Books and Articles on Online Therapy and Online Counselling (General)

There are quite a few broad surveys of what is available or of general browsing behaviour (both of which fall under the heading of market research), plenty of general overviews and introductions, and a few relatively narrow outcome studies. Deep insights, landmark empirical studies, or even rigorous philosophical or conceptual engagement are much harder to find. This section includes a partial sample of what is available, but caveat emptor.

Online Service Provision and Technology


Alleman, J.R. (2003) 'Providing Psychotherapy Over the Internet', Psychiatric Times XX (7). [available online]

This article raises more questions than it answers, but nonetheless it does ask many of the right questions.

BAC (1999) Counselling Online: Opportunities and Risks in Counselling Clients via the Internet. Rugby, England: British Association for Counselling.

Although, like most publications in the area more than a year or two old, this one is starting to show its age, nonetheless it provides a useful glimpse both at the field itself and of the development of BAC (now BACP) thinking in the area. Slightly marred by a weak discussion of encryption technology as well as by more than a few errors of citation (such as referencing the non-existent DSM-V, or a repeated incorrect reference to Pelling and Renard (1998)), the document is still worth reading even several years on.

BACP (2003a) Introduction to Online Counselling and Psychotherapy. [BACP Information Sheet] Rugby, England: British Association for Counselling and Psychotherapy. [available online]

This information sheet, written by Kate Anthony and Stephen Goss, provides a high level overview of the field and suggests that, "the potential for providing access to those unable or unwilling to access help by other means may yet prove to be immense". It is interesting to note that the document, the most publicly-accessible expression of BACP thinking in the area, strongly recommends additional training before providing internet-based services -- and provides a link promoting one co-author's own business for providing such training. This observation is not intended necessarily as a criticism, but I believe it is worth noting the conflict of interest.

Barak, A. (1999) 'Psychological Applications on the Internet: A Discipline on the Threshold of a New Millennium', Applied and Preventive Psychology 8: 231-46. [available online]

This well-researched review of ten different types of internet-based psychological resources, ranging from self-help guides to single-session email advice, concludes with a call for "intensive research and international brainstorming" (p. 231).

Cabaniss, K. (2001a) Counseling and Computer Technology in the New Millenium: An Internet Delphi Study. PhD dissertation at the Virginia Polytechnic Institute. [available online]

This is the full 232-page dissertation on which the summary in Cabaniss (2001b) is based.

Cabaniss, K. (2001b) 'Computer-Related Technology Use by Counselors in the New Millenium: A Delphi Study', Journal of Technology in Counseling 2(2). [available online]

This study points out that online service delivery is only one part of the overall range of uses to which counsellors are putting computer technology and urges that counselling training programmes better equip their graduates in the basics of computer-related technology. See Cabaniss (2001a) for the full study.

Christensen, H.; K.M. Griffiths and A. Korten (2002) 'Web-based Cognitive Behavior Therapy: Analysis of Site Usage and Changes in Depression and Anxiety Scores', Journal of Medical Internet Research 4(1): e3. [available online]

Although the authors are very circumspect and point to the need for randomized controlled trials to support any conclusions about efficacy, nonetheless this study of the authors' MoodGYM website for delivering CBT demonstrates both the feasibility and the real potential of this type of service delivery. Also see Christensen et al. (2004).

Christensen H.; K.M. Griffiths and A.F. Jorm (2004) 'Delivering Interventions for Depression by Using the Internet: Randomised Controlled Trial', British Medical Journal 328: 265. [available online]

This RCT concludes that both cognitive behavioural therapy delivered over the web and psychoeducation delivered over the web are effective in reducing the symptoms of depression; the CBT treatment mode also reduced dysfunctional thinking. This ground-breaking article builds on the success of MoodGYM -- see Christensen et al. (2002).

Day, S.X. and P.L.Schneider (2002) 'Psychotherapy Using Distance Technology: A Comparison of Face-to-Face, Video and Audio Treatment', Journal of Counseling Psychology 49 (4).

This randomized controlled trial compared process and outcome variables for psychotherapy conducted face-to-face, via video teleconference, and audio-only using a handsfree device. The study indicates that clients actually participated significantly more in both distance modes than in face-to-face psychotherapy, perhaps in part because clients feel they have to 'work harder' to convey meaning to the therapist than when in a face-to-face setting. In terms of outcome, all three delivery modes were similarly effective.

Eysenbach, G.; J. Powell, O. Kuss and E-R. Sa (2002) 'Empirical Studies Assessing the Quality of Health Information for Consumers on the World Wide Web: A Systematic Review', Journal of the American Medical Association 287: 2691-2700.

