It's a time for quiet celebration. Somewhere around here, although the exact date has vanished, is the tenth anniversary of the alphagarage -- that intrepid cluster of a dozen online friends whose bright ideas and incessant conversation made it obvious that we needed some kind of a website for adolescent peer counseling.
Since then, some parts of the equation have made a lot of progress, and some haven't. In June I finished my master's thesis, which was a compilation of literature about therapists' attitudes toward online therapy; it took me an extra year, came out to over a hundred pages, and nobody who knows me will be surprised by either of the above. (My diploma is still hung up by completely unrelated administrative issues, and nobody who knows anything about grad school -- etc.) By the beginning of this winter I should be able to launch a couple of web-based surveys about online therapy, about which more later.
It was fascinating to go to grad school and find out so many of the professional terms for the stuff that the garage arrived at, e.g., that what we used to call the "canary in the coal mine" is universally referred to as the identified patient -- but the principle is still the same: one person, usually under heavy duress, agrees to be a family's publicly disordered person so that the real extent of the family's dysfunction can be hidden as far as possible. No surprise there either, right? But in school, so far as online therapy was concerned, I was only able to arrive at two solid conclusions -- first, that it's vitally necessary, and second, that (in the United States at least,) it's not really happening. Yet.
I could point to a dozen reasons why that's true -- for example, the militant disinterest of most professional associations -- but there are two particular obstacles that will prove very difficult to get over. One is that, in almost every state in the United States, a therapist who resides in one state is forbidden to treat a client who resides in another, especially if treatment is taking place across that state line. This is a logical (but not terribly reasonable) consequence of being licensed, as a therapist, in only one state at a time. The roadblock that it creates to free exercise of online therapy is obvious. Less obvious, but still true, is the fact that most serious research and practice of online therapy is taking place in countries -- like the UK and Australia -- which don't have internal "state lines" that affect the national jurisdiction over therapy.
The second obstacle may be worse. Almost from my first week of classes I suspected, and after writing my thesis I know, that very few therapists are comfortable with computer use, with cyberspace, or with involving computers with therapeutic practice in any way. Again, there are too many reasons for this to look at separately here. But the distaste that the therapeutic community feels for computing impairs more than just online therapy; it keeps therapy expensive and logistically inconvenient, and saddles the practice of therapy with an incredible (and indefensible) administrative burden, especially for clients who pay through medical insurance. Other comparable professions, like law, accounting, and internal medicine, have embraced computing enthusiastically. Psychotherapy isn't there yet, and is still embroiled in tremendous arguments as to whether cybertherapy is appropriate at all. The community of practicing online therapists, and the one professional association to which I belong (the International Society for Mental Health Online, http://www.ismho.org), are much smaller in 2008 than I would have foreseen in 1998. All of this can be discouraging, but it also really defines the struggle for acceptance. And as it becomes more and more clear that we were all pioneers who took huge risks, I'm more and more proud of having been involved with the garage from the very beginning.
It may take ten more years, or twenty, or even more time than I have left, for online therapy to be comprehensively accepted in the United States. But it has to happen, or therapy constrained by the limits of "face-to-face" will dwindle to an old-fashioned, arcane, and inconvenient practice that excludes most of the people who need it. I'm going to spend (a lot of) the rest of my life trying to bring therapy into the 21st century; and of course, anybody who wants to join me is welcome.
honor, power, and more than ever, love,