Can computers replace the therapist’s couch?

| July-August 1997

You’ve got an appointment with your shrink in five minutes, so you saunter into your den, settle into a comfortable chair (or even a couch) . . . and boot up your computer. Presto! The familiar visage of your therapist takes shape on the screen and, before you know it, you’re navelgazing with ease via modem and microphone, as if it were the real thing.

Welcome to video therapy. Though it’s hard to imagine therapy taking place in the hardwired, virtual world of cyberspace, therapists have begun exploring the potentials of this new kind of practice, both as a business opportunity and as a chance to reach clients who might not be able to get to their couch. Psychologist Marlene Maheu, editor of the online magazine Self-Help and Psychology, calls it the “next frontier in psychotherapy,” and like many of her colleagues, is both enthusiastic about its potential and worried that the managed care system will try to regulate it before the field has had a chance to work out the kinks. “I’m not against telepsychology at all,” she says in Family Therapy Networker (March-April 1997). “But I am against it being mandated.”

While most therapists have yet to take the leap into cyberspace (in part because video conferencing equipment costs as much as $5,000), there are already several shrinks who are offering Dear Abby-like advice on the net. Writing in Internet World (Feb. 1996), David Zgodzinski surveys a range of these advice sites, including Helpnet, whose panel of psychologists charge $20 a question and respond within 72 hours. “This apparently is a bargain,” writes Zgodzinski, “because these psychologists typically charge $100 to $200 per 45-minute session.”

But is it really a bargain if there’s no therapeutic benefit? Maheu cautions that e-mail exchanges are not sound evidence on which to base a clinical diagnosis. Zgodzinski is less critical. “If people can get satisfactory help and experience real healing via a paragraph of e-mail and a $20 debit from their credit card, so be it,” he argues. “These pay-per-use efforts are businesses, and they will succeed if their products are useful and attractively priced.”

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