Self-Help Guidance a Modem Away
A college student is afraid to seek treatment for her depression because she has little money. She turns to her computer, posting a message online inquiring how she might find help--she has had suicidal thoughts.
The responses roll in, offering tips such as going to her campus health center. Many of the message-senders let her know they’ve been through similar pain.
In the same depression forum, one of 20 mental health topics explored in Online Psych, a recent addition to America Online, one can look up the definition for depression, signs and symptoms of the condition, resources (including hotlines, books and support groups), information about medications and areas to post messages on the topic or chat live with others.
Promoted as “a virtual mental health information shelf,” Online Psych is one of numerous psychological services in cyberspace. And while you still see the self-help sections of bookstores brimming with eager readers looking for the answers to life’s trials, more and more people are turning to their computer screens, where, with the click of a mouse, they can learn and commiserate about everything from aging to angst.
The technology has opened a whole new world of psychological help, said Stephen Bond, Online Psych president.
“I think people are surprised and pleased by the depth of the content. . . . It is just the beginning of the revolution in how people get the information they need.”
Evidence that people are diving into this new wave of psychological help can be seen in the popularity of a World Wide Web site called Psychology & Self-Help magazine, whose editor in chief is San Diego clinical psychologist Marlene Maheu. In it, updated daily, users can find links to support groups (called newsgroups), read articles about the latest research and find out about mental health professionals’ Web sites.
Maheu attributes the popularity of computer self-help to low cost and convenience. “People can sit there in their jammies and talk to someone at 3 a.m.,” she said. And for people with relatively rare conditions, “How do you find 50 people to get together and talk about medication and other issues? There is no other place that has that many people talking on that topic in your own home on your own time.”
The Internet already has more than 200 newsgroups, where people with similar concerns, such as eating disorders, can discuss their issues.
“The real power of computers lies in directly connecting people with each other, even though they may be on completely different continents,” said John Grohol, a psychologist who is a list administrator for psychological newsgroups online.
“Support groups for similar problems are where the most fascinating and useful things are going on right now online. It’s a very good and warm feeling, because it is communicating with other human beings, even if it is through the computer.”
In support groups, as in other arenas online, there is always the chance of misinformation, but Maheu said errors tend to be self-correcting.
“Say someone writes in that a certain medication is the best to work. Within 24 or 48 hours, if that is incorrect, someone will correct it. If someone uses this type of information right, they can go to a physician and see if it’s correct or go to a professional’s Web site,” she said. “They aren’t limited to one resource.”
*
Experts are quick to point out that these services should not be considered a form of therapy or used as a substitute for traditional therapy with a practicing mental health professional.
They are a place to find information and support, like a self-help book or a discussion meeting. Many, such as Online Psych, provide disclaimers emphasizing that the arena is not to be considered therapy.
“The American Psychological Assn. has not authorized psychotherapy through the Internet,” Maheu said. “We can give advice, much like TV talk shows or radio call-in shows. One way to do this is through composite questions. I get a question a day about some topic. I can gather these questions and develop a composite answer for them.
“A therapist has to have a complete understanding of the patient’s history to provide a diagnosis. You can’t get that through a few sentences or a paragraph,” she said.
Adds Grohol: “A person should never act directly on any medical advice given online, but should see the online experience as an adjunct to, not a replacement for, regular therapy or treatment,” he said. “Your doctor knows important background information about you that obviously people online couldn’t know.”
Thomas Nagy, a Palo Alto psychologist and APA member who helped write “Ethics for Psychologists: A Commentary on the APA Ethics Code” in 1994, said, “It’s important to try not to offer too much online. I would say participating in a support group online is much like seeing information in a pop psychology book. It’s one thing to get online and have specific questions and have a psychologist give general advice. It’s another thing to get individualized attention. That is unprofessional and could be damaging.”
Even general advice can cause problems. Some tips for depression aren’t good for all sufferers, he added.
“A computer is so easy to use, but it might be a Band-Aid when you need to have a leg set in a cast,” Nagy said.
*
Still under review and not endorsed by many psychologists are other forms of psychological self-help through computers, such as one-on-one sessions with therapists, software programs touting cures for ailments and online services offering help for a fee.
These have been criticized by professionals, as has telephone therapy, which is viewed as effective along with live therapy but not on its own.
“Software programs are never a substitute for individualized therapy or antidepressants, which can be helpful for people in some depressing circumstances,” Nagy said. But, “I am aware of a computer program that can be helpful, which takes you through and helps you pinpoint and isolate the cause of your depression.”
Research shows that 80% to 90% of one’s communications with others can be nonverbal, Grohol said, adding: “This becomes a staggering handicap online, when one is reduced to using smiley faces and words only to express themselves. For instance, sarcasm is extremely difficult to detect and differentiate from humor or anger online, without explicitly saying so. So that’s a big advantage real-world support groups and therapy still hold over online groups. This may certainly change with time and technology.”
Grohol said people should keep in mind that professional help is needed when problems are serious enough to interfere with normal functioning at home, work or leisure-time activities, or if one has thoughts of suicide.
But as first steps toward help, the computer may provide a stepping stone previously unavailable.
“For us, it’s more about the value of information,” said Bond, Online Psych president. “Do people benefit from reading books? From going to lectures and seminars? From seeing a special on ‘Nightline’ or ‘20/20’? Yes, people benefit from information, but not in the same way as through a therapeutic relationship.
“We can provide that information to you 24 hours a day, 365 days a year, at any time that you choose,” he said. “What do people use that kind of information for? I think for many people, it’s a place to start. For some people, the point at which a mental health concern touches your life--when it’s your kid, your marriage, someone close to you--it’s a difficult moment. So that information becomes vital. The informed consumer is in a better position to make good decisions.”
