Thanks, and what is the disadvantage?

It is truely online therapy like mental therapy,spiritual psychotherapy,relationship problem ,family counseling etc.

Advantages

1. Quick

2. Accessible in the technology ridden areas of the world

3. Effective (written) message

Disadvantages

1. Information from a stranger ( specially a professional company)

2. General information

3. Access to email (internet facility)

4. Lack of one on one interaction

5. therapy requires reading the message instead of thinking aloud and open communication 

6. Reading emails could be stressful specially those with therapeutic long messages

Hello Béatrice,

I think one big disadvantage is that email therapy is asynchronous (I am only talking here about email therapy.. no such things like voice or cam). Instead of having regularly meetings some therapists write to their clients each and every day. Paired with the fact of asynchronicity I see a higher risk that clients become too much dependend if not to say addicted. Another disadvantage: Many feedbacks get lost... like body language, the way a person speaks, spontanous reactions. As far as I can say for many therapists those play a big role too. When it comes for example to anxiety you cannot prepare anything for your client and lead your client through that process.

I agree with João that for some people any access might be helpful. But at what cost? Is a - so to say - sufficient therapy as good as conventional therapy? Or is it just momentarily sufficient? Or can it replace other therapies?

Advantage: it something instead of nothing (regarding the client implication and intention of change)

Disadvantage: the clinical relationship is absent. If we consider the 20%- 40% of therapeutic effect of the psychotherapist-client relationship, is a big point. I agree with Carmen Wrede that the problem of lack of reliable feedback is also a big issue here.

Dear Béatrice Edvalds-Kvist,

Advantages of an e-mail therapy might be: - regular contact between the client and the therapist.

- I might be possible that the client confesses details he would not tell in a direct communication.

The disadavantages are: no direct contact between the client and the therapist. Thus this therapy may not be the only therapy, but should be completed by other forms of therapy.

Dear Saima,

Thank you for your elaborate answer!

Dear Carmen,

Thanks, because e-mail therapy serves people who cannot leave the house and cannot afford more expensive forms of therapy I think it has its place.

Dear  F-M Werner,

Thanks, you wrote "It might be possible that the client confesses details he would not tell in a direct communication." This is an important point in a secular society where it is  no longer "in" with regular pastoral care.

Dear Abdul Khaleque,

I agree that according to my experience it is an effective form of therapy. A problem may consist of the confident's writing of many problems at the same time.·

I"m not a therapist, but a meditation teacher who also does research on meditation. Perhaps my experiences are still relevant?

I support my 1600 or so clients by email, Skype, telephone, and online forum. I would never be able to support them in person since they live all over the world.

I find that answering their questions by email works over half the time, by which I mean that they return from problems and dissatisfaction to peace and joy as results of their twice-daily meditation sessions.

For those whom email fails, switching to more interactive methods (Skype or telephone) almost always provides success.

In fact, every once in a while my advice produces better results than they are getting through psychopharmacology and psychotherapy alone (for those with diagnosed disorders). This most often happens, and happens spectacularly, when the complaint is with panic attack and anxiety. For those practicing effective meditation techniques, these disorders are easy to cure with an average of a week of simple advice. The reason is that meditation techniques like Transcendental Meditation and NSR actually dissolve the stored stresses (due to overloads of experience in the past) that cause such problems, With the stresses gone, only habits remain (habits of judging, disliking, and avoiding), and those are easy to fix by a process of interactive experimentation.

While it is insufficient to offer people who are suffering from disorders that reduce their functioning in life only email support, combining email with other modern modes of communications, and including the teaching of an effective meditation method such as TM or NSR, results in a very cost-effective and results-producing system for eliminating psychological and emotional problems, or in healthy people improving functioning in all aspects of life.

These are some of the reasons that several medical doctors, psychologists, and psychiatrists have regularly referred their patients to me over a period of years.

I hope my good experiences help others considering using modern communication methods to move forward with employing such usage. Let's help our patients and clients more by working more efficiently and more on their terms and at their convenience.

David Spector

Thank you. You write "good experiences help others considering using modern communication methods to move forward with employing such usage". This sounds very good. I think that the therapist can by means of email give better support because he/she can take time to elaborate the question from many different aspects.

