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There's an alternative to traveling to your therapist's office and talking face-to-face. There, across the desk, you try to find the words that express your feelings. You'd rather be somewhere else. But, you could stay comfortably at home, and thoughtfully express yourself through the written word to carry on a therapeutic dialogue.

Online therapists generally use email, but may also use instant messaging, chat (live, real-time online conversation), phone calls, and in some cases occasional face-to-face meetings. It can be an alternative for someone who is reluctant or afraid to visit a therapist's office, is homebound, lives where services aren't easily accessible or is hearing disabled.

You can choose a therapist with the expertise that fits your needs regardless of location. A business traveler can have therapy sessions online wherever she may be at the time. Young people, who already use the Internet for maintaining relationships, might be more comfortable clicking than coming to an office.

A therapist and client might use graphical representations of themselves called avatars to interact with each other, a technique young people commonly use in online communication. It can be easier to express yourself as a character you've created.

Why use online therapy?
Online services provide anonymity to those who might not otherwise reach out. Using the written word can allow participants to be more honest, more uninhibited, and more expressive.

When someone is depressed, making appointments and keeping them is difficult. It can be easier to connect with their therapist via the Internet

A therapist may use diaries or artwork to enhance the therapeutic experience. You're able to keep a record of conversations to review after the session, expanding its value. You can take time to express yourself on the keyboard and you can do it at any time.

Here's what you should know before participating in therapy online:

Professional associations for online therapists have established guidelines for all aspects of the practice. These are some of the issues addressed.

Procedures

• The client should know counselor's name and qualifications.
• The client should be informed of the potential risks of receiving therapy online.
• The counselor and the client should agree on how they will communicate and how often and how fees will be charged and paid.

• The counselor should thoroughly evaluate the client before providing mental health services.
• A backup plan should be established in case of technology breakdowns. The client and therapist should identify a local professional who could provide assistance in case of emergency.

Security
Anyone considering online therapy should be aware of security concerns. Information stored on computers can be accessed by others. But responsible online therapists will use safeguards, such as digital signatures and encrypted emails, secret passwords, code words to confirm identities. Professionals who provide therapy via the Internet should have special training in technology applications and ethics.

To find a online therapist
Dr. John M. Grohol's Psych Central site provides a source for licensed therapists for every state who have undergone background checks. However these do not all practice online therapy. Grohol suggests you visit Help Horizons, which does provide listings of online therapists.

While OLM does not endorse any therapist or locator service, you will find many results from a search for "find an online therapist." You can also ask your doctor for recommendations.

Be a responsible consumer. Your questions should include:

• Is the therapist licensed? (They should be.)
• Is the therapist certified? (This generally means they have met standards for qualifications and ethics.)
• How many years of experience do they have?
• Can they provide a professional reference?

Discuss other issues with them based on the guidelines above. For severe problems, see your doctor.

Sources
National Board for Certified Counselors, Inc.
The International Society for Mental Health Online (ISMHO)

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