Re: Why does the state still stand:

["E. ALLEN SMITH" <EALLENSMITH@ocelot.Rutgers.EDU>]

	Here's a partial copy (edited to stay within fair use) of the U.S.
News & World Report article I mentioned, off of their web site.
	-Allen

                           _UPSET? TRY CYBERTHERAPY_
                         
  _AN ONLINE VISIT TO THE PSYCHOLOGIST MAY PROVIDE AN ANSWER, CHEAP_
  
   Got the blues? Can't stop scarfing down bags of potato chips? Your
   spouse is always hostile, and you and the kids are, too? Therapy might
   help--at $125 a session. Or you could test a '90s solution: E-mail
   your way to mental health for a fraction of the cost.
   
   In the past year, angst has become a thriving niche on the World Wide
   Web. Many psychologists who are setting up home pages see electronic
   consultation as a way to plump up incomes hit by managed care and to
   attract new patients to the office. For the most part, these
   cyberpractitioners are careful to warn potential patients that the
   medium doesn't allow for detailed probing. "I give advice like Ann
   Landers and Dear Abby do," explains Dorothy Litwin, a New York
   psychologist who specializes in substance abuse, women's issues and
   couples therapy.
   
   Litwin is one of five women who joined forces about a year ago to form
   an electronic practice, Shrink-Link (address, box, Page 83). Four are
   New York State-licensed psychologists; one is a psychiatrist. Each has
   her own regular practice and specializes in a particular area of
   psychotherapy. For $20--you pay upfront by typing in your credit card
   number--you can send off your 200-word (or less) question; it is then
   routed to the appropriate therapist. Within 72 hours (often within 24
   hours), you get back two or three paragraphs of privately E-mailed
   advice.
   
   _ The short answer._ The cybercouch is most effective at giving people
   who can clearly identify the dilemma (my daughter is anorexic; I'm
   deep in debt and can't stop spending) a start toward a solution. A
   typical Shrink-Link question: "My 5-year-old was diagnosed with
   attention deficit disorder (ADD) in 1993 and has been on Ritalin ever
   since. She has been having trouble falling asleep for the past several
   months and has been moodier than usual of late. What do you think?"
   
   The gist of the response: "Some trial and error is often required
   before the correct dosage and timing are found, and symptoms such as
   sleep disturbance and moodiness often occur in the interim. Moreover,
   since children's rates of metabolism change, dosages often need to be
   adjusted. Even if the dosage is correct, the behavior irregularities
   you describe could be caused by administering the drug too late in the
   afternoon or by a host of other factors, such as nighttime fears.
   These possibilities need to be ruled out one by one until the culprit
   is found."
   
   The advice could well be to seek face-to-face counseling. E-mail
   exchanges are no basis for a diagnosis, for example, warns Marlene
   Maheu, a San Diego clinical psychologist who headed the American
   Psychological Association's subcommittee that recently looked into the
   ethics of cybertherapy. "It's impossible to get an anonymous patient's
   complete family history in a 200-word question," she says. And without
   such cues as voice tone, facial expressions and body language, how can
   a therapist be sure what the problems really are? "Smiley screen faces
   are a poor substitute for real communication," agrees Leonard Holmes,
   a therapist based in Newport News, Va., who says his online services
   are not therapy but "E-mail discussions." ("It's a bit more private
   than a call-in radio show," he notes.) Holmes charges $1.50 per minute
   and will spend as much time "with" a patient as the patient desires.
   
   Maheu's subcommittee and other psychology professionals worry that a
   lack of standards makes people seeking online help vulnerable. "When
   you are answering questions by E-mail, it's tempting to stray beyond
   your area of expertise," says Maheu. "The APA's ethical principles
   prohibit that." Critics also worry that confidentiality is at risk.
   While patients remain anonymous, a hacker could conceivably identify
   them. And these Internet sessions aren't encrypted. "You have no way
   of knowing who is printing the E-mail message out or where it is
   stored," says Thomas Nagy, a psychologist and Stanford University
   School of Medicine psychiatry professor. Nagy also worries that people
   with really significant problems will stop with an online Band-Aid.
   
   Troubling, too, is the fact that patients may know little about the
   therapist and his or her qualifications. Many sites don't disclose
   details about the counselors' experience and where they earned their
   credentials. Leonard Holmes, by contrast, provides a complete
   biography on his Web page that includes his educational background,
   what state he is licensed in, as well as areas of expertise. That way,
   interested patients can check out his professional background before a
   session.
   
[...]

   BY KERRY HANNON
   
   _A few routes to mental health_
   
   _Shrink-Link_ (http://www.westnet.com/shrink). These New York women--
   four psychologists and one psychiatrist--offer E-mail advice for $20 a
   pop.
   
   _Leonard Holmes_ (http://www.psychology.com/holmes.htm). Holmes is a
   therapist in Newport News, Va., who answers E-mail questions for $1.50
   per minute and provides links to other sites.
   
[...]

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