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.
1. Introduction
Never in the history of civilization has so much information been readily available to so many people. An 'information revolution' is in progress. The most obvious manifestation of this ongoing paradigm shift is the proliferation of home personal computers used to search out information available on the Internet. Among the millions of daily Internet users are an unknown number of mental health consumers who are concerned with understanding and treating an emotional or psychological problem that they, or a loved one, are afflicted with. Mental health professionals worldwide are pioneering new services that offer to establish a therapeutic relationship over the Internet, sometimes on a fee basis. There are numerous books and other publications devoted to assisting people to use the Internet to find such information and how to connect to cyberspace forums dedicated to various mental health topics (see Ferguson, 1996; Grohol, 1997). To date, very little has been written to help psychologists understand why people are choosing, in large numbers, to use the Internet to seek therapeutic interventions and peer support.
Within the field of psychology and among mental health practitioners there are different opinions about the ethical, legal, and professional issues raised by offering mental health services online. A close review of both self-help resources and online therapy is presented here in effort to clarify the many issues that are of concern, and to further understanding of how the Internet can ethically be used to assist treatment of emotional and mental disorders. Protocols and methodologies for analyzing the value of self help and therapy online are evaluated for the unique ethical dilemmas facing researchers in this field.
An overview of the nature of text based interpersonal relationships is provide first, as it has applications in both self help online and one to one therapy conducted by email. Self help mutual aid online groups are open forums and have a number of advantages and disadvantages for participants. Defining these boundaries will help in understanding the dynamics of online therapy efforts. Small, closed moderated groups that are organized by professional are called support groups, and the value of text for therapeutic interventions is explained before dealing with the one to one nature of email therapy.
Psychologists and other mental health professionals who offer, or plan to offer, therapeutic services over the Internet are dealing with a new and poorly researched form of interpersonal dynamics; text only relationships are not the norm. "Today's online professional may suddenly find him/herself in an arena where the written word is determined to be evidence of the quality of one's professional expertise and finesse. Voice tonality, pitch, and timbre—all good qualities in face to face (f2f ) and telephone communication—no longer apply where email and online conferencing are increasingly commonplace, actually preferred in many circumstances. With the advent of real-time chat groups, avatars, and two-way cameras, Virtual Therapy is already upon us" (Poulos, 1997).
In the ongoing debate about the value of, and ethics of, therapeutic virtual environments there are proponents at both extremes. Some conceive of technology as a panacea, a means to a bright future where anyone's emotional needs can be instantaneously addressed. Others are adamantly opposed to the use of distance psychology for any kind of intervention. It is important for mental health workers and social scientists to take an accurate appraisal of what is currently happening online. The Internet is, essentially, anarchy. If someone, anywhere in the world, wants to put out information or provide services by email, there is very little that can stop them. This is forcing the consumer to be the ultimate arbitrator, as the debate over net pornography illustrates. The current laws in the United States, regarding censorship of net porn, concede the world wide nature of the net; consumers are advised to install point of contact filters. So it is with fee based mental health efforts online, it is a 'let the consumer beware' situation. There are hundreds of open, unmoderated Internet forums that exist as self help, mutual aid groups. There is no way to stop members from disseminating misleading or false information concerning any aspect of the diagnosis and treatment of mental disorders. It is entirely on the shoulders of the concerned mental health professional to educate themselves about the psychology of online relationships, in order to help clients who are involved online, as well as to offer an ethically correct service when involved themselves online.
Several Internet forums exist for professionals to consult with each other and discuss the issues raised by the use of the Internet by people seeking help for mental illnesses. NetPsy is an open, unmoderated email discussion list for the discussion of the delivery of psychological services over the Internet. Instructions on how to join this list are available at http://www.concentric.net/~astorm/me/netpsy.html
'Research' is a similar list devoted to issues that are raised by researchers trying to delineate the psychology of online interpersonal interactions. Instructions on how to join this list are available at http://www.concentric.net/~astorm/me/research.htmlThere exists a wide variety of online service providers. Some are small and regional, others are national. America Online (AOL) has millions of subscribers, and offers content, and chat rooms, available only to it's members. Some of these areas self-help groups. Local bulletin boards exist that connect only people in one region with each other, and they often have self-help forums. For the purpose of the chapter, we will refer to online Internet groups and Internet therapy, without trying to address how these topics are different in electronic forums not connected to the Internet.