This review of 79 studies evaluating the quality of health information on the web (not specifically counselling or psychotherapy information) revealed that most (70%) cite quality as a problem, with 22% offering neutral evaluations and only 9% coming to a positive conclusion. Unfortunately, the methods used by different studies vary widely, making direct comparisons difficult, and the authors press for clear operational definitions of quality criteria.

Fenichel, M. (2002) 'Online Psychotherapy: Technical Difficulties, Formulations and Processes'. [available online]

This paper provides some basic observations about online therapy, including comments about fluency, visual cues, online disinhibition, and other aspects.

Fenichel, M.; J. Suler, A. Barak, E. Zelvin, G. Jones, K. Munro, V. Meunier and W. Walker-Schmucker (2002) 'Myths and Realities of Online Clinical Work', CyberPsychology & Behavior 5: 481-497. [available online]

This article, based on the experience of the Online Clinical Case Study Group formed by the ISMHO, examines and dismantles 10 different myths about providing counselling or psychotherapy online, making it an excellent basic starting point for uncovering assumptions about online work.

Goss, S. and K. Anthony, eds. (2003) Technology in Counselling and Psychotherapy: A Practitioner's Guide. London: Palgrave Macmillan.

A few minor complaints aside, this edited volume offers a solid contribution to the literature on how technology in three specific areas (email and IRC, telephone and video link, and stand-alone and practitioner-supported software) has been used in counselling and psychotherapy. The book is reviewed in full at

Granello, P.F. (2000) 'Historical Context: The Relationship of Computer Technologies and Counseling', ERIC Digest identifier ED446333. [available online]

This short historical survey concludes that "the greatest challenge to our profession in the future is not only to exploit the benefits of the computer-counseling relationship but also to advocate for the use of computer technology by the society as a whole in ways that protect -- rather than diminish -- human freedom and dignity".

Grohol, J.M. (2002) The Insider's Guide to Mental Health Resources Online. New York: Guilford Press.

Although prone to becoming dated rapidly due to its paper form, this is probably the most well-known paper compendium of online mental health resources. Grohol also runs PsychCentral and was a founder of the ISMHO.

Heinlen, K.T.; E. Reynolds Welfel, E.N. Richmond and C.F. Rak (2003) 'The Scope of WebCounseling: A Survey of Services and Compliance With NBCC Standards for the Ethical Practice of WebCounseling', Journal of Counseling & Development 81(1): 61-9. [available online as PDF]

This study of 136 sites offering internet-based counselling services reveals wild variation in practitioner qualifications, conformance with ethical guidelines, regard for client security and privacy, technical sophistication, and even site longevity. (Some 37% of the sites included in the study were no longer in operation 8 months later.) Not a single site included in the study was fully compliant with the then-current version of NBCC guidelines (since superseded by NBCC 2001). Although the study was published in 2003, data were gathered in 1999, and the field has moved on significantly since that time; even so, the research serves as a stark reminder that internet-based services must strive for very high standards indeed if this valuable method for delivering counselling and psychotherapy is not to be killed in its infancy by practitioners taking a cavalier or irresponsible approach.

Helft, P.R.; F. Hlubocky and C.K. Daugherty (2003) 'American Oncologistsí Views of Internet Use by Cancer Patients: A Mail Survey of American Society of Clinical Oncology Members', Journal of Clinical Oncology, 21 (5): 942-7.

An estimated 30% of US cancer patients turn to the internet as a source of cancer information, and oncologists identify both positive and negative effects on their work with the patients.

Kaplan, E.H. (1997) 'Telepsychotherapy: Psychotherapy by Telephone, Videophone, and Computer Teleconferencing', Journal of Psychotherapy Practice and Research 6: 227-37.

Written by a US neuropsychiatrist with personal experience of treating patients by videophone.

Kraut, R.; M. Patterson, V. Lundmark, S. Kiesler, T. Mukophadhyay, and W. Scherlis (1998) 'Internet Paradox: A Social Technology that Reduces Social Involvement and Psychological Well-Being?', American Psychologist 53(9): 1017-31. [available online]

This longitudinal study of families which had just begun to use computers and the internet at home provides evidence of a causal link between internet use and depression, but see LaRose et al. (2001) for evidence that the effect may be traceable to the fact that novice internet users experience stress induced by inexpert internet use, stress which contributes to depression.

LaRose, R.; M.S. Eastin and J. Gregg (2001) 'Reformulating the Internet Paradox: Social Cognitive Explanations of Internet Use and Depression', Journal of Online Behavior 1(2). [available online]

This study identifies two relationships between internet usage and depression. First, "usage as well as prior Internet experience increased self-efficacy, which in turn decreased stress encountered online, a contributor to general life hassles related to depression". Second, "as Internet use increased so did email sent to known associates, which increased social support, and in turn decreased depression. In other words, Internet use decreased depression through the use of electronic mail to obtain social support". The upshot: "social support can partially reverse the effects of Internet stress on general life stress and so on depression. But Internet usage can also increase depression by creating a new source of Internet stress, although that stress may be controlled by the development of Internet self-efficacy". Also see the earlier Kraut et al. (1998).

Lundberg, D.J. and C.I. Cobitz (1999) 'Use of Technology in Counseling Assessment: A Survey of Practices, Views, and Outlook', Journl of Technology in Counseling 1(1). [available online]

This brief article reports on then-current technology use by counselors and urges the development of technological expertise and effective technology training within counselling curricula. For a broader look at technology use, see Cabaniss (2001b).

Mulhauser, Gregory R. (2005) 9 Observations About the Practice and Process of Online Therapy, [available online]

If you've had trouble finding articles on online counselling or online therapy written from the perspective of a practitioner experienced in actually doing it (as distinct from merely writing about it or teaching others about it), this one is for you -- written by the first practitioner to log over 1 million words of fully documented, fully peer-supervised individual online therapy. From the abstract: The underlying therapeutic process of online counselling via email displays novel qualities in terms of its dimensionality, the role played by empathy and momentum, the significance of memory and sensory modalities, and the influence exerted by self selection bias. Asynchronous online counselling also introduces novelties to the basic mechanics of daily work, including a need for awareness of the practice peak to mean ratio, some subtleties regarding client consent for research, challenges for handling client backlogs, and a problem of representing counsellor experience honestly. Despite all this novelty, however, it seems that no fundamentally new ethical territory has been created by the advent of online counselling; there is, rather, merely new technological territory which challenges us to grasp its ramifications for existing normative principles.

Pelling, N.J. (2001) 'The Use of Technology in Career Counseling', Journal of Technology in Counseling 2 (2). [available online]

Although focused on career counselling rather than counselling in general, this article is useful for its well-referenced, if fairly basic, overview of the field.

Pelling, N.J. and D.E. Renard (1998) 'Integrating Cyberspace Into Counseling Practice and Research', Michigan Journal of Counseling and Development 25 (1): 5-12.

Referenced by Pelling (2001) in connection with information overload and referenced with an incorrect citation in BAC (1999).

Powell, J.; N. McCarthy and G. Eysenbach (2003) 'Cross-sectional survey of users of Internet depression communities', BMC Psychiatry 3:19. [available online]

This survey of users of online depression support communities in six European countries indicates high levels of clinical depression and underscores the existence of a large body of users with mental health needs that are not being met in primary care. While the study suffers somewhat from methodological challenges surrounding online surveys, nonetheless its findings break new ground in terms of understanding online depression support in Europe.

Stofle, G.S. (1997) 'Thoughts About Online Psychotherapy: Ethical and Practical Considerations', Rider University. [available online]

This interesting early article explores some of the ethical and practical challenges of online psychotherapy provision and concludes with a question just as relevant now as it was then: "If the ethical therapist is not online, who is?". The article comments favourably upon, and includes a link to, an online counselling site which when checked in April 2003 appeared actually to be an illegal online pyramid scheme.

Suler, J. (2000) 'Psychotherapy in Cyberspace: A 5-Dimension Model of Online and Computer-Mediated Psychotherapy', Cyberpsychology and Behavior 3: 151-60.

This article, both broad in its coverage and deep in its insights, explores five axes along which the therapist-client communication pathway can be understood: synchronous/asynchronous, text/sensory, real/imaginary, automated/interpersonal, and invisible/present. The article has been updated in the online version of Suler et al. (2003).

Suler, J. et al. (2003) The Psychology of Cyberspace, Rider University. [available online]

This online book was initiated in 1996 but is being continually updated and expanded. Including articles contributed by Suler as well as some from others, it is probably the single best resource available on the topic.

Sussman, R.J. (1998) 'Counseling Online', Counseling Today. [available online]

This brief survey explores the advantages and disadvantages of online service delivery via email, chat and videoconferencing and offers a positive prognosis for the development of the field.

Wilson, P. (2002) 'How to Find the Good and Avoid the Bad or Ugly: A Short Guide to Tools for Rating Quality of Health Information on the Internet', British Medical Journal 324: 598-602.

Probably the clearest conclusion from this short article is that, as yet, there is no guaranteed way of evaluating the quality of online health information. Nonetheless, the author usefully surveys codes of conduct, quality labels, user guides, filters, and third party certification.

Wright, J. and K. Anthony, eds. (2003) 'Future Therapy Stories', Counselling and Psychotherapy Journal 14(9): 22-25.

This imaginative story about the future of avatar technology in psychotherapy was created by Jeannie Wright and includes several alternative endings contributed by other authors, including Dr Greg Mulhauser, the editor of this site.


This page was last reviewed by Dr Greg Mulhauser, Thursday, 3 November 2022.