Computer-mediated interpersonal communication has become widespread by Internet technology. This revolutionary channel of communication has opened a new window of opportunity for psychologists interested in interactive therapeutic interventions. The new way of therapeutic communicationÑhaving prospects and promises as well as risks and hazards (Childress, 1998)Ñhas attracted a growing number of service-providing mental health professionals (Barak, 1999). The asynchronous communication optionÑmade possible by e-mail and e-mail-based discussion groups and web-based forums for individual and group communication, respectivelyÑhas a major advantage: time and place elasticity. This technology, however, lacks a key feature of human interpersonal communication characterized by spontaneity, authenticity, immediacy, and directness. This feature is directly related to the commonly accepted and generally appreciated therapeutic factor of Òhere and now.Ó Numerous schools of psychotherapy argue that this immediacy factor may be responsible to a great degree for dramatic therapeutic developments. In addition, defense mechanisms or cognitive distortions (depending on school of therapy) are less likely to take place in a Òhere and nowÓ therapeutic situation.

Nevertheless, cumulative evidence, from anecdotal reporting as well as from empirical studies, supports the use of asynchronous, Internet-based communication for both individual and group mental help (e.g., Barak, 1999; Fink, 1999; King & Moreggi, 1998; Murphey & Mitchel, 1998). Online group interventions have focused primarily on support groups in various areas of need, such as sexual abuse of women, cancer patients, and single parents. The clinical proposals for interventions, and actual interventions provided, have primarily been asynchronous. An exception are the attempts made by Suler (1996a, 1996b), who viewed and analyzed psychological opportunities at the Palace, an Internet-based multimedia, live chat environment. Therapy-focused groups, using synchronous (i.e., real-time) communication, however, have hardly been offered and, therefore, have not been subject to research to date.

There might be two explanations for this: first, Internet chat rooms are relatively newer than e-mail distribution lists (listservs), and hence have had fewer opportunities to be used for therapeutic purposes. Second, from a technical point of view, web-based chat rooms have changed from the less reliable and less friendly HTML-based technology to advanced and efficient Java applications. In addition, the technology of password-protected chat rooms is relatively new. Suler (1999) listed several advantages offered by synchronous Internet communication: clear scheduling and definition of Òmeetings,Ó a feeling of presence, more spontaneous interactions resulting in more revealing disclosures, perceived commitment and dedication, and the inclusion of specific cues not present in asynchronous sessions (e.g., pauses in communication). He listed a few disadvantages as well: less convenience, and reduced time for responding and reflecting. Sempsey (1998), too, advocated the use of synchronous Internet chats (basically referring to MUD communities). To date, however, only a few attempts have been made to exploit synchronous Internet communication for therapeutic and/or consultation purposes. With the exception of Cohen and Kerr (1998), those attempts that have been reported (Colon, 1996; Quimby, 1999) lack close research, and mainly refer to practical considerations. The purpose of this study was to examine group therapy procedures that took place in an Internet, Java-based, password-protected chat room, and to compare its usefulness to a standard therapy group as well as to a no-treatment control group. We employed both quantitative and qualitative methods in examining the impact of the new intervention.
 

Participants

Interventions

Participants in both intervention groups received time-limited, dynamically oriented therapy (Hudson-Allez, 1997; Wells, 1993). Therapy was provided by two female group therapists. Both therapists were similarly experienced professionals, in their 30s, and skillful in brief dynamic therapy. We preferred having two different therapists over a single therapist to prevent contaminating biasing effects. The therapist for the Internet chat-room group, in addition to her therapeutic skills, had reasonable personal experience in using the Internet and in participating in Web chats. Participants in the Internet-based group therapy met in a Java application, password- protected chat room for seven sessions of 90 minutes each. All sessions were held at a predetermined timeÑthe same day and time every week. Graphically, the chat room had three scrolling screen windows: a vertical side window on which the nicknames of participants were shown, a large window on which all group message exchanges appeared, and on top of this one a smaller window on which the therapistÕs messages appeared. Under the windows was a text box in which participants typed their messages. All participants in the chat room used nicknames, whether real or fabricated. At the beginning of the first session, the therapist provided a list of several specific rules in regard to communication and behavior (e.g., stay alone by the computer; use of certain code symbols to denote certain messages). Then the therapeutic communication began. Upon completion of each therapy session, we electronically saved the transcript of the group communication. The therapist used the transcripts after each session to analyze the group and to prepare for the next session. After the completion of the project, the transcripts were used to evaluate group processes.

Participants in the standard, face-to-face therapy group also met at a predetermined time in a convenient room on the campus of the University of Haifa.
 

