Reaching Out for Virtual Therapy

Around Christmas of 1994, Sara Reynolds had had enough of life. One evening, the 35-year-old Seattle resident, who coordinates a program to build low-income housing, logged onto the Internet and typed, “I’m quitting.”

Within hours of her suicide note, Reynolds was inundated with encouraging e-mail from her depression news group. “I felt bad,” she recalls. “I didn’t want people to worry about me. If I ended up dead, I didn’t want to have anybody feel responsible. So I thought I should wait a while.”

Around the same time, Rita Macklin, an administrative assistant at Cornell University, was sitting at her desk, crying uncontrollably. She wrote a message titled “Stop the World,” containing a detailed description of her misery and e-mailed it to her Internet friends. Minutes later, she received a reply: “Rita, you need to get to a doctor today. You are severely depressed and you’re going to need some help.”

A white-collar heroin addict maintains an e-mail relationship with a recovered addict. A suicidal Midwestern university student, with no one to turn to, types a despair-filled letter to the Samaritans--a group in Great Britain.

Via the thousands of communities that coalesce on the information highway, airing out your personal problems on-line is fast becoming the self-help route of the ‘90s.

Much of the action takes place around a portion of the Internet known as the Usenet, a collection of newsgroups (electronic bulletin boards where people can post and reply to messages) each dedicated to a different topic.

Groups such as alt.support.depression, alt.support.depression.suicide, alt. support eating-disord, alt.support.aa attract hundreds, if not thousands of people a day who come to read, share and help others.

Other areas that attract the psychologically ailing include chat groups, MUDs (multi-user dimensions--hybrid news group and chat areas) and person-to-person e-mail. These occur on the Internet and forums sponsored by major on-line service providers such as CompuServe’s Human Sexuality Forum and the Mental Health areas on America Online’s Better Health & Medical Forum. In addition, many people discuss their problems via private e-mail with people they’ve met somewhere on the Net.

From such relatively benign postings and analyses as appear on alt.dreams to the excruciatingly candid self-disclosures on alt.support.sexual-abuse, there’s a whole lot of reaching out going on--almost always between people who have had no personal contact.

“I don’t even know who they are,” Reynolds says about the virtual friends who, she maintains, helped her out of the worst of her depression. “Just the fact that somebody can care about you. It’s so anonymous and yet they connect on such a personal level.”

Reynolds is a regular participant in some of the depression newsgroups and frequents the America Online forums and MUDs. After she left her flesh-and-blood therapist, cyberspace became her only therapeutic outlet. The advantages, she says, are many.

“You do it in the middle of the night,” she explains. “You have total control over the time factor. I know 24 hours a day I can contact somebody someplace and I can at least be heard. The other side of it is, unlike my friends--because I do have friends who try and help me out--if I choose not to respond to the mail, I don’t have to.” And, if the problem is particularly deep or embarrassing, she says, you can always post anonymously.

Macklin, whose on-line venting serves as an adjunct to her conventional therapy, believes keyboard counseling has a lot to offer. “I feel like I got better advice over the Internet than I did from the place I went to at work,” she says.

And of course, there’s the one tremendous advantage getting shrunk on-line has over the real thing: “It’s cheaper,” says Reynolds, whose monthly America Online bill has topped $100. “But therapy is like $75 to $100 an hour. Working-class people can’t afford that. I can get 25 hours on a computer for an hour with a person.”

And while she says that the two modes are not comparable, “There’s some really good information out there.” One reason is that mental health professionals also lurk in cyberspace. Reynolds says she’s encountered psychologists and counselors on-line.

“I’ve always been interested in emotional education,” says Dr. Jean Hantman, a Philadelphia-area psychotherapist who participates in many on-line forums and answers psychology-related questions via e-mail. “My motive is that we just don’t have emotional education at all. I enjoy doing it. I enjoy steering people into things that I think will be helpful for them. I think a lot of people are just lost out there emotionally, mentally and they’re not getting enough support.”

While Hantman sees connecting in cyberspace as an opportunity to help, others see it as an opportunity to make some money. Last February, Cyberlink Consulting, a Westchester, N.Y.-based company with a presence on the World Wide Web portion of the Internet, launched ShrinkLink, an on-line psychological service. It allows anyone with troubles or a psychology-related question to e-mail a query--with a credit card number--and ShrinkLink’s panel of psychologists and psychiatrists will e-mail their response within 72 hours.

