This work is a chapter for the Academic Press book "Psychology and the Internet", edited by Jayne Gackenbach. Copyright and all rights therein are retained by Academic Press. This material may not be copied or reposted without explicit permission. (Copyright 1998 by Academic Press).
Cite as;
King, S. A & Moreggi, D. (1998). Internet therapy and self help groups - the pros and cons. In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Implications (pp. 77-109). San Diego, CA: Academic Press.
Internet therapy and self help groups - the pros and cons.
V1. Conclusion
There are people in need of mental health services who can not or will not present for traditional therapy, and are using the Internet for interpersonal communications. This population is being served by the growing field of behavioral telehealth; psychologists and other mental health professionals who offer counseling by email and in chat rooms. The question of whether this should be done is now moot, there is no way to regulate the exchange of information on the Internet. The world wide nature of the vast interconnection of computers means that, regardless of the current efforts of the APA and other counseling regulatory bodies, the hypothetical situation of the mental health worker in Australia counseling the suicidal Internet user in Switzerland exists, and will not go away. Today's children will grow up with a different set of expectations about what is normal in their use of the instantaneous world wide communication network for information retrieval and friendship formation (Papert, 1996). As technology advances allow online activity to become even more integrated into daily life, many uses of the Internet that are today controversial, such as online therapy, will seem common place.
Self-help groups offer an alternative to people looking to connect with others. For every advantage that is known to exist about these electronic therapeutic forums, there is a corresponding disadvantage. Since these groups are easier to join the f2f ones, does that mean they are easier to leave as well? If not having a f2f social presence reduces anxiety about sharing, what is the effect of not having hugs and handshakes and other personal contact that comes with f2f groups? Future research will elaborate on what little is known at this point. Many variables of online interpersonal interactivity remain to be researched. "...online support groups can be helpful in a limited fashion to individuals with mental illnesses. By taking away the barriers of social status, location, physical attributes, and emotional inhibitions, Internet groups will provide people with a communication tool designed to help them address specific problems." (Dubin, et. Al 1997).
Email and chat room therapy is NOT therapy, it is virtual therapy. This point is must be made clear to online therapy providers and the general public. The text-based nature of the communications, devoid of sensual clues, has distinct advantages and disadvantages. If the practitioner is not intimately familiar with the nuances of text based relationships, the potential to do more harm then good exists. The least obvious, but most profound, aspect of the difference between text based relationships and real life ones is the potential for projection. People can not communicate to a void, so the mind fills in the missing data. Flame wars, cyber romances, and Internet addiction occur at an alarming rate, because what the mind projects as aspects of the other is filled with misunderstandings, and misguided attributions.
People are conditioned from a long history of reading written words to think that these words represent the well thought out and carefully edited views of the author. When a personal relationship develops that is text based only, people are not accustomed to reading what is 'typing off the top of ones head.' Newcomers to this medium have a particularly hard time, because the social norms for typing to strangers engender a huge disinhibiting effect. The lack of local repercussions for ones expressions, combined with the Internet reversal of the social norm that says 'don't talk to strangers', results in a higher frequency of acting out behavior. People type things to each other that they would never say in person.
Therapy that is done by email is most effective when the missing data is in place. This occurs when email therapy is used as an adjunct to traditional therapy, or as part of an aftercare plan. If people have met f2f, then the amount of projection possible is lessened. Small, closed, moderated, and professionally facilitated email lists have an undeveloped potential for effective group therapy with populations such as people with Social Phobia. All Internet therapy should be accompanied by expressed limits of confidentiality, referrals to local crisis help, and referrals to appropriate psychoeducational material posted to the web.
References
Ainsworth, M. (1996, Nov. 22) Discussing the Limits of Confidentiality Concerning Use of: WWW, IRC, Newsgroups, Email, Video, Audio. Available WWW: http://cybertowers.com/cgibin/ethics_forum.cgi?-E1845285.25008
Bond, N. W. & Siddle, D.A.T. (1996). The Preparedness account of social phobia: Some data and alternative explanations. In. Rapee, M. R.( Ed.). Current Controversies in the Anxiety Disorders. The Guilford Press, New York, NY.
Brennan, P. F., Moore, S. M. & Smyth, K.A. (1991). ComputerLink: Electronic support for the home caregiver. Advancements in Nursing Science, 13, 4 14-27.