Email therapy is a convenient and effective way to resolve problems.The Email-therapy, is extremely fast and reliable. This promotes greater connections with people than ever before.It allows people in rural areas or who otherwise have transportation problems to still have access to specialists in the  medical fields.

Email therapy is only part of e-medicine, for example-e-psychotherapy, e-psychiatry etc. Disadvantages of emails is the same as that of usual letters  ( see epistolary novels)

I don't think that email therapy has any advantages when it comes to serious medical problems nor can it replaceable a visit. In the contrary: You may misdiagnose your patients. It may work well when it comes to aftercare. But how should one differ for example between acute infection and serious problems like cancer without having that person in front of you? Without touching, making blood tests, smear test? Even when it comes to psychiatric issues: How exactly do you make a difference between depression and pretty serious hormone issues? Or don't you make blood tests first to exclude any manifest or latent problems?

Dear Carmen,

It is a known fact that e-mail therapy is not for acute crises and other serious problems.

Hello Béatrice,

it's also a well known fact that if doctors prescribe too much antibiotics bacterial resistance increases. Yet most practitioners are pretty reluctant about this fact. And what I think is: If some people go to seed this topic even more might do when it comes to email therapy. And I bet (!) especially when it comes to psychologic therapy there are enough smarty-pants who think it first of all is an easy way for making money  and people themself don't care. Just by googeling it I already found one example. They don't even want to see their clients. 15 minute talk on the phone and they are fine to offer you therapy.

There are good people and there are bad people.

Use and misuse is nothing new. There are also house band people.

Dear Beatrice, as it has been mentioned, the main advantages is rapid response. However, the main disadvantage is the lack of direct connection. The most important issue is a correct diagnosis, and direct contact is a most important for it. In too many case small details of patient response is crucial, but one can not explain this by email!

Dear Iva,

Use and abuse seems to go hand in hand. There are people paid for constructing viruses and other disturbances in computers. A percentage of the humans lacks empathy or has a toxic attitude towards life in general. A continuous struggle between good and evil - the good is winning in the end - is going on. However it does not decrease the value of reaching out to house-band persons with e.g. social phobias.  

Dear Taras,

Vielleicht fühlen sich einige Leute sicherer und weniger unangenem um etwas wertvolles oder peinliches to mitteilen. Jedenfalls ich danke Ihnen.

In some cases it can be a problem because the person who receives it will read the message with the "tone" according to his mood at the moment. He is not feeling well already, what if he reads the message with sarcasm, or as if the therapist were fighting with him? Another aspect of such messages is that people tend to use this message as an unrefutable message. On direct contacts we can question, agree with part of the message and  in written we tend to accept it without any questioning. So, it is a great and strong means of approaching a patient. The therapist has to be exteemely cautious. From far, a therapist does not speak to one's minds, he screams to people's minds and the message will not be printed on paper, but on stones. 

Dear Vilemar,

Our educator warned us during the training that we will always sound more harsh in written form!

The lack of emotional cues (body language, tone of voice) can indeed make emails seem harsh. I proofread my messages many times, not only to make sure that they are readable to clients, but also to ensure that they cannot be misinterpreted as mean-spirited, arrogant, or critical.

That does impose a little additional time overhead for each message, but such an overhead is well worth the speed and specificity of my response to the needs of my clients. I also use a variety of response methods, not just email, including voice consultation (via telephone or Skype) and an online forum. This tailors the speed and expense of the response method to the needs of the clients.

THank you David for the answer!

Dear Marcovic, 

True the belief factor is strong in the recovery process!

Marković G. Đoko , 

Matthew 18:18"Truly I say to you, whatever you bind on earth shall have been bound in heaven; and whatever you loose on earth shall have been loosed in heaven. 19 "Again I say to you, that if two of you agree on earth about anything that they may ask, it shall be done for them by My Father who is in heaven. 20 "For where two or three have gathered together in My name, I am there in their midst."

However I do not understand how this is connected to the present discussion?

