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Cyber Analysis

Patients wary of face-to-face therapy or simply eager for the convenience inherent in the Internet are seeking online counseling.


Kenny Evans knew he needed professional help for depression, but one thing always stopped him. The Russellville, Ark., man is partially paralyzed, and the idea of having to display both his physical disability and his emotional pain was enough to dissuade him from reaching out.

Then Evans, 49, discovered an Internet site operated by a Newport Beach psychologist who counsels patients computer to computer instead of face to face. For Evans, it offered a way to give therapy a try while overcoming his qualms about anonymity and privacy.

Now Evans e-mails Julie Keck whenever he feels the need, and she responds, usually within 24 hours. Evans credits Keck with helping him gain a new perspective on life.

"She is an empathetic and caring person," he says. "And I get an unconditional acceptance through her counseling."

Evans and Keck are among a growing number of patients and therapists using the Internet as an alternative to traditional in-office counseling, helping to push the mental-health field into new territory. Together with other Web sites that offer online chats with doctors, interactive health assessments, and personalized diet and fitness programs, online therapy is further establishing the Internet as a powerful provider of health information and services.

For the Record
Los Angeles Times Monday March 13, 2000 Home Edition Health Part S Page 3 View Desk 1 inches; 34 words Type of Material: Correction
Online Therapy--A story in Health on March 6 should have said that an Internet site operated by June Caldwell of Redondo Beach provides referrals to mental health therapists who provide in-person counseling rather than online counseling.

Online therapy, which typically involves an exchange of e-mails over hours or days rather than an almost simultaneous conversation, or "real time" chat, seems to capture the essence of Internet communication--anonymity, convenience and uninhibitedness. And patients and therapists say the medium helps lessen some of the stigma about mental-health counseling that can discourage some people from seeking treatment.

Americans are generally reluctant to seek out mental-health counseling and to stick with it once they start. About 30% of people who make a first appointment for counseling don't show up, and many people never return after a first session, says John Grohol, a psychologist in Austin, Texas, who has studied the subject.

One recent study suggests that people are less reticent about seeking mental-health information in the anonymity of the Internet. A report in Behavioral Healthcare Tomorrow, a professional journal, found that an estimated 40% of all health-related Internet searches are on mental-health topics.

But online therapy is not without its critics, who cite concerns over the quality of online therapy and issues of privacy and legal protections.

Dr. Walter E. Jacobson, a Los Angeles psychiatrist, says that while online therapy may reach people who might otherwise not seek counseling, it lacks a crucial element in the relationship between patient and therapist: "A bond has to form--being able to make eye contact, how comfortable they are. You are not going to get that in e-mail. I think sometimes the treatment may be suboptimal."

Even so, Jacobson echoes other experts who say that online counseling is probably here to stay. He believes the mental-health profession needs to develop guidelines to regulate such counseling.

"Most people recognize this is one of those snowballs that you can't stop from rolling down the hill," Grohol says. "It's a question of how can you do it the most ethical and effective way possible."

Keck, a clinical psychologist who is Kenny Evans' counselor, was introduced to online therapy in 1997 after receiving an e-mail from a distraught college student named Joseph. He had picked her name from a list of psychologists and wanted to know if she would do e-mail counseling.

"I decided to try it with just that one person," Keck says. Based on that and later experiences, Keck created a Web site called and now does 40% of her counseling online while also maintaining a traditional office practice. She acknowledges that there are limits to the type of counseling that can be done over the Internet.

"I call it 'e-mail counseling,' " she says. "This isn't therapy. Therapy is a lot more leading the patient to their own solutions . . . learning who they really are. E-mail counseling is more like direct advice. Anyone who says it's more than that is fooling themselves."

Joseph, who asked to be identified only by his first name, says that at the time he contacted Keck, he was spending most of his freshman year in his room due to a then-undiagnosed anxiety disorder that made him highly fearful of social interaction.

"I wanted to find help, but I was afraid of going to a public health clinic," says Joseph, now 23. "My biggest problem was the bad reputation people can get when they seek mental health care. And, when you suffer from the disorder I have, you are nervous about the social impact of seeking therapy. So a computer was an easy way to talk to someone."

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