In an article in the American Journal of Psychiatry, Dr. Thomas F. Dwyer, a Massachusetts psychiatrist, says he has practiced “telepsychiatry,” via video teleconferencing, for five years. Its “adoption by psychiatrists and patients,” he predicts, “will proceed quickly if the organizers cope with the irrational responses of some users.”

That article appeared almost 40 years ago (Am J Psychiatry 130:865-869, August 1973. It told how microwave television signals were used to connect a satellite clinic to Massachