Freud’s great contribution is not only in understanding the mind but also in forming an approach to therapy for people whose minds are suffering — that is, psychoanalysis. This approach links the patient’s reported symptoms to an emotional and mental stalling, or fixation, in early childhood. The trained therapist helps the patient, by means of a long and structured process, to revisit that early stage and handle the fixation.
The possibility of online emotional therapy came up even in the Internet’s early days. Critics of the idea balked at the thought that the therapist and patient would communicate online by typing, and they asserted that clinical emotional therapy has no place online. They argued that normally body language helps the therapist read the patient’s hidden messages, and that since long-distance typing leaves body language invisible, much misunderstanding could result. In fact there are cases where a patient’s body language expresses great distress that would not come through in text.
Nonetheless, I’m inclined to believe that if we could ask Freud, he would oppose the critics and strongly support online therapy. After all, in classic Freudian therapy the patient lies on the couch in order to enter a state of near-sleep that enables the unconscious to express itself, while the therapist sits in a chair at an angle that leaves the patient invisible. The absence of any line of sight between them is intended to help liberate the patient from inner defenses so that he or she may confidently release the sought-after story. It gives the patient a feeling of disconnection from daily experience, and of undisturbed immersion in the intimate monologue.
A variety of problems can be treated over the Internet, ranging from eating disorders, depression, and addictions (nicotine, alcohol, gambling) to various forms of anxiety that harm a person’s functioning by generating tension and uneasiness. Like regular therapy, the Internet sets up a therapeutic relationship between the patient and therapist; and online therapy accommodates the various approaches that are in the field today. Sessions are held using various means of communication, from private text-only chat to systems like Skype that make the patient and therapist visible to each other.
The limits of online therapy
Research shows some success for online therapy in cases of mild to moderate disturbance. And when patients might be a danger to themselves or their surroundings, or when the patient’s disturbance worsens and makes everyday functioning difficult, the Internet could be a brief way station, enabling the patient to rally and report for therapy in person. Such cases could involve severe depression or psychosis (where the patient loses touch with reality and hallucinates), bipolar disorder (manic-depression, where the person swings between deep depression and extreme euphoria), and more.
Online therapy offers the patient several advantages:
• There is no fear of being stigmatized. Even today there are people who worry “What will the neighbors think?” and those people may fear that going for therapy will brand them unfavorably in society. Therapy should not trigger a social stigma, and we should remember that emotional therapy is a professional procedure like any other — just like seeing the doctor for the flu — but until society corrects itself, there is comfort in knowing that for online therapy, you won’t be seen entering a clinic and you don’t even leave the house.
• Distance means nothing. Whether good therapists of the type you want aren’t available nearby, or whether you started therapy in person but then relocated, the Internet can serve as the solution.
Freud would presumably have supported the availability of online therapy. He would have seen this growing, developing field as an additional arena for a delicate discourse among the personality’s components: the id, the ego, and the superego. The Internet could even help reconcile the id, the ego, and the superego. For example, online role-playing games are a place where you can exercise less-developed parts of your identity in order to better integrate your identity as a whole.
But it’s not simple. Even the Internet has its rules, and respecting them is part of being a good web user or netizen. You can notice the rules as soon as you land on the home page of a site that is open for public use. A public website posts rules notifying every visitor what behavior is expected and what behavior violates the rules of the site. Repeated violations can result in a “ban” against the “offender.” A forum lays down clear rules such as “Keep your language clean,” “Don’t start a battle of insults,” “Direct any complaints against participants to the forum administrators,” or “No sale of illegal or stolen merchandise.” The penalty is clear: “Violators will be blocked.” In other words, you can’t simply say whatever youh want and do whatever you want.
And it turns out that even behind closed doors, inside fantasy games, people are under control. In Freudian terms, people’s online behavior can be defined as regression in the service of the ego rather than complete release of the id. “Regression in the service of the ego” means acting immaturely in order to advance the ego’s long-term goals. Behind some immature behavior that we see on the Internet, there may — from Freud’s perspective — be a significant purpose involving adaptation to life. Given the ability to occasionally leave strict behavioral formulas behind in favor of openness and creativity, people can more easily improve their definitions of themselves.