Your therapist’s name is ELIZA, and she interacts with you through text on a computer screen. However embarrassing or difficult your problem may be, ELIZA will not hesitate to ask you a question about it, or respond graciously, “That is very interesting. Why do you say that?”
Computer-based therapy has come a long way since ELIZA, a 1960s computer program designed to emulate (and parody) a therapist. Today, with the Internet, people can use the instant message format to communicate with real therapists.
A new study in The Lancet suggests that real-time chat therapy with a psychotherapist is successful in helping people.
Participants were randomly assigned to either receive online cognitive behavioural therapy in addition to usual physician care — which may include antidepressant medication — or to continue their usual care and be placed on a waiting list. The intervention consisted of up to 10 55-minute sessions, five of which were expected to be completed by the four-month follow-up.
Of the 113 people who did online therapy, 38% recovered from depression after four months, compared with 24% of people in the control group. The benefits were maintained at eight months, with 42% of the online therapy group and 26% of the control group having recovered. The level of benefit shown in the study is about the same as could be expected from traditional therapy.
Experts say the Internet has enormous potential for psychotherapy, especially for reaching people who do not have access to face to face care.
People may be more willing to talk about things that are embarrassing or difficult if they’re not interacting face to face with a therapist.
There is also evidence that writing about traumatic events may contribute to mental health, said Dr. David Kessler of the University of Bristol, United Kingdom, who was the lead author of the study. “We think that writing gives people time to pause and reflect, and that this may help the therapeutic process,” he said in an e-mail.
This is exactly the kind of study that we need to show that computerised and Internet-based psychotherapy can be effective, but that’s a far cry from saying that this is going to replace psychotherapy. But there’s plenty of room for both in-person and Internet-based psychotherapy, Kessler said.
Another approach is more akin to e-mail, in which therapy takes place through messages between patient and therapist, but not in real time. This would also be less costly than in-person therapy because it would presumably require less time, Simon said. For a full live session over the Internet, the amount of time required is the same as an office session, so it may cost the same, or less, he said.
Generally, computer-based therapies are being marketed as stress management or employee assistance programs, Simon said.
Nagy has tried telephone therapy and video conferencing with patients whom he had already treated in his office, but who had moved away. Besides some technical difficulties with the video setup, he found it very much like a face-to-face meeting.