4. Technological reliability. Despite rapidly advancing technology, the Internet still has its shortcomings. Though websites can be made "secure," says Maheu, E-mails can be intercepted and chat sessions hijacked unless they are protected by both parties with encryption. Moreover, the connection can be spotty. Imagine if the moment after you divulge your deepest secret during a chat session, service drops. What would you think as your cursor blinks?
5. Lack of nonverbal cues. During face-to-face sessions, therapists have access to an array of nonverbal cues: whether a patient becomes tearful or blushes, say, or fidgets, bristles, or avoids eye contact. "These things make a difference," says Nagy. Even videoconferencing doesn't allow for the same clarity of signals that therapists normally get to help them understand their patients. Ask yourself if you're comfortable with that.
6. Backup. Issues that arise during therapy often are being explored for the first time, and emotions can spill forth unexpectedly. Maheu advises asking: What does the online therapist do if I get emotional during a session? What if we get disconnected at those times? Does he or she call my house or just forget about me? How does the therapist know where to send me in my local community? A therapist is supposed to have some ability to respond to your acute needs.
7. Training. Finally, it's fair to ask if the therapist has had any training in Web therapy, says Grohol. "I would be looking for people who had taken courses and really gone out of their way to try and be an expert—a specialist in this field." The American Psychological Association stipulates in its ethics code that professionals provide services "within the boundaries of their competence or undertake relevant education, training, supervised experience, consultation, or study," says Maheu. Yet, many professionals who offer therapy online can't document that they've undergone such training, she says. "Rather, they are just Dr. Pete or Dr. Sally, who might have had a practice for a while down the street and now decides to open a website and start delivering services to the world."
Though Maheu is an advocate of telemental health, she doesn't believe that therapy delivered over the Internet is quite ready for prime time. "Much better technologies exist than the Internet alone at this point," she says. An example, she says, is the videoconferencing system in use by the military worldwide. But she's training professionals in how to best use technology in practice now—and in the not-so-far-off day when the Internet can be unleashed in full force to counsel patients. Says Maheu: "It's so ready to explode."