ShrinkLink, which charges $20 per question, is the first on-line support facility to charge a per-use fee. Still, says Cyberlink President and ShrinkLink creator Dan Litwin, the service has many advantages.

“Those are great for what they are,” Litwin says about free on-line groups. “They provide a valuable service and on occasion a qualified therapist may respond to queries, yet when you post a query it’s there for the whole world to see and you have no guarantee you’re getting advice from a trained, qualified therapist or that you’ll get any response at all.”

The speed with which people have exploited the Internet for psychological self-help has taken the psychology community by surprise.

“People have raised some concerns about it,” says Doug Fizel, deputy director of public affairs for the Washington-based American Psychological Assn., which issues standards for professional behavior. “But it’s not something the APA has addressed yet. We’re still discussing the potential problems involved in telephone therapy.”

Others in the mental health field are more outspoken about on-line psychological help.

“It’s really terribly risky to engage in that,” says Dr. Thomas Nagy, a clinical faculty member at Stanford University’s Department of Psychiatry. Nagy served on the ethics committees of both the APA and the California Psychological Assn. and maintains a private practice.

“Nobody’s been trained really to do this,” he says. “We’re supposed to base what we do somewhat on research and there’s no research on psychotherapy on the Internet. Plus, all you see are the words on the screen. You don’t even know what gender they are. So there’s so much you don’t know. How can you with any confidence offer any advice about what they should do in a given situation with their marriage or with their boss or with their eating disorder or their sleep disorder? You can’t.”

Nagy is even more dubious about advice from non-professionals in such encounter groups as a Usenet bulletin board.

“I wouldn’t take my problems on-line,” he says. Although he says the Internet could be helpful in finding general information about a certain topic, anything more specific is fraught with hazards.

“If someone who’s had incest and is having panic attacks and they go on-line, they might get some sympathy, they might get some very inappropriate, awful responses from the opposite sex or they may be conned. It’s a crapshoot. I’ve had patients tell me they were very grossed out by the reactions they’ve gotten on the Internet.”

Still, the profession is far from monolithic in condemning the Internet. “Psychiatry has no bone of contention with how people choose to help themselves,” says Dr. Avidah Offit, an assistant professor of clinical psychiatry at Cornell University and the author of “Virtual Love” (Simon & Schuster, 1994), a novel about an e-mail romance. “I have very few reservations about its use in that way. I think it’s a very unifying, very important new way for people to communicate their problems to one another.”

Because of legal and ethical concerns and insurance, virtual therapy is still a long way away. Litwin characterizes what his company purveys as advice rather than therapy. Offit says she won’t set up shop on-line, although she encourages her patients to keep in contact with her via e-mail if they are away.

Offit’s main caveat is developing an addiction to the medium itself. “You don’t want to become someone who sits at their computer all day communicating,” she says. “And this is what’s happening, particularly among troubled people.”

Nagy says that perhaps on-line encounters are helpful, “but even in programs where people are screened--like group therapy--there can be sharks. And on the Internet, you’re wide open, totally unscreened to millions of people potentially. So the odds for destructive encounters increase. I hate to be the doomsayer on this, because it’s really exciting to think that this really could provide a peer group.”

Reynolds agrees that opening up on-line was not a totally risk-free proposition for her. In one of her earliest forays on the Net, she participated in a sexual-abuse forum and asked where the file of frequently asked questions (FAQ) was located.

“I got badly flamed from a girl who said, ‘How dare you tell us how to run this forum. You’re obviously new. You don’t belong here.’

“If you’re already depressed, this is the last thing you need.” Also, she says, unwanted sexual attention is an ever-present nuisance, one she tries to mitigate by using a gender-neutral signature.

But in spite of the drawbacks, even Nagy concedes that the number of professional and peer cybershrinks will only increase. Whether that is good or bad remains to be seen.

“It made me realize that I wasn’t alone and that some people had worse problems than I did,” says Reynolds, who characterizes herself as “a bit more out of the woods.”

“You would see people who would post pretty bad stuff and later they would say, ‘Oh, thanks. I’m much better.’ ” Then again, she adds, “Some people disappear, and that’s frightening.”