Internet May Be Therapeutic
Excerpt By Nancy A. Melville, HealthScoutNews

(HealthScoutNews) -- The Internet may be many things to many people, but for some it can be downright therapeutic.

Among the professions that have been transformed by the ability to connect online, the field of psychiatry, despite its special demands for confidentiality, has been no exception.

As with many areas of medicine, information on diagnosing various mental health problems online abounds. Worried that your social drinking may be crossing over into problem drinking? Take this quick online questionnaire. Is your increasingly gloomy mood a normal reaction to events in your life, or are you suffering from clinical depression? Take that test to find out. Feel like your anxiety since the 9/11 terrorist attacks is unusual? Click here.

The questionnaires are not unlike any that have appeared in magazine articles and on morning programs for years. They typically advise heading to your local therapist if you meet the criteria for needing professional help, and may even offer links to help you find the right one.

Depending on the therapist you hook up with, however, the Internet may continue to be an important tool in your care.

More and more therapists are extending their care beyond the traditional face-to-face sessions to include telephone, e-mail and even Instant Message "coaching."

Such accessibility has broad appeal -- ranging from patients and therapists who simply are too busy to coordinate schedules to meet regularly, to patients who may feel the need for support between appointments.

Dr. Michael Nuccitelli, executive director of SLS Health, a residential treatment and wellness center in Brewster, N.Y., that offers such services, says the operative word is "coaching." Due to both legal and professional considerations, the practice of psychotherapy can still only be conducted in a professional, face-to-face setting.

"It's important to clarify that e-coaching and phone-coaching are used as supplemental tools to professional help," he says. "It's not psychotherapy -- if a patient hasn't been to a therapist, it's an encouragement to seek professional help. And with existing patients, it's a tool to teach and reinforce prevention education techniques."

Nuccitelli says in those cases, e-mail can let patients contact therapists seven days a week with pressing problems that can't wait until the next appointment.

"For instance, a patient is perhaps traveling, he has a problem with panic attacks and drinking, and is feeling tempted to become intoxicated to deal with it. He may call or e-mail me and I can help coach him through it until he can return and come in for an appointment," he says.

Similar situations can arise among patients with problems ranging from stress and anger management to weight reduction, Nuccitelli says.

While the same measures are taken to ensure patients' confidentiality as are taken in office visits, Nuccitelli says those skittish about online privacy may want to think twice before discussing issues over the Internet with their therapist.

"Our policy is to delete all e-coaching e-mails after we read them, but people who don't trust the privacy of the Internet probably should just not use the option of e-coaching at all," he adds.

The American Psychiatric Association's policy on the subject is that it "supports the use of telemedicine as a legitimate component of the mental health delivery system to the extent that it's used in the best interest of the patient and is in compliance with the APA policies with medical ethics and confidentiality."

Despite the endorsement, however, health plans will only rarely cover fees stemming from e-coaching, and billing practices for online assistance are in fact as varied as the prevalence of therapists who offer such services.

Many psychotherapists still don't offer such accessibility at all; some who do may simply offer their e-mail address for clients in special cases, but not choose to bill for accessibility, while others may offer e-coaching as a standard option, complete with standard fee schedules.

Whether or not they offer e-coaching, however, the consensus among many in the field is that online accessibility is, in most cases, an advantage for patients.

"Based on the research on this, my opinion is that (e-coaching) is useful in some cases, as long as its primary purpose is as an adjunct to regular therapy, because it allows patients to have a better sense of connection to the doctor between appointments," says psychotherapist Dr. Russell Lim, an assistant clinical professor at the University of California, Davis.

"In the context of one-on-one therapy, I think it's very helpful," he says.

What To Do

People who don't have therapists and begin their search online for mental help may face a daunting array of options. Experts recommend starting with recognized professional organizations such as the American Psychiatric Association or the National Mental Health Association.

Visit the American Psychological Association to read why the broad range of Internet therapeutic offerings make it hard for the organization to come down for or against online therapy.

Reference Source 101

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