Welcome to e-therapy, help in the comfort of your computer room.
Like so many other Internet services, e-therapy is anonymous, convenient and fast.
For a price - not as much as you might think - you can pour your heart out, hit send and wait for your personal e-therapist to respond.
And why not?
Already, you can search for companions, buy groceries, book flights and sell stock simply by clicking a mouse.
According to the monitoring service ABCs of Internet Therapy at www.metanoia.org, what started in 1995 with 12 independent, fee-based sites grew in 2000 to include 300 independent e-therapy sites plus an additional three e-clinics with 700 additional e-therapists.
They charge anywhere from $35 for one e-mail response to $100 for a monthly package, far less than a traditional office visit of $100 or more for an hour or less. (Keep in mind that most insurance companies cover at least a portion of traditional office visits, while few cover the expenses of online therapy.)
Recognizing this growing trend, professional organizations, including the International Society for Mental Health Online, the American Counseling Association and the National Board for Certified Counselors, have created principles and guidelines that address everything from security and confidentiality to liability and appropriate counseling plans.
Don't run to your computer just yet, though. E-therapy is considered experimental. And it's not for everybody.
If you are in a serious crisis situation - such as feeling severely depressed or suicidal - you should call a mental health hot line immediately, says Martha Ainsworth, Internet communications specialist and e-therapy consumer watchdog.
In addition, she says, you must have the ability to express yourself well in writing.
"E-therapy can be a viable alternative source of help when traditional psychotherapy is not accessible, if approached with appropriate caution," Ainsworth says. "It's not therapy, and it should not be compared with therapy."
Ainsworth's New York-based Web site, ABC's of Internet Therapy, warns potential e-therapy clients to make sure they understand the limitations of the online relationship, the time line for responses and the privacy of the information they reveal. In addition, she says, they need to find out whether their e-therapist is for real. Her Web site offers a directory of e-therapists that includes ratings based on their credentials, fees, payment and services.
Perhaps most important, say both proponents and opponents of online counseling, consumers must recognize the risks of revealing personal details to strangers.
For starters, says Hiten Patel, a psychiatrist in Novi, Mich., "You need to check references so you know you're not dealing with somebody who has just decided to become an e-therapist."
Patel, who prefers meeting with clients face-to-face, says that although e-therapy offers some benefits, he's not ready to log on to the Internet: "I know there are people who are very comfortable striking up relationships in chat rooms ... but therapy is give and take, a dialogue between two people. With e-therapy, it becomes a series of monologues."
Patel says that he doesn't discount the Internet as a therapy tool and sometimes uses it to converse with clients after a face-to-face session.
"Occasionally, my patients will send me an e-mail after we meet for clarification on something," he says. "But we don't do actual therapy."
Besides opening the door to "a lot of misuse by unscrupulous people," online communication lacks some key elements of good therapy, Patel says.
"A lot of our work ... is an art, not a science," he says. "The way a person walks, what he dresses like, what kind of grooming he has, how he shakes hands and whether he makes eye contact are some of the subtle ways we communicate things about ourselves."
Dr. Vic Strecher, professor at the University of Michigan's School of Public Health, says that study after study in the past decade has proved that people are more honest with a computer about their bad health habits than they are with a therapist.
"People seem to be more comfortable in front of a computer," says Strecher. "On average, they elicit more factual information."
The University of Michigan team has been studying the effect of new media to create software that mimics human therapy sessions for Web intervention, prevention and management of disease.
Although it has had success dealing with issues like smoking and weight loss, therapy is a different challenge, Strecher says.
"How do you replicate what great therapists ask into a software program?" Strecher asks, noting that one element surely missing will be the "emotional support and empathy" that only human beings can give.
On her Internet advocacy Web site, Ainsworth says e-therapy provides an outlet for people who are disabled or who live in rural areas as well as those who are not comfortable with the stigmas attached to therapy.
