Although nothing in life remains constant but
change, change is something mankind resists. It is clear to most people that
the parts of our world based on information and communication will be hijacked
by cyberspace and yet professionals, maybe more than patients, resist.

Nevertheless, the editor of E-Therapy,
Robert Hsiung, guides us through the inevitable by harnessing the opinions of
clinicians, lawyers, patients, telepsychiatrists, and even webmasters. The
user-friendly book explores electronic therapy as a way to prevent some from
falling through the cracks without ignoring the pitfalls of losing the
face-to-face practice.

Chapter 1 is an overview and brief history of
using the Internet in the mental health arena. Robert Kennedy, the author of
this chapter discusses the information exchange from both the consumer and the
clinician’s point of view.  He states that the professional wants something
different online than the consumer — greater depth and scientific accuracy.
Yet Kennedy does not really make a good case for this. I believe he gives less
credit to the online consumer than I do.

The "Internet Expert" is covered by
Ronald Pies in Chapter 2. It is a delicate balance to provide useful
information and not give advice. The expert, for ethical, moral and legal
reasons, must learn to suggest options to solve a problem without suggesting
the solution to the problem. Tricky business but necessary if one wants to
retain their professionalism. He offers the all-proverbial warning that
"e-therapy is not a substitute for standard care but a supplement for
it." Possibly he’s right, yet might Pies be minimizing the impact of  24/7
medical support and instant information? Could it be that Internet care will
soon be the standard and face-to-face will become the supplement?

Joel Yager also describes in Chapter 3
"Case Study: Adjunctive E-Mail" how e-mail exploded as an adjunct to
his therapeutic approaches and how quickly it became an integral part of his
practice. Patients like the 24/7 access and Yager likes the support that he is
able to give in return. Yet, Yager, like Ronald Pies in Chapter 2, interprets
electronic therapy as an adjunct to face-to-face, not even exploring the
possibility of his face to face becoming an adjunct to the 24/7 support of
Internet. Having been through a crisis myself, I found that I went to my
therapist twice a month but logged on for support, information seeking, and an
on-line coach everyday. The land-therapist was definitely the adjunct to my
healing, not the primary source of my recovery. I think both these men-in fact all
of the authors in e-Therapy have not faced their own limitations in the
magnitude of what cyber medicine is offering today and will continue to offer
in the future.

Three women, Sara Gibson, Susan Morley, and
Catherine Romeo-Wolf, are more realistic in their appraisal of e-therapies in
Chapter 4, saying with candor that "the patients have tended to like telepsychiatry
more than the staff." The women seem less invested with ego-filters than
their male counterparts when giving their views about the benefits of mental
health cyber-treatment.

In Chapter 5 Gary Stofle reviews "Chat Room
Therapy" and explains the advantages and disadvantages of using that
medium. In Chapter 6, Peter Yellowlees examinesthe principles that should guide
the e-professional such as being flexible, recognizing their limitations, and
being respectful of the patient. He also warns of the dangers of the Internet
creating sicknesses as well as alleviating aliments. He humorously notes that hypochondria
turns to cyberchrondria. In a move the other chapters failed to address, Yellowlees
shows a chart from the consumer Health Infomatics contrasting the Industrial
Age of medicine, where self-care is discouraged, with Information Age health
care, where self-care/individual care is highly encouraged. He seems to have
the best grasp of the overall picture of what is happening in the electronic
therapies and how that relates to people gaining the upper hand in their own
care.

In "The Legal Implications of
E-Therapy," Nicolas Terry does a good job of explaining the areas of
concern from regulations (both state and federal), ethics, and privacy. And last
but not least, we see in Chapter 9 the whole business from the point of view of
the patient. Martha Ainsworth reviews e-therapy and walks the reader through
the evolution of Internet care from individuals to organizations. And she
defiantly points out the shift in professional thinking: it is not
"if" e-therapy should be provided but "how."

All-in-all the book provides a good solid
discussion of how mental health professionals can and should incorporate cyber
space into their practices. I would have liked to see more on how the Internet
can cause illnesses and the downside of misinformation than was presented. I
would have liked a whole chapter on circumventing the pornography/sex
addiction/child exploitation that any exposure to the Internet can fuel, but
that may be a whole book, rather than a chapter. The book is worth reading for
any professional in the mental health field-and although it fell apart in my
hands, just like everything else in the electronic age, it’s going to be
outdated by the time I need it again.

©
2004 Shelly Marshall

Shelly Marshall, CSAC, is a best-selling author,
leading researcher, and professional in addiction recovery and young people.
Visit her site: www.day-by-day.org

Categories: Psychotherapy, MentalHealth