Online neurotics take problems to the e-shrink

JUST LIE down on the couch and try to relax. Now what seems to be the problem with your life? Take your time, log on and in your own words e-mail me all about it.

JUST LIE down on the couch and try to relax. Now what seems to be the problem with your life? Take your time, log on and in your own words e-mail me all about it.

Dr Freud had his couch, but now psychotherapy has entered the computer age. From today, a website will let would-be patients call up a psychotherapist's virtual consulting-room on their computer screens.

Neuroses, phobias, complexes, psychological problems, or a general unhappiness about your life ... the first step towards finding help, according to Paul Williams, a psychotherapist who set up the site, may be just a web-page away.

Other specialists in the field are not so sure. They point out that not only could such initiatives compromise confidentiality but the lack of face-to-face interaction between patient and client could result in the wrong diagnosis or referral.

However Dr Williams, who has set up the website independently of his NHS work, cautions that it is only a first step in "reaching a better understanding of yourself".

Those logging on to the site will be asked to respond to a series of on-screen questions by e-mail. Their answers will be, according to Dr Williams, analysed by a panel of six psychiatrists, psychologists and psychotherapists who will spend an hour preparing a report. It will be sent to the "patient" by e-mail within 28 days.

The service is not being run for profit and an on-line consultation costs £25, about a quarter of the real cost. It was set up to help people find out more about what is on offer.

"There are so many kinds of psychotherapy and much is of poor quality," Dr Williams said. "It is unregulated or self-regulated: anyone can set up and call themselves a therapist.

"Our report is only the first stage, but it does guide you in the right direction for further help, from an expert with the right sort of skills, in your geographical area, whom you can see face to face.

"And it does relieve a bit of pressure. There are in the NHS millions of patients and too few psychoanalysts or psychiatrists."

Other professionals questioned the effectiveness of the approach, saying on-line therapy needed rigorous academic research. "Making a provisional diagnosis or recommendation on the basis of a written response is fraught with potential problems," said Dr Hugh Koch, a chartered clinical psychologist.

"The panel can't make a reliable assessment because, by definition, the written information will be incomplete. There is no opportunity for the psychotherapists to question the patient and obtain more information and there will be no non-verbal information from the patient. This raises the risk of inappropriate treatment being offered because a patient may mention one or two problems without referring to underlying issues or disorders.

"People with depression or psychotic disorders could be given information or pointed in directions which are not in their best interests."

Susan Irving, of the British Association of Psychotherapists, said the service resembled the initial application form used by most psychotherapy institutions prior to a face-to-face meeting, rather than a full consultation.

"No live consultation would progress through a set series of questions," she said.

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