Childress, C. (1998). Subject: AOL Depression Group. Posted to NetPsy: Date: Sun, 8 Feb 19:23:17 EST. Available WWW: http://maelstrom.stjohns.edu/archives/netpsy.html
Coate, J. (1992). Cyberspace innkeeping: Building online community. Available WWW: http://www.sfgate.com/~tex/innkeeping
Cohn, M. J. (1997, February). Technogap: The diversity issue of the early 21st century. Counseling Today, pp. 19, 39.
Colón, Y. (1996). Chattering through the fingertips: Doing group therapy. Available WWW: http://www.echonyc.com/~women/Issue17/public-colon.html
Ferguson, T. (1996). Health Online. Addison-Wesley. Reading, MA.
Grohol, M. J. (1997). The insider's guide to mental health resources online. Guilford Press.
Cutler, R. (1994, Nov.) Self & community in cyberspace. Presented in panel at the 1994 Speech Communication Association, New Orleans.
Cutter, F. (1996). Virtual Psychotherapy?. Psychnews International, 1, 3. Available WWW: http://www.cmhc.com/pni/pni13b.htm
Dubin, J., Simon, V. & Orem, J. (1997). Analysis of survey results. Presented as a paper for New York University School of Social Work, N.Y.
Dunham, P. (1996) Young, single mothers find support on the Internet. As reported in the APA Monitor. Available WWW: http://www.apa.org/monitor/nov96/novnews2.html
Gustafson, D. H., Hawkins, R. P., Boberg, E. W., Bricker, E., Pingree, S., & Chan, C. L. (1994). The use and impact of a computer-based support system for people living with AIDS and HIV infection. Proceedings of the 18th Annual Symposium on Computer Applications in Medical Care, 18, 604-608.
Herman, S. (1997). Career HOPES: Online career exploration groups. Paper presented at the 105th Annual Convention of the American Psychological Association, Chicago, IL.
Holmes, L., G (1998) Delivering mental health services online: Current issues. CyberPsychology and Behavior, 1, 1, 19-24.
Huang, M. & Alessi, N. E. (1996). The Internet and the future of psychiatry. American Journal of Psychiatry, 153, 7, 861-869.
Humphreys, K. & Rappaport, J. (1994). Researching self-help/mutual aid groups and organizations: Many roads, one journey. Applied and Preventive Psychology , 3, 217-231.
Humphreys, K. (1997). Individual and social benefits of mutual aid/self-help groups. Social Policy, 27, 3, 12-20.
Kelley, B. B. (1994) New therapy: Cybershrink. San Francisco Examiner, Sunday, May 1, 1994, p. A-10.
Kessler, R. C., Mickelson, K. D. & Zhoa, S. (1997) Patterns and correlates of self-help group membership in the United States. Social Policy, 27, 3, 27-47.
Kiesler, S., Siegel, J. & McGuire, T. W. (1984). Social psychological aspects of computer-mediated communication. American Psychologist, 39, 10, 1123-1134.
King, S. A. (1994). Analysis of electronic support groups for recovering addicts. Interpersonal Computing and Technology: An Electronic Journal for the 21st Century 2,3, 47-56. Available WWW: http://www.helsinki.fi/science/optek/KING.2N3.
King, S. A. (1995). Effects of mood states on social judgments in cyberspace: Self focused sad people as the source of flame wars. Available WWW: http://www.grohol.com/storm1.htm
King, S. A. (1996a). Researching Internet communities: Proposed ethical guidelines for the reporting of the results. The Information Society, 12, 2, 119-127.
King, S. A. (1996b). Is the Internet addictive, or are addicts using the Internet? Available WWW: http://rdz.stjohns.edu/~storm/iad.html
King, S. A. (1997a). Subject: Re: Risks and Benefits of Online Therapy (long answer). Posted to NetPsy. Date: Wed, 29 Oct. 1997 12:45:22 -0800 Available WWW: http://maelstrom.stjohns.edu/archives/netpsy.html
King, S.A. (1997b). Ethics of online psychology. Paper presented at the annual meeting of the California Psychological Association, San Jose, California.
King, S.A., Poulos, S. T. & Engi, S. (1998). Using the Internet to assist family therapy. British Journal of Guidance and Counselling, 26, 1, 43-52.
King, S.A., & Poulos, S. T. (1998). Using the Internet to treat Generalized Social Phobia and Avoidant Personality Disorder. CyberPsychology and Behavior, 1, 1, 29-36.
Kirk, M. A. (1997, Feb.). Current perceptions of counseling and counselor education in cyberspace. Counseling Today, 17-18.
Madara, E. J. (1997) The mutual aid self-help online revolution. Social Policy, 27, 3, 20-26.
