For `Neurosis,' Press `Enter'

Rhonda Vought, an Augusta (Ga.) psychiatrist, has many patients she has never met. Take the woman who developed a severe food phobia after biting down on a hypodermic needle that mysteriously found its way into her restaurant meal. The woman had become weak from not eating and couldn't travel far for help. So she got on a computer hooked to a video relay at a nearby community center and poured out her feelings to Vought on the other end of the line. After two sessions, the woman resumed eating, says Vought, who works for the Georgia Statewide Telemedicine Program, which links psychiatrists to patients in remote locations.

VIDEO LINKS. It was bound to happen: The age of the cybershrink is upon us. With many people too far away, too busy, or too sick to make an office visit, a growing number of mental health practitioners are plying their trade on a PC. Some online therapists, such as Vought, offer video links to clients via a camera that sits atop monitors at both ends. But the majority of cybersessions are carried out through E-mail. Some counselors provide one-time "Dear Abby"-type advice on specific problems. Others engage in long-term E-mail exchanges. And a few host one-on-one, real-time, chat sessions.

Prices vary, from as little as $20 for a one-shot query to $100 or more for a month of regular E-mail exchanges. California recently passed a bill requiring medical insurers to pay for tele-health the same way they handle claims for face-to-face services. In other states, check with your carrier to see if you are covered.

However the cybertherapist conducts his or her practice, mental health professionals say that in most cases, online counseling should be used as an adjunct to traditional in-person therapy. For one thing, nonverbal cues so important to a therapist's understanding of a patient cannot be communicated well electronically. And while studies have shown remote therapy to be helpful for straightforward problems, such as mild depression and phobias, it is not recommended for treating serious illnesses such as schizophrenia or depression so severe that the patient is suicidal.

If you're interested in exploring online therapy options, a number of Web sites can lead you to Net practitioners (table). For example, the Telemedicine Information Exchange based in Portland, Ore., lists 47 test projects--some free--sponsored by hospitals, government agencies, and universities. One such project involves online psychiatry clinics offered by the University of Kansas.

In addition, dozens of psychiatrists, psychologists, and counselors make their services available through private Web sites. Before you sign up, you should know the therapist's real name, address, credentials, and references. A reputable site should tell you how long you will have to wait for a response, whether encryption is available for your exchanges, and what the limitations of this form of therapy are. "The more information a provider gives, the happier we are," says John Grohol, a psychologist and director of Mental Health Net, which verifies credentials of online counselors.

Licensing, liability, and ethical issues remain fuzzy. There are no formal standards for cybertherapy, nor is there any regulation. Since professional licenses are issued by states and the Internet cuts across state and national borders, it's unclear who would have jurisdiction if a patient wanted to sue.

Despite these challenges, the cybershrink field is growing. "I think we are going to see an explosion of this sort of therapy," says Martha Ainsworth, a Princeton (N.J.) Internet consultant who created the Metanoia Guide to Consumer Internet Mental Health Services Web site. While on a long trip, Ainsworth started corresponding with a counselor via E-mail and continued for over a year. "It was a wonderfully positive experience," she says. "I shared what was going on in my life with someone who brought professional expertise into the relationship. It really helped me through some rough patches."