A Brief History of Online Counseling
Online counseling (and online therapy) is the practice of providing outpatient psychotherapy services remotely through the use of an online platform. In this article we will trace key points of the history of online counseling from the founding of the discipline of psychotherapy in the 19th century to the present day.
1890-1910: Origins of psychotherapy . . . and remote psychotherapy
Sigmund Freud, the famous Austrian neurologist, founded the profession of psychotherapy in 1890 with his psychoanalysis. Freud’s couch has become an enduring symbol of the field of psychotherapy, but a lesser known fact is that in addition to in-person treatment, Freud conducted psychotherapy remotely through the exchange of letters. Remote practice, in other words, has been with psychotherapy since its inception.
The profession blossomed over the next half-century, and while psychoanalysis itself has since come under heavy criticism, other psychotherapy models such as cognitive-behavioral therapy came into being by the 1950s and are well-supported by research today. By the 1960s, professionals began practicing psychotherapy with the audio capabilities of the telephone. While there is no known record of the nature of these pioneering audio-only psychotherapy sessions, this was a landmark event for the mental health professions and foreshadowed the movement of the field into the online sphere.
1966: The Massachusetts Institute of Technology (MIT) creates a computer application that simulates a psychotherapist.
In the 1960s, the internet as we know it did not yet exist. Computer pioneers were beginning, however, to experiment with creating interconnected networking systems from one computer to another. In 1966, the Massachusetts Institute of Technology (MIT) created a text-based computer application, named ELIZA, to simulate a Rogerian psychotherapist who is trained to respond to a client’s question for the therapist with a question in turn for the client. Some versions of ELIZA are still live on the internet, and are amusing (and somewhat irritating) to play around with. In the 1960s, some users believed they were chatting with a real medical professional –don’t make the same mistake!
Similar applications made by other universities followed soon after. The next decade would see new breakthroughs in interconnected computer technology including the advent of the internet as we currently know it. With these advances came new understandings of the potential for online counseling.
1972: The UCLA-Stanford demonstration
Unsurprisingly, the rise of online counseling has been intimately to the rise of the internet as a whole. But just how quickly the potential for online therapy followed the advent of the internet is is rather surprising. The first demonstration of the internet occurred in 1969 between computers at the University of California-Los Angeles (UCLA) and Stanford. Only three years later, in 1972, computers at the same universities simulated a psychotherapy session.
1986: Cornell University Launches “Dear Uncle Ezra”
Cornell University launched the world’s first online advice column, Dear Uncle Ezra, in 1986 under the direction of psychologist Jerry Feist. “Uncle Ezra” has responded to over 20,000 questions from both Cornell students and advice-seekers from over 30 countries. The identity(ies) of Uncle Ezra over the years has been kept private by the university, though it has confirmed that Ezra has a background in mental health. Questions answered by Uncle Ezra range from curiosities such as “how long does it take for a tulip to bloom?” to serious queries about mental health including suicidality. Uncle Ezra went on sabbatical in 2012.
Early 1990s: Mental health professionals take online advice-giving from the university into the private sphere
From 1993 to 1995, several mental health professionals, including Ivan Goldberg, M.D., John Grohol, Psy.D. began to offer mental health advice online in free online support groups and chats. Leonard Holmes, Ph.D., who offered online mental health advice on a ‘pay if it helps’ basis, was perhaps the first who could have been considered a professional online mental health provider due to his acceptance of monetary compensation for his work.
David Sommers, Ph.D., however, is generally identified as the originator of online counseling as we know it today. Rather than answering single questions in an advice column format, Sommers in 1995 was the first to establish long-term therapeutic relationships with clients from around the world through internet technology using a fee-based model for services. Ainsworth notes that before 1995 she had identified only 12 mental health professionals practicing online.; by the late 1990s, online mental health clinics began to appear with regularity.
Late 1990s: The Rise of Online Counseling
The last few years of the 20th Century can be seen as time period in which the industry of online counseling emerged. With the rise of online mental health clinicals came the first broad attempts at regulating the practice of online counseling. In 1997, the International Society for Mental Health Online (ISMHO) established itself with the intention of aiding mental health professionals in online practice by developing standards for online interactions between practitioners and clients.
We see again that developments in the field of online counseling followed close behind similar developments of the internet as a whole. The early attempts of the ISMHO to provide guidance and standards for online counselors came four years after the word ‘netiquette’ was coined, which itself represented an acknowledged need to define standards of behavior for interaction in an online world.
The 2000s: The arrival of the internet age
With the arrival of the 21st Century came a new internet age. The Dot-com boom of rampant speculation in internet companies was nearing its height, and in 2001, for the first time, most American households had a personal computer. By the close of the decade, over 75% of Americans used the internet.
Around this time, research began to catch up with technological innovation. A number of core studies began to validate the practice of online counseling beginning around the decade’s end. The United States Veteran’s Affairs (VA) began a four-year study in 2006 concluding that online psychotherapy consistently yielded positive results for clients, including significantly reduced clinical symptomology and negative outcomes.
An even larger study conducted by the University of Zurich, begun in 1996 and concluded in 2011, found clinical results of online online counseling comparable to those of traditional in-person counseling. Additional research has further validated this finding. As a result of clinical trials affirming the effectiveness of online counseling, the Netherlands began reimbursing online cognitive-behavioral therapists with its public insurance.
Still, despite these validations there remained criticism of online mental health treatment.
2010s: Startups enter the field, and insurance companies expand their coverage.
The 2010s saw new developments in the field of online counseling. The online-only counseling service Talkspace was founded in 2012, which today is one of the leading online counseling providers in the country. While initially a strictly group therapy platform, it morphed over the years into the online counseling behemoth it is today. This decade also saw more countries follow the Dutch in authorizing insurance companies to provide coverage and reimbursement for online counseling.
This writer began practicing online counseling in the latter years of the 2010s with clients who had begun treatment in-person but had for various reasons moved to other parts of the state. The availability of telehealth technology, and coverage of online counseling by many insurance providers, has helped many such individuals to maintain both stability of treatment and financial feasibility of treatment throughout periods of transition.
2020 and beyond: Online counseling goes mainstream
The outbreak of the COVID-19 coronavirus pandemic has cast a shadow over all else since the current decade has begun. With the unbelievable tragedy and loss of life the virus has wrought, there have also been silver linings. One of these has been the normalization of online counseling in the mainstream, as well as the rapid expansion of coverage of online counseling services by insurance providers.
While we don’t yet know what the field will look like when the pandemic finally passes, it is informative to trace the history of online counseling throughout the decades and to recognize that remote practice of therapeutic counseling services has been a part of the field since its inception, with Sigmund Freud himself utilizing the resources of his time — in his case, the post office — to treat clients from afar (not that this would be an acceptable practice today). We see that innovators in the profesion of psychotherapy have been pioneering ways to use the technology available to them since the inception of the field.
Online Therapy in Virginia
Virginia Counseling offers online therapy to everyone in Virginia. Contact me to schedule an appointment.
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References:
- Skinner, A; Zack, J. (2004). Counseling and the internet. American Behavioral Scientist.
- Ainsworth, M (2004). E-Therapy: History and Survey. Metanoia.
- Green, D. (2004) The History of Online Psychotherapy. Psychom.
Photo credit:
- Jason Scott, CC BY 2.0 https://creativecommons.org/licenses/by/2.0, via Wikimedia Commons
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