Psychotherapy Making Inroads on the Internet

As if the World Wide Web has not already seeped into nearly every aspect of our collective consciousness, now comes an enterprising group of mental health professionals using the Net to delve into our psyches.

At numbers that one expert said are growing “exponentially,” mental health professionals, from licensed clinical social workers to psychologists, are using the Web to augment their practices, doing everything from conducting online group therapy to offering one-on-one sessions via video cameras.

On June 1, a group of mental health professionals here officially launched VideoShrink.com (www.videoshrink.com), one of the few mental health Web sites that offers only videoconferencing online therapy (as opposed to the more prevalent e-mail and chat room approach).

Although the going has been fairly slow for the site thus far--only five clients have had video psychotherapy sessions since the site’s unofficial launch in March--backers of the program see it as the next big thing coming from Cyberspace, and hope to eventually expand the operation nationwide.

“I think this is going to be huge,” said Lynne D. Steinman, president and one of three directors of Santa Clarita-based Psychological Success Associates Inc.

“I think the Internet, in terms of it becoming an integral part of people’s everyday lives, is expanding logarithmically. I can only see that continuing at even faster rates.”

And that growth, she hopes, will expand the market for her services.

“We’re just trying to combine being good professionals with being good business people,” she added. “We see this as the wave of the future.”

Although the Web continues to expand the dizzying array of health-related products and services available to the surfing masses, some observers urge caution when it comes to matters of the mind.

“We assume that there will be some ways that [using the Internet] can help the psychologist’s practice,” said Russ Newman, executive director for professional practice at the American Psychological Assn. “We always want to be careful, though, that these new ways aren’t sacrificing patient care simply for the purpose of business development.”

Even the most ardent supporters of using the Net to help in psychotherapy concede that today the practice constitutes only a tiny portion of the $69-billion mental health care industry.

“This still accounts for a very small proportion of the total therapy that’s done in the United States today,” said John Grohol, chief operating officer of Boston-based HelpHorizons.com (www.helphorizons.com), a site that includes a “virtual office” in which consumers can find mental health professionals.

“It’s probably not even one-tenth of 1%, that’s how small we’re talking.”

Grohol estimates that there are about 400,000 mental health professionals practicing in the U.S. today. Of those, only about 300 to 400 use the Internet in their practices, and of those, he said, only about 10% use videoconferencing.

But Grohol, who also is author of The Insider’s Guide to Mental Health Resources Online, said that the numbers are growing rapidly and the potential marketplace is vast.

“Most people who have a mental health issue or concern don’t seek any type of mental health treatment because of the cost and the stigma associated with treatment,” Grohol said. “So here’s a huge set of people that, if you provide them with an anonymous, private confidential service at an inexpensive cost, they might be inclined to get treatment for some of those issues. That’s where the Internet comes into play.”

But there’s a debate raging in the mental health community as to whether what patients are receiving online is really treatment.

Even therapists on the HelpHorizons.com site acknowledge that the service offered online is not psychotherapy, treatment or counseling in the traditional sense of the words. Instead, they offer official-sounding services like “facilitated self-help and individual coaching” and “guidance and feedback,” and use approaches like “an online adaptive of cognitive behavioral therapy.”

Proponents say online assistance offers convenience (no driving, no parking, accessible even to rural clients), relative anonymity (no hiding behind the potted palm in your therapist’s waiting room to avoid being spotted) and, in some cases, a lower cost. Some therapists will respond to an e-mailed query for as little as $10, while others charge more than $100. Grohol said most online assistance is done through e-mail.

That’s where Steinman hopes to carve out a new market niche within this new market niche.

Her group offers only what it calls video therapy, in which both patient and therapists can make eye contact, without reliance on the Southland’s crowded freeways.

“When you just do chat therapy or e-mail therapy, you’re missing all of the nonverbal clues, which are a really important part of psychotherapy,” Steinman said.

In the case of VideoShrink.com, a one-on-one session can be less expensive than a similar face-to-face meeting. Steinman said she would charge a full-fee, private-pay patient $130 for a 50-minute session. A 45-minute online video session with a clinical psychologist would cost $95.

That’s not always the case. Many therapists offer no price break for an individual online session, charging as much as $130.

But market savvy therapists are not blind to the ways of the retailing world.

Like Macy’s and Robinsons-May, VideoShrink.com is having a summer sale--four sessions for the price of three.

“At this point, because it is a new concept, we’re not exactly sure what the market will bear,” Steinman said of the pricing strategy. “We’re trying to be competitive.”

She also said the group spent a considerable amount of time exploring ethical issues, and will accept only clients for whom video therapy is deemed appropriate.

To stand out in the crowded Internet field, the company plans to run banner ads, as well as purchase ads on the radio.

Other online therapists offer discounts for private-pay patients to “eliminate the often intrusive middle man.”

But that “middle man” is not about to be left out of the cyber loop. And that’s a prospect that has people like Newman worried.

He said he can envision a scenario in which patients insured by managed care companies will be encouraged to seek self-help materials and other assistance over the Internet before being allowed to schedule an office appointment with a mental health professional.

Newman said he was unaware of any insurance company currently directing patients to the Net rather than the therapist’s sofa, but he said there are clear signs of the growing use of the Internet by the insurance industry.

He noted, for example, that earlier this month Magellan Health Services, one of the nation’s largest specialty managed care organizations, announced that it will offer its members “online behavioral health services” provided through Epotec, a Wilmington, Del.-based company that develops and markets Internet-based behavioral health services.

He said he expects that trend to continue.

“Insurance companies, which are looking to do claims submissions online, are going to further the development of the Internet culture in the mental health community,” said Newman. “You’ve already got large Internet companies dedicated to the provision of health care services.”

“At this point there’s a concern [about the use of the Internet] based on the way managed care cost containment has been handled up to this point.”

Grohol, on the other hand, said such fears have “absolutely no basis in reality,” and noted that many health care insurers do not currently reimburse for online health care, let alone steer patients to it.

Even if managed care does not bring the Web more into the mental health mainstream, therapists will, according to people like Steinman and Grohol.

In aiming for a national presence, Steinman said, the Net offers her company a chance to “increase our income not based on our time,” because her firm would receive a portion of the fees paid to those off-site therapists.

It’s conceivable to Steinman that in the next five years, as many as half of the nation’s therapists may be using the Internet in their practices in some way.

“It goes back to the growth of the Internet,” she said. “I think people are continuing to look for ways to use the Internet in their daily lives.”

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Valley@Work runs each Tuesday. Karen Robinson-Jacobs can be reached at Karen.Robinson@latimes.com.