the convenience of online therapy is perhaps the most frequently cited plus. Clients can log on for a chat or an e-mail when they re most overwhelmed in their pajamas on a Saturday night or from small towns, where finding a therapist can be not just traumatic, but impossible. For many clients, cost is also a compelling draw: $70 for an hour of chat, compared to $100 and up in-office. The article adds that some therapists, sick to death of managed care, like the financial incentive too, to which Newsweek then poses the all-important key question: But at what cost?

While online counseling may work as a first step or adjunct to face-to-face therapy, many are concerned about how it obliterates some of the pillars of traditional therapy. Therapists rely not only on what is said, but what is not said. Visual cues are absent in online therapy--wringing hands, tapping feet, and tears speak for trapped emotions and many clients rely on their therapist's sensitivity to in-person interaction. As one client puts it: Online, it would be too easy to lie.

The What-Ifs

For therapists and clients nationwide, says Newsweek, the what-ifs abound. Many feel the risks are still too great, including Howard Brown, psychotherapist, founder of 4therapy.com, and one of the mental health professionals whose perspective was featured in the Newsweek article. What if, asks Brown, a client hooks up with someone who isn't qualified or doesn't have his or her best interests at heart? What if a suicidal patient sends e-mail to a therapist who has logged off? What if (computer) communication crashes while a client is discussing his or her fear of rejection?

Other concerns cited by Brown include the legal, jurisdictional and ethical issues of providing therapy via the Internet. Offering an example of some of the serious potentials for problems online therapy presents for both clients and therapists, Brown asks, "Can or should therapists residing in and licensed by one state treat clients via the Internet who are in another state and if so, is it possible to establish an adequate crisis plan?" "As a therapist," he adds, "I know, first-hand, the motivating desire that drives (mental health professionals) to provide help and comfort to people in need cannot be addressed, much less satisfied, by anything that might compromise our profession's integrity or our high standards for caregiving."

Interested in offering the public the best that technology can offer while also insisting on providing the most thoughtfully considered care possible, Brown has developed a multi-faceted Internet site that benefits clients and therapists.

Rather than offering online therapy services, which Brown feels in its current state is riddled with too many risks, 4therapy.com is responding to the public's need for convenience by providing easily accessible and constantly updated information about mental health issues, as well as assisting in identifying and accessing local, well-qualified therapists who are especially suited to helping each individual with their particular issues.

For therapists from coast to coast, 4therapy.com is using the technology of the Internet to offer a wide range of practice-enhancing services, including ongoing opportunities for client referrals via a Therapist Locator that's prominently displayed on more than 22 of the Internet's most popular health and lifestyle websites; access to a wealth of resources shared by a top-level community of fellow mental health professionals; concisely presented information on the latest developments in the field of clinical psychology; as well as a constantly updated source of practice management tools.

In December 2000, all of the above-mentioned services offered by 4therapy.com won them a Gold Award for "Best Use of the Internet Medium." As for their future plans regarding online therapy, Brown explains that when and if it becomes possible for the Internet to evolve sufficiently for online therapy to provide competent, ethical, well-monitored, high quality care without the present day drawbacks, limitations, and ominous "what-ifs," 4therapy.com may also include online therapy in its services--but until then, like the American Psychological Association, 4therapy.com is choosing to wait and see.

Newsweek finds that such a concerned and cautious approach is a popularly supported one, by both the public and by professionals in and out of the field of mental health. As a Georgetown law professor put it, until thoroughly adequate, thoroughly enforced standards are put in place, online therapy web sites are ticking time bombs when it comes to liability.