Truly understanding the Bible always seems a matter of interpretation. Its meaning is sometimes clear and obvious, other times metaphorical or allegorical.

Dear David, 

What am I missing here?

I have no idea, sorry. Can you be more specific?

Thanks for your comments. However I lost the red thread when Michelangelo and 

the thought  "ask and it shall be given unto you" came into picture as regards e-mail therapy. 

My personal opinion is that normal prayer and alone time are good but you need someone to mirror your thoughts. Personality disorders go with a rather twisted lines of thinking. 

That is why we need someone to redirect our thoughts!

Or why we need the fourth state of consciousness/physiology to eliminate the dysfunctions that actually cause thought disturbances. Manipulating thinking can only produce temporary results. If you see a plant with brown, curling leaves, do you paint the leaves green, or do you water the root? If thinking is disturbed, find and fix the cause of the disturbance, don't advocate redirecting thoughts, a form of avoidance behavior. In the analogy, that is like painting leaves green.

Dear Beatrice

Email is another form of communication and like other forms, it can offers a media of healing - depending of course on the nature of the exchange and the value the participants have for it. My take on this is that value is substantiate by:

1. Belief in the person or the therapeutic methodology used.

2. The extent of knowledge – i.e. field of reference that support that belief or disproves it.

3. The emotional depth that support that belief and knowledge.

4. Other and more intangible factuality like intuition that maybe activate - consciously or unconsciously.

5. And another enfeeble element called love...

All these and probably more, are elements that support the value a person may have for that kind of communication or another.

Many people have already related to it in response to this question and your other question regarding the surprise recovery. I believe that the lesser the value the lesser the effect of the healing - no matter what kind. If the patient believe their therapist the healing would occur much more than if s/he does not - that belief would also support their belief in their own ability to recover. I even heard of some cases of placebo knee operation – with, anesthetic, scars and all the rest – but without replacing anything from real - that worked almost as a real operation.  

Probably two forms of love in this context:

Immature love says: 'I love you because I need you.'

Mature love says 'I need you because I love you.'

Erich Fromm

It takes a lot to come to the latter stage with a demanding and complicated client!

Yes it’s a wise saying – thanks for sharing it.

If to take it away from the personal arena - as a teacher of teachers one often uses the very simple approach; if you don't love people (in this case children,) there is no point in you becoming a teacher. Perhaps the same can be applied to therapists or healers of any kind?

Yes Erez, 

Life passes by and many things demand attention. To be too compassionate is not always good especially for those who think they are entitled to your time for free. 

Kindness is in our power, even when fondness is not.

Samuel Johnson

Absolutely Beatrice

Balance is the key factor for the movement forward

Compassion is one element; other basic elements that may partake in both therapeutic and educational processes can be:

Knowledge and knowing

Intuitive creativity

Principles and ethics

Applicable practicality

And many more of course…

Dear Erez, 

I agree fully!

If bibliotherapy can be healing, then e-mail therapy can. I suppose it could be like an interactive bibliotherapy, tailor made to the needs/concerns of the individual, rather than a mass-produced item geared to a more general audience.

This would actually be a great area for study.  Do you know of any research in this area?

Dear John, 

Thank you for your answer. I have not found good research in this area of therapy. 

Compassion, empathy, and so forth are excellent motivations to offer email contact to patients who are already receiving psychotherapy of some kind.

But what about patients who cannot afford therapy, or normal people who are unhappy with their lives, but have complaints that do not meet any DSM criteria?

I am a meditation teacher, and I routinely help these folks who are ignored by the traditional medical system.

The basis of my help is providing my clients with printed materials for learning transcending, an effortless mental technique that brings about a unique state of deep rest that gradually eliminates the stresses, tensions, and dysfunctions that are stored in our nervous systems merely by living in a stressed family, a stressed society, and a stressed world.

Most well-functioning clients find transcending sufficient for adapting to challenges at work and challenges in relationships. But a few have problems learning transcending correctly, or practicing it correctly over time.

Those clients need support, and I provide it through four useful channels: a free public forum (for help that can be explained quickly in text), email for questions and answers, and telephone and Skype for more in-depth or experiential voice consultations.