Madara, E. J. (In press). From church basements to world wide websites: The growth of self-help support groups. International Journal of Self-Help and Self-Care. 1,1.
Madara, E. J. & White, B. J. (1997). On-line mutual support: The Experience of a self-help clearinghouse. Information & Referral, 19, 91-108.
Moursund, J. (1997). Sanctuary: Social support on the Internet. In J. E. Behar, (Ed.), Mapping Cyberspace: Social Research on the Electronic Frontier. Dowling Collage Press. pp. 53-78.
Nickerson, R. S. (1994). Electronic bulletin boards: A case study of computer-mediated communication. Interacting with Computers. 6, 2, 117-134.
North, T. (1994). The Internet and UseNet global computer networks; An investigation of their culture and its effects on new users. Available WWW: http://foo.curtin.edu.au:80/Thesis/
Papert, S. (1996). The connected family: bridging the digital generation gap. Atlanta, GA, Longstreet Press.
Poulos, S. T. (1997). Literacy and the online professional. (Online) Self Help & Psychology Magazine. Available WWW: http://cybertowers.com/selfhelp/ppc/viewpoint/literacy.html
Reid, E. M.(1994). Cultural formations in text-based virtual realities. M. A. Thesis, University of Melbourne. Available WWW: http://www.ee.mu.oz.au/papers/emr/work.html
Rheingold, H. (1993). The Virtual community: Homesteading on the electronic frontier. New York: Harper Collins.
Sagen, D. (1995 Jan.). Sex, lies and cyberspace. Wired, 78-84.
Salem, D. A., Bogar, G. A. & Reid, C. (1997). Mutual help goes on-line. Journal of Community Psychology, 25, 2, 198-207.
Sampson, J. (1997). Public Email Correspondence, posted to list nbcc-webcounseling@virginia.edu on Tue, 11 Mar 1997 12:48:39 -0500 (EST).
Sampson, J., Kolodinsky, R. W. & Greeno, B. P. (1997). Counseling on the information Highway: Future possibilities and potential problems. Journal of Counseling and Development, 75, 203-211.
Schiano, D. J. (1997) Convergent methodologies in cyber-psychology: A case study. Behavior Research Methods, Instruments & Computers, 29, 2, 270-273.
Smith, M. A. (1993). Voices from the WELL: The logic of virtual commons. UCLA: Department of Sociology.
Sparks, S. N. (1992, Dec.). Exploring electronic support groups. American Journal of Nursing, p.62.
Sproull, L. & Kiesler, S. (1984). Encountering an Alien Culture. Journal of Social Issues, 40, 3, 31-48.
Sproull, L. & Kiesler, S. (1995). Computers, networks and work. In The Computer in the 21st Century. Scientific American. [special issue], Vol. 6, pp. 128-139.
Sproull, L. & Faraj, S. (1995). Atheism, sex, and databases: The net as a social technology. In Kahin, B. & Keller, J. (Eds.), Public Access to the Internet. MTI Press.
Stein, D. J. (1997). Psychiatry on the Internet: survey of an OCD mailing list. Psychiatric Bulletin, 21, 95-98.
Stoll, C. (1995). Silicon snake oil: Second thoughts on the Information Highway. New York: Doubleday.
Suler, J. (1996). Why is this thing eating my life? Computer and cyberspace addiction at the "Palace". Available WWW: http://www1.rider.edu/~suler/psycyber/eatlife.html
Walther, J. B. (1996). Computer-Mediated communication: Impersonal, interpersonal, and hyper-personal interaction. Communication Research, 23, 1, p3-43.
Walther, J. B., & Boyd, S. (1997). Attraction to computer-mediated social support. Paper presented at the annual meeting of the International Communication Association, Montreal.
Wellman, B. & Gulia, W. (1995) Net Surfers Don't Ride Alone: Virtual Communities as Communities. In P. Kollock & M. Smith (Eds.), Communities in Cyberspace. Berkeley; University of California Press.
Wellman, B. (1996). An Electronic group is virtually a social network. In S. Kiesler (Ed.), Culture of the Internet. (pp. 179-205). Mahwa, NJ: Lawrence Erlbaum,
Winzelberg, A.J. (in press). The analysis of an electronic support group for individuals with eating disorders. Computers in Human Behavior.
Wuthnow, R. (1994). Sharing the Journey: Support Groups and America's New Quest for Community. The Free Press, MacMillan, Inc., New York, NY.
Young, K. S. & Rogers R. C. (1998). The relationship between depression and Internet addiction. CyberPsychology and Behavior, 1, 1, 25-28.
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