Academic journal article American Journal of Psychotherapy

E-Mail as an Adjunctive Tool in Psychotherapy: Response and Responsibility

Academic journal article American Journal of Psychotherapy

E-Mail as an Adjunctive Tool in Psychotherapy: Response and Responsibility

Article excerpt

In a world of technological breakthroughs, it is not surprising that psychotherapists have, along with the general population, taken to the multiple possibilities offered by devices or systems that affect communication. E-mail, now an ever-present phenomenon of near "real time" interaction, provides a myriad of possibilities for enhanced dialogue in psychotherapy relationships. This paper will describe the growing phenomenon of e-mail as an adjunctive tool in psychotherapy practice by initially reviewing the most current of the recent literature. The authors will present a model for the adjunctive use of e-mail between patient and therapist. Case material will illustrate this model as applied to ongoing treatment, crisis intervention, and follow-up.


"Hey, maybe we could start doing my therapy through e-mail.

Save me 3 bucks (parking) and 2 hours of work time" - patient e-mailing to therapist

E-mail is ubiquitously present in all facets of life. The e-mail revolution features millions of subscribers in business, personal relationships, and now even inpadent care. For many, the purpose of a computer is primarily for transfer of information to friends and colleagues and for some, it has clearly taken the place of the now primitive telephone. It is efficient, retains a record in minimal, if not microscopic space, can be hard copied, and streamlines communication. One can even both e-mail and speak on the telephone at the same time-an impolite behavior- but efficient, nonetheless.

E-mail is somewhat sterile and might appear less personal than a telephone conversation or a face-to-face communication. Sighs, frustrated emotions, terseness, irritation-all may be lost in the process of the e-mail transaction. Even when the e-mail interaction is near-immediate in nature, that few seconds before the response is received can dramatically alter the emotional quality of the interaction.

In exploring the e-mail revolution's potential in the world of psychotherapy, we will first review the small body of work addressing this subject. A description of the potential for e-mail exchanges as an integral adjunct to some psychotherapy situations will follow. Warnings of both the obvious and not-so-obvious pitfalls will be addressed. The question of whether e-mail really can be injurious to the course of psychotherapy will be considered. Case examples will be reviewed that illustrate the process at its best and worst.

In focusing our attention on e-mail as an adjunctive tool in psychotherapy, we will not address the still unresolved questions about the ethics, legal implications, depersonalization, and privacy issues, often mentioned in criticism of e-mail and the psychotherapy process. In limiting our discussion, we are not suggesting that these are unimportant considerations; but as the e-mail revolution has already arrived and is in active use in the clinical community, we will instead proceed with our intention to address the safe and ethical application of this technology.

The paper will initially review the limited but varied literature on e-mail applications in clinical practice. Distinctions shall be made between the utilization of this model as a primary means of communication between patient and therapist versus its application as a facilitating adjunctive communication device in face-to-face psychotherapy. We will not tackle the broader application of this technology to conducting "online psychotherapy"-a growing yet still fledgling form of the clinical practice. By focusing narrowly on e-mail for adjunctive utilization, we hope to build a foundation for more comprehensive application of the e-mail phenomenon as a primary tool in doing psychotherapy. We, one a personality psychologist turned clinical social worker, and the other, a clinical social worker from the outset, have utilized this medium in the practice of individual psychotherapy.

E-mail communication is still in the early stages of evolution, having been adapted by some clinicians influenced by market forces. …

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