This is in contrast to most other ways people learn transcending, which require them to visit with a teacher, either in the teacher's home or in a meditation center. While there is nothing wrong with such a requirement, it adds dramatically to the cost of providing service to the client.

In order to reach anyone, my organization has chosen a business model that costs clients little more than the cost to us of producing and mailing printed manuals. We are run by volunteers, none of whom take a salary.

The use of email and other convenient channels makes support practical for us. The amazing truth is that one skilled meditation teacher (myself) is able to support anyone in the world with their practice of transcending. You can't get any more cost-effective than that without sacrificing quality or effectiveness.

I recommend modern computer and cell phone based communications for anyone offering help or support to clients.

Beatrice:

I have found some very good studies on your topic in ResearchGate and thought I'd share them:

https://www.researchgate.net/publication/227842148_Computers_email_and_therapy_in_eating_disorders

https://www.researchgate.net/publicliterature.PublicLiterature.search.html?type=keyword&search-keyword=advantages+of+providing+therapy+via+e-mail&search-abstract=&search=Search

I extend best wishes for every success in your research.

Debra

Article Computers, e‐mail and therapy in eating disorders

You may also wish to see our paper:

Robinson, P., Serfaty, M (2001). "The Use of E-mail in the Identification of Bulimia Nervosa and its Treatment." European Eating Disorders Review 9(3): 182-193.

This was one of the first RCTs to look at Email therapy.  

Here's the abstract, the paper is attached:

Despite the great potential of new technologies, no systematic study of e-mail therapy for subjects with eating disorders has been published. We recruited, using a single announcement made via e-mail, from all 20000 staff and students of a large college of the University of London, 23 individuals 􏰁all female) who appeared to fulill diagnostic criteria for Bulimia Nervosa or Binge Eating Disorder 􏰁DSM IV). These women were offered on-line therapy by one of two clinicians experienced in the treatment of eating disorders. At 3-month follow-up, 19 returned questionnaires and showed signi®cant reductions in outcome scores. Significant correlations were found between word count, a measure of engagement with treatment, and outcomes. This pilot study suggests that the Internet may be a useful way to recruit and treat those with eating disorders. A randomized controlled trial is indicated. Copyright 5 2001 John Wiley & Sons, Ltd and Eating Disorders Association.

Thank you Debra and Paul, 

This is very interesting and seems to work well for people who hesitate to 

seek help in other forms of therapy!

As I've said, I've used only email, online forum, Skype audio and video chat, and telephone for the last ten years in supporting my two thousand meditation clients all over the USA and the world. Few of these clients would have traveled in person to a meditation center for support. I've always found voice consultation (Skype or telephone) to be the most effective, due to the instant interaction, and email and forum being next as effective. I've also offered postal mail support for all these years, and never had a single taker.

While it is true that I am not a professional mental health provider, and that my support has not been psychological in nature, the results I have obtained have surprised even me, and pleased the physicians, psychologists, and psychiatrists who have referred their patients to this unique form of meditation.

I have also been able keep those clients with a diagnosed condition on their medication and/or keeping them regular in seeing their therapist.

Note: this is a nonprofit activity and I take no salary for this work.

Effects of Natural Stress Relief Meditation on Trait Anxiety: A Pilot Study, Fabrizio Coppola, Istituto Scientia, in Psychological Reports, August, 2007, vol. 101, pages 130-134

Natural stress relief meditation as a tool for reducing anxiety and increasing self-actualization, Fabrizio Coppola, PhD, and David Spector, in Social Behavior and Personality: an International Journal, May, 2009, 37(3), pages 307-312.

Dear David,

Your answer makes me feel the stress. We live in a world where there are very many takers and very few payers for help. Perhaps there is a gender difference. 

Dear Béatrice,

In my ten years of offering support online, I have not seen a gender difference in requests for help, in general. However, chronic pain disorders, such as myofascial pain disorder and fibromyalgia, are reported only by females, while sexual disorders are only reported by males.

My mentally ill clients (diagnosed or not, and treated or not) tend to get into a peculiar self-absorbed complaining mode (blaming external factors for internal distress), whereas my healthy clients tend to report stress (meaning challenges) in work life or relationships, prior to practicing transcending and enjoying the strength, intelligence, and creativity it generates for handling life's challenges.

