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The New Portable Practice of Online Psychotherapy

by Louis J. Wasser

“There are many ways of getting strong; sometimes talking is the best way.” — André Agassi

Since Freud practically invented the art (or science) of talk therapy single-handedly in the late 19th Century, psychoanalysis, and its more casual sister, psychotherapy, have emerged as the most intimate of professional relationships. Patients will share more personal details with their psychotherapist than they will with their life coach, divorce lawyer, or oncologist.

The dynamic of this interaction is about to change — big time! Patients in increasing numbers are seeking help from psychotherapists on the Internet, especially since the advent of Skype. Whether the therapist-patient relationship retains intimacy online remains to be seen.

Remote therapist-patient communication is by no means new. Sigmund Freud frequently exchanged letters with several patients. In fact, many therapists have experienced a late-night call from the patient undergoing a panic attack. But virtual contact —complete from signup to cure — is a byproduct of our Internet age. Now it’s possible to shop for a therapist, get wind of his or her credentials, and buy an hour of therapy time via credit card or PayPal. The therapist with a little more business savvy will arrange for you to sign up for multiple-sessions at a discount.

While 1 in 5 Americans have a diagnosable psychological problem, nearly two thirds of them never seek treatment.

While staunch traditionalists will swear by the benefits of in-person therapy and insist on the importance of eye contact (the psychoanalyst’s couch has become as antiquated as the rotary phone), cybertherapy entrepreneurs stress the advantages of patient privacy and anonymity. Let’s face it: you won’t have to worry about accidentally running into your boss’s wife in the waiting room if the two of you happen to consult the same therapist. Also, if you’re an agoraphobe who hasn’t been outside the house in three years, unless you sign up with a psychotherapist who makes house calls, online psychotherapy is your only way to go.

Let’s not forget the geographical aspect of this new trend. With all due respect to the salubrious effects of living in the Wild West, HealthGrades yields the number “9” when you enter the words “clinical psychologist” and “Helena, Montana” in the search bar. Now substitute the words “Philadelphia, PA.” Or go ahead, choose your own city… well, you see what I mean.

Then there’s the stigma issue. According to the 1999 Surgeon General’s report: “While 1 in 5 Americans have a diagnosable psychological problem, nearly two thirds of them never seek treatment.” It doesn’t take much of an imaginative leap to appreciate that online psychotherapy has the potential to address a deep need in our society.

Look at this way: how many people vowed to buy a particular book, or at least stop to look for it in their local library, back in 1994? Their promise to themselves went by the wayside, didn’t it? Now ask yourself, how many more potential book buyers honored that commitment to themselves once Amazon.com went online in 1995?

Say what you will about the sense of intimacy and feeling of protection in a therapist’s office. We have a way of creating our own sense of intimacy and personal space once we power on, don’t we?

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