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14 Mar 2003

Cybertherapy as future of psychotherapy
Dear Cybershrink,

I am an Hon. student in Psychology tasked with an assignment on Cybertherapy and whether it is truly the new way to conduct psychotherapy.

I have had a look at the variety of questions that have been submitted as well as your responses. I was originally under the impression that in order to successfully conduct therapy via the Internet the therapist would have to attain certain linguistic or language skills - to read between the lines so to speak. However it doesn't seem to be necessary - as the questions have a tendency to be fairly descriptive (whether for the person self or a friend, relative of..).

I was also not aware that this type of facility existed in SA as Internet access and its benefits are not available to a large segment of the SA population.

I would like to ask you a few questions as a cybertherapist and as part of my research for this assignment.

* Do you think that this form of therapy could become a replacement for traditional face to face psychotherapy?

* What makes cybertherapy more appealing or a better option than would calling Lifeline which is also a form of distance therapy, with the benefit of staying anonymous and it will also more or less cost the same?

* Do you know if cybertherapy is effective?

* Do you build relationships with the individuals submitting their questions?

* Do you end up referring certain individuals for face-to-face psychotherapy? or to yourself for that matter?

I basically want to understand how you find conducting cybertherapy as opposed to traditional psychotherapy and how would you incorporate a cognitive behavioural appraoch, if at all?


I would really appreciate a response to my enquiries as so far you are the only cybertherapist in SA that I have managed to track down, and I believe that your insights will contribute to my understanding of cybertherapy and its efficacy.

Looking forward to hearing from you!!

Kind regards,
Evette.
Answer 511 views
Expert
CyberShrink
cybershrink

01 Jan 0001

Dear Evette,

Maybe, through our offices at Health24, you should obtain the details to enable you to contact me directly, as the issues you raise are too complex to deal with successfully entirely within this format ! Be sure to quote be accurately and with proper attribution in your assignment, and send me a copy !
Here are some initial responses --- so far as I know I am still the only "cybertherapist" in SA, if that is what we would call this art form. And I believe I am the longest-running such service in the world, so far as we can discover. Way back in the dim and distant early days of the Internet, before MWeb and other current ISP's existed, I was advising the CSIR, which ran an ISP called Worldnet Africa, which later became MWeb, and I developed the concept of a set of Expert advice web-sites, recognizing both their potential limitations and their poential advantages. We began with Cybershrink, and a GP, Dietician / Nutritionist, a Legal advisor, and a Vet ; and it proved successful and popular from the start.
Since responsibility for running these sites ( the Lawyers and Vet dropped out ) moved to the good folks at Health24 ( originally YourHealth.co.za ) the site has continued to develop more and more strongly, and we are planning further exensions to the MentalHealth section within this year, including a wider range of standing materials about disorders, enabling self-diagnosis and better choice of referrals, and far more information about all aspects of mental health.
I am convinced that this is NOT "the new way to conduct psychotherapy", but A new way to provide mental health services. To over-emphasize psychotherapy as such, rather than to see it within the context of a wider range of services, would be an error. DOn't focus only on cybertherapy as an equialent to formal psychotherapy ( which itself is not what most people need for most problems ) --- there is also a need for counselling, advice, and information. I am appalled by the extent to which the quesions I receive seem to reveal how many patients receive referrals for therapy, drug prescriptions, even major surgery, without apparently receiving basic explanations about the meanings of the terms used, and the mplications for them of the decisions being made. So clearly we also have a valuable supplementary function in helping people understand their options, choose treatments and interventions, compl with therapy, and evaluate the effectiveness of interventions from whatever sources.
Remember, there are obvious limitations to this medium. Until the noxious and greedy Telkom monopoly which has so chronically damaged and retarded the deveopment of Internet services in SA, is ended, major limitations remain. Access is needlessly costly, and could be enormously cheaper, were it not for the corporate greed that has insistd on maintaining the highest possible prices, especially for ordinary folks using dial-in services. Were it not for such greed, ordinary modem dial-in services could be nearer to free ; and ISDN and other fast access services, affordable to many more than the privileged few, as at present. Then voice-over-internet systems could enable services in which therapist and client could speak and hear each other. A Video facility to enable tem to see each other need not be expensive, were it not strangled by monopoly protectionism.
So there are limits to the extent to which a therapist can fully and compehensively examine the client, and the volume of information exchanged is necessarily lmited by currently available and affordable technologies.
On the other hand, there are advantages. Complete anonymity is possible for the. The requirement to summarize the problem in writing is, as some research has supported, valuable in itself. The system use here, allows both the opinion of the Shrink, and the participation in the discussion of other regular readers --- so there are elements of group as well as individual therapy.
Apart from my personal preference for cognitive-behavioural methods as the best-proven methods of psychological intervention, it is a method well-matched for this particula format. Years back I worked with an evaluated various methods of Brief Therapy, and there are elements of this, too, in the methods necessarily used in internet work.
Although the queries are often detailed and descriptive, it is still necessary to "read between the lines" ; and perhaps my earlier work in ( and my book about ) Psycholinguistics in Illness and Healing, may have helped !
There have been many wasted opportunities in the development of internet access in SA, but slowly access is being made more widely available, as through terminals in Post Offices and similar public facilities. More people get access through school, and many more at work. I have noticed a major shift in the last several years from the early years when most of the workload arrived on weekends, and week-nights, as people used home-based access ; to nowadays when by far the largest volume of queries arrives during the working day and working week, as presumably many people use office access.
Remember, internet access is far more widely and democratically spread acoss the SA population than is any form of access to traditional psychotherapists. It won't and shouldn't, in the foreseeable future, Replace traditional counselling, but can be an invaluable supplement to it, and can reach needy folks otherwise not reached at all. Combined with the langid and inexperienced "leadership" for mental health within the Dept of Health, I see no sign of any realistic effort toe xtend mental health services to most of the population. So supplemental services are essential.
Services like Lifeline are obviously also valuable, though they do not provide, as Health24 does so far, access to a fully and comprehensively trained specialist, rather than to a partially trained volunteer. Both services can be useful, but cannot replace each other.
Clearly, we do build relationships, though this varies. Some people pop in for a quick question, and don't follow-up ; but an increasing nmber of readers do as I recommend, and return to let us know how they're doing, and these confirm that many people have received a service they truly value and feel benefit from. Follow-up varies, but some have continued over a year or more ; and my record is a former patient from my days of running a major psych emergency and consultation service in London, who had been given up as hopeless and doomed by other colleagues in the UK, who I had treated intensively some 30 years ago --- who found me on the net, left us a message about the excellent life he has been leading in the interim, and we now have email contact.
Do I refer individuals ? Yes, often, as you'll see from the Archive. Many problems are clearly too complex for full management on-line, and need face-to-face therapy, and you'll notice that I frequently advise people to seek counselling, from a shrink, perhaps from agencies like FAMSA or POWA. I do not refer people from the web-site to myself in ordinary clinical practice, for a variety of reasons.
I notice among my non-webbed colleagues that one of their major interests in such work would be to see it as a means for promoting their more lucrative private practice, but personally don't want it to be seen as a method for advertising or as a "loss-leader" for other services. Most colleagues immediately lose interest when they realize that there is currently in this country no recognized method for them to be paid for providing such services --- neither the Medical / Health Professions Council ( usually paranoid about anything that might give sharper and brighter practitioners any advantage ) nor the Medical Aids, have seriously considered these issues, nor the value that providing a modestly priced, separate, online service might give to the deplorable sate of broad public mental health provision in Africa.
Well, there ae some thoughts to be getting on with ! I look forward to reading your conclusions and ideas on the subject.
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