Since transcending dissolves stored stress and tension, all of my clients report dramatic relief from both "normal" and unusual levels of stress reaction, usually within the first day to three days after the beginning of self-instruction (the NSR course consists of two lessons a day taken over three consecutive days). More rarely, clients may show a delay in such reports for several weeks or longer, due to incorrect practice that has finally been corrected by online support. A surprising number of clients who need support do not take advantage of it (whether free or paid) until overwhelming problems develop.

Concerning payment, those of my clients who are referred to NSR by mental health or medical professionals never report a problem in paying for services. Rarely, a member of the public complains about the course fee, even though we charge only 7% of the fee of our most popular competitor. It is not clear that such individuals actually learn NSR after I give them a reduced rate, since none has ever provided any follow-up information after they receive their learning materials. It seems to require a bit of motivation for people to learn something new, even when the instructions are very simple.

Note: NSR's business model is to charge only slightly more than it costs us to provide products and services. We charge $47 for our printed manual, mostly so that our clients will have the respect, motivation, and discipline necessary to learn from a manual. This payment "hurdle" seems to be necessary, as those receiving NSR as a free gift or at a reduced rate have never reported the usual benefits, which probably means that they never followed the instructions in the manual. In my opinion, charging artificially high fees for psychotherapy is probably unnecessary, since even a low or scaled fee probably has the same large psychological effect of generating a serious or interested attitude.

Dear David, 

You have a lot of energy and I am sure your work is appreciated. 

Dear Béatrice,

Thank you. My clients certainly appreciate our work, but we need the kind of recognition from society that would make NSR a household word. We've designed the organization so we can scale up our distribution linearly, without limit, so all we need is publicity. That means we need major unsolicited celebrity endorsements and coverage by major media, preferably National Public Radio and TV in the USA. And we need it without money, since we have none. These are our current needs.

All you need is the plan, the road map, and the courage to press on to your destination.

Earl Nightingale

.In our day and age, all you need is a GPS.

But I would add that it needs to be an inner & moral GPS too; thus you can also go into the unknown without a plan or a map.

Perhaps I am not understanding this conversation. It seems more abstract than the simple question whether or how email therapy can work. Is the root of this new conversation that we have fear about the use of email therapy? Are we afraid that patients will be harmed, or something like that? Or are we afraid that we will be harmed by using email to help people instead of just arranging practical things in life?

If there is fear, then that fear should be respected and explored. In fact, any fear should be explored independently of the story that seems to be associated with it. Such stories are mere excuses by the mind to torture us. Our inner self is greater than this, and is a source of confidence, peace, and happiness, never fear. Listen to the inner self, not the mind.

I hope this abstract response is of help to anyone feeling fear. If you need further help, use this forum, which is like email, to receive the therapy you need. In this way, fear can lead to an understanding of how email can be used to eliminate fear through understanding and accepting it.

Dear Erez,

you saved my day:)

Dear David.

All you need is exposure for your point of view and you get it through this "email-therapy"

“Courage doesn’t happen when you have all the answers. It happens when you are ready to face the questions you have been avoiding your whole life.”

                                     Shannon L. Alder¨

In conclusion:

“Abstraction can provide stumbling blocks for people of strange intelligence.”

― Gustave Flaubert,

Thank you. Quotations (epigrams, really) challenge us to understand how poetry can teach us. Poetry is the art of saying much in a few words.

In my opinion, email is an integral part of our time. The information can go anywhere in the world. It makes people work easier.

Dear Beatrice

Current world affairs with the corona-virus caused a situation when many more people would be ready to perceive your question and the value possible in this communication therapy.

In my opinion, 1) Email is much faster than regular mail. 2) a letter can reach the farthest corner of the world in a few minutes. 3) during the day, you can exchange letters with your correspondent on another continent several times.

Dear S. Béatrice Marianne Ewalds-Kvist

I think it is a positive, modern way and has many advantages, especially for the patient, but certainly there are some cases where we cannot do without clinical test

best regards