Dependent Measures

Measures of Therapy Impact: Self-Esteem, Social Relationships, and Well-Being

Group Process Variables

Evaluation Questionnaire

Procedure

Participants were given the research questionnaires approximately two weeks before the intervention started. The questionnaires were sent to and returned from the Internet and standard intervention group participants online and through regular mail, respectively. Participants continued with their regular lifestyle during the seven weeks of therapy; they were invited to contact us in cases of technical difficulties. Participants in the Internet-based therapy group commonly used their home computers, but were allowed to use any location they wished for connecting to the chat room. In several cases, participants in this group contacted us for technical reasons (e.g., difficulties in connecting to the Internet). In all cases, problems were solved satisfactorily. Upon completion of therapy, the research questionnaires were re-administered to the participants. Members of the no-treatment control group were administered the questionnaires at the same points in time as were the members of the therapy groups. Later, we independently interviewed the therapists in regard to their respective professional experiences.
 

Results

Quantitative Analyses of Dependent Measures

The Evaluation Questionnaire revealed that participants in both groups expressed general satisfaction with their respective group therapies; there was no statistical difference here between the two groups. A review of the specific items administered to the participants of the chat-room-based therapy found that anonymity was a major factor in their readiness to open up. Furthermore, although participants in this group felt emotionally close to one another, they were not particularly interested in actually meeting the other group members.
 

Qualitative Analysis of Chat Room Transcripts

TherapistsÕ Evaluation

Although this study should be considered preliminary, and its findings should be handled carefully, it seems that an anonymous, Internet-based, chat-room group therapy is a legitimate method of psychological intervention and has a positive impact on interested individuals in need. The quantitative measures showed a trend toward positive change in terms of participantsÕ self-esteem, interpersonal relations, and well-being in comparison to the standard therapy and the no-treatment control groups. We believe that the statistical non-significance of these findings should be attributed mainly to the very small group size and apparentlyÑas emerged from both participants and therapistsÕ feedbackÑfrom the limited number of sessions, as well. In terms of group dynamics, as reported by the participants, some of the group processes evinced by the two groups were similar, and others were different. Interestingly, the factors found to be different between the groups are consistent with those that characterize online group behavior (King & Moreggi, 1998). In terms of satisfaction with therapy, both groups were similarly partially satisfied. From a qualitative perspective, moreover, the chat-room group experienced therapeutic factors that typically exist in therapy groups. Taking all this evidence together, we may cautiously conclude that an Internet chat-room could be used for group-therapy purposes.

The current research has several limitations that warrant attention. First, as mentioned above, the groups were very small therefore one should be cautious with generalizations. That is, we do not know how individuals in other age groups, level of education, or problem areas would react to such an online intervention. Moreover, as indicated, the small size of the groups prevented us from detecting what seemed to be significant differences. Only future research, replicating and extending our preliminary investigation may offer answers to these problems. Second, while we preferred using two different therapists in the face-to-face and the online groups for methodological reasons (preventing a therapistÕs biasing effects), this choice could have resulted in yet other erroneous findings. That is, differences in the therapistsÕ personality, motivation, or skill level could be responsible for differences between the groups rather than the different therapeutic modality. This possibility, too, should be examined in future investigation. Intensive research is needed to further examine numerous other professional and scientific questions, such as the preparation of therapists for this type of professional conduct, the rules by which groups ought to operate, and so on. The findings of this study, however, provide initial empirical support for the use of an Internet chat room as a legitimate therapeutic mode.

Much has been said and written in recent years about the growth and change mental health professions are going through in relation to the Information Revolution and opening opportunities in cyberspace. For instance, Grohol (1998) listed seven significant reasons why online therapy has prospects for becoming an effective and accepted line for provision of mental help: perceived anonymity of users, computer-mediated communication disinhibiting effects, accustomed Net use, response immediacy, trying out new behaviors in a secured online situation, providing of help to people who cannot access help otherwise, and the resemblance of online situations to real-world situations. Finfgeld  (1999) added a few other reasons for providing mental help online, emphasizing institutional aspects: general professional moving from inpatient to outpatient clientele; the change toward short-term, crisis-oriented care; availability of computers and Internet communication; and the resourcefulness and ingenuity made possible by the new technologies. Fink (1999) extensively demonstrated how the Internet, in addition to the exploitation of personal computers, can effectively be used for psychotherapeutic applications. The current research, though limited in scope and empirical examination, is taking the field a step forward in proposing and testing what only a short while ago seemed to be a science fiction. If we can maneuver our professional conduct wisely, profiting from the advantages while avoiding the pitfalls of online-based mental help (Barak, 1999; Childress, 1998; Lebow, 1998), we may advance psychotherapy to a new and much improved realm.
 

A shorter version of this article was presented in S. A. King (Chair), Internet Support Groups: Group Therapy by E-mail and Chat, Symposium conducted at the annual convention of the American Psychological Association, Boston, August 1999. The authors are indebted to NetVision, an Israeli Internet Service Provider, for the donation of the Internet chat room and related programming. Correspondence concerning this paper should be addressed to Prof. Azy Barak, Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel. E-mail: azy@construct.haifa.ac.il
 

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