By Michelle Rafter
Nov. 2, 2009
When Dr. William Hapworth started offering psychiatric counseling and behavioral health services online, Google was a startup and MySpace, Facebook and Twitter didn’t exist.
That was in 2000, eons ago as far as online services go.
A lot has happened since then. Internet technologies got faster, smarter and easier to use, making people more comfortable doing all manner of things online: banking, shopping, dating—even sharing intimate details of their lives with total strangers. At the same time, companies started offering employees more inducements to stay healthy mentally and physically as a way to keep them working productively and curtail rising costs of health care and other benefits.
The confluence of these trends has given rise to Internet-based counseling and behavioral health services that are finding their way into company employee assistance programs alongside in-person and telephone-based therapies. The services use a variety of Internet-related platforms, including e-mail, instant messaging, live chat and, in some cases, Skype video calls or other Internet-based videoconferencing. Some providers even offer 24/7 service, so depending on who is running a company’s EAP, an employee could schedule a Skype counseling appointment at 3 a.m.
There’s no question Internet-based therapies are still a novelty. But vendors of the online services and the EAP benefit management companies they work with say they’re signing up more employers all the time and pitching others who are considering adding online therapies to their EAP benefits in the near future.
“Patients love the 24/7 access,” says Hapworth, an assistant clinical professor of psychiatry at New York University and founder of Treatment Online in New York City. “It’s treating patients where they are, not forcing them to comply with the idea that to get treatment they need to make an appointment to see me next month on a Tuesday.”
Treatment Online is currently rolling out an Internet-based therapy portal to 50,000 employees at the Cleveland Clinic, the nonprofit medical center. The online therapy provider already offers services to a portion of the approximately 1 million employees and dependents covered by Lubbock, Texas-based HealthSmart Preferred Care’s national PPO network.
Raleigh, North Carolina-based Workplace Options provides outsourced work/life counseling and other services for 150 EAPs covering 20 million employees and their families in 15,000 companies including Cisco, Pepsi and MetLife. Workplace Options has offered online therapy since 2002, “though it’s taken up to the last year or so for people to get comfortable” with it, says Alan King, the company’s president and COO.
Most of Workplace Options’ EAP providers offer their employer customers online therapy services for short-term problem-solving that would require up to six or eight sessions. Internet-based therapy doesn’t cost anything over and above what an employer would already pay. “For us, the e-platform is just one more mode of access,” King says.
One of Workplace Options’ clients is EAP Preferred, a private Phoenix company that provides work/life and other benefits to approximately 500,000 people who are mainly Arizona residents, including employees and dependents of public agencies, manufacturing and transportation companies. EAP Preferred president Paul Fleming started offering online therapy to 5 percent of his customers a year ago to see how it would take.
“I didn’t know how I felt about it,” Fleming says. “But after six months, use increased—to my pleasant surprise. Now customers are reporting great satisfaction from their employees. They like having the option of scheduling an Internet counseling session anytime it suits them.”
Over the next year, Fleming will begin offering online therapy to all existing and new customers. He now believes employers need to offer it to their workforces, especially if they want to hang on to Gen Y workers. “When you have a younger workforce that has been raised on Google, Twitter and e-mail, they work much better through Internet counseling,” he says.
As more employers consider online therapies, it’s causing vendors to jump into the business, including Internet startups such as MindSite.com, eTherapistsOnline.com and MyTherapyNet.com.
One new venture, MyTherapyJournal.com, withstood a grilling on the prime-time reality TV show Shark Tank in September to walk away with $80,000 in exchange for selling a controlling interest to two of the show’s celebrity investors. In a follow-up interview with AOL’s WalletPop finance blog, MyTherapyJournal.com co-founder Rodolfo Saccoman said the 2-year-old business accepted the deal because of the investors’ experience launching Internet companies. Because of the publicity, the company is now in “fourth-level” talks with Aetna to offer its service to the insurer’s corporate customers, and is in discussions with two other potential partners, Saccoman said in the interview.
Another startup, Breakthrough.com, gave the first public demonstration of its services at the TechCrunch50 technology showcase of Silicon Valley startups in September. The Palo Alto, California, company is currently talking to EAPs and other potential partners, according to founder and CEO Mark Goldenson, a former technology vice president at PayPal, the online payments company.
Providers say research done over the past few years in the U.S. and U.K. has shown online therapies to be as effective as counseling they would get in a therapist’s office or over the phone, if not more so. They also say because most providers offer it 24/7 via the Internet, it eliminates problems counselors encounter with patients dropping out of therapy because of embarrassment, lack of time or other issues.
But not everyone is convinced online therapy is ready for prime time. HIPAA regulations mean therapy companies must take steps to keep patients’ health care records private and secure. Many comply by channeling therapist-patient communications through an encrypted Web site, thereby preventing potentially sensitive messages from ending up in an employee’s work e-mail inbox.
State therapist licensing requirements are another potential stumbling block. Some states restrict therapists to treating only patients in the states in which they’re licensed. Other states bar therapists from treating patients online if they’re not also treating them in person.
About a year ago, Kellen Von Houser, a licensed professional counselor in Austin, Texas, bought the domain name MyOnlineTherapy.com and started an online therapy practice. She quickly discovered that therapists in Texas can treat people online only if they’re also treating them in person. Von Houser thinks the Texas law is unclear on exactly what’s allowed, and knows therapists who have chosen to ignore it. But she wasn’t willing to risk it and ended up shutting down her online practice. “We’re all waiting for a lawsuit to happen to settle those questions, but I’m not willing to be the guinea pig,” she says.
John Grohol was on the bleeding edge of online therapy when he started a company called HelpHorizons.com in 1999. The service was popular with therapists and patients, but Grohol and his partners didn’t have financial backing to go after EAPs, which at the time needed lots of coaxing to try the approach “We had a very uphill battle,” Grohol says. In 2006, he sold the business to Workplace Options, which incorporated it into its own online therapy offering.
Since then, Grohol has focused his energies on running PychCentral.com, a mental health information Web site. But he remains an online therapy fan and says the question isn’t getting companies on board—they’re all for anything that could potentially reduce costs while helping improve employees’ mental health. Rather, the sticking point is whether enough people will use it in lieu of face-to-face or even telephone counseling.
“Online dating or online banking are very different from having a therapeutic relationship” online, Grohol says. “The question is, have people gotten to the point where they’re comfortable enough in large enough numbers to understand the value of doing therapy online?”
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