E-Therapy

Although nothing in life remains constant but change, change is something mankind resists. It is clear to most people that the parts of our world based on information and communication will be hijacked by cyberspace and yet professionals, maybe more than patients, resist.

Nevertheless, the editor of E-Therapy, Robert Hsiung, guides us through the inevitable by harnessing the opinions of clinicians, lawyers, patients, telepsychiatrists, and even webmasters. The user-friendly book explores electronic therapy as a way to prevent some from falling through the cracks without ignoring the pitfalls of losing the face-to-face practice.

Chapter 1 is an overview and brief history of using the Internet in the mental health arena. Robert Kennedy, the author of this chapter discusses the information exchange from both the consumer and the clinician's point of view.  He states that the professional wants something different online than the consumer -- greater depth and scientific accuracy. Yet Kennedy does not really make a good case for this. I believe he gives less credit to the online consumer than I do.

The "Internet Expert" is covered by Ronald Pies in Chapter 2. It is a delicate balance to provide useful information and not give advice. The expert, for ethical, moral and legal reasons, must learn to suggest options to solve a problem without suggesting the solution to the problem. Tricky business but necessary if one wants to retain their professionalism. He offers the all-proverbial warning that "e-therapy is not a substitute for standard care but a supplement for it." Possibly he's right, yet might Pies be minimizing the impact of  24/7 medical support and instant information? Could it be that Internet care will soon be the standard and face-to-face will become the supplement?

Joel Yager also describes in Chapter 3 "Case Study: Adjunctive E-Mail" how e-mail exploded as an adjunct to his therapeutic approaches and how quickly it became an integral part of his practice. Patients like the 24/7 access and Yager likes the support that he is able to give in return. Yet, Yager, like Ronald Pies in Chapter 2, interprets electronic therapy as an adjunct to face-to-face, not even exploring the possibility of his face to face becoming an adjunct to the 24/7 support of Internet. Having been through a crisis myself, I found that I went to my therapist twice a month but logged on for support, information seeking, and an on-line coach everyday. The land-therapist was definitely the adjunct to my healing, not the primary source of my recovery. I think both these men-in fact all of the authors in e-Therapy have not faced their own limitations in the magnitude of what cyber medicine is offering today and will continue to offer in the future.

Three women, Sara Gibson, Susan Morley, and Catherine Romeo-Wolf, are more realistic in their appraisal of e-therapies in Chapter 4, saying with candor that "the patients have tended to like telepsychiatry more than the staff." The women seem less invested with ego-filters than their male counterparts when giving their views about the benefits of mental health cyber-treatment.

In Chapter 5 Gary Stofle reviews "Chat Room Therapy" and explains the advantages and disadvantages of using that medium. In Chapter 6, Peter Yellowlees examinesthe principles that should guide the e-professional such as being flexible, recognizing their limitations, and being respectful of the patient. He also warns of the dangers of the Internet creating sicknesses as well as alleviating aliments. He humorously notes that hypochondria turns to cyberchrondria. In a move the other chapters failed to address, Yellowlees shows a chart from the consumer Health Infomatics contrasting the Industrial Age of medicine, where self-care is discouraged, with Information Age health care, where self-care/individual care is highly encouraged. He seems to have the best grasp of the overall picture of what is happening in the electronic therapies and how that relates to people gaining the upper hand in their own care.

In "The Legal Implications of E-Therapy," Nicolas Terry does a good job of explaining the areas of concern from regulations (both state and federal), ethics, and privacy. And last but not least, we see in Chapter 9 the whole business from the point of view of the patient. Martha Ainsworth reviews e-therapy and walks the reader through the evolution of Internet care from individuals to organizations. And she defiantly points out the shift in professional thinking: it is not "if" e-therapy should be provided but "how."

All-in-all the book provides a good solid discussion of how mental health professionals can and should incorporate cyber space into their practices. I would have liked to see more on how the Internet can cause illnesses and the downside of misinformation than was presented. I would have liked a whole chapter on circumventing the pornography/sex addiction/child exploitation that any exposure to the Internet can fuel, but that may be a whole book, rather than a chapter. The book is worth reading for any professional in the mental health field-and although it fell apart in my hands, just like everything else in the electronic age, it's going to be outdated by the time I need it again.

© 2004 Shelly Marshall

Shelly Marshall, CSAC, is a best-selling author, leading researcher, and professional in addiction recovery and young people. Visit her site: www.day-by-day.org