On the Virtual Couch

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Not everyone agrees. "There is no such thing as online therapy," says Dr. Thomas Nagy, a psychologist, Stanford professor and author of two books on ethics. "They're missing the nonverbal clues." For example, someone could claim to feel great but look disheveled and despondent in person. In an extreme case, notes Russ Newman, executive director of the American Psychological Association, a person could be talking to the online therapist while pointing a gun at his head; a dismissive comment from the therapist might just prompt the person to pull the trigger.

Therapists who counsel people online may be playing Russian roulette with their licenses and insurance. Most mental-health professionals are licensed only by the state in which they practice; counseling an online patient who resides elsewhere might be construed as practicing without a license. And while malpractice-insurance providers don't specifically ban online therapy, their coverage is contingent on adherence to state licensing laws.

Yet even these uncertainties haven't dissuaded the online therapists. "You take risks sometimes when you do this kind of work," says Jeanne Rust, who runs the eating-disorder website edrecovery.com "I decided to do that, because some of these people would never get into therapy if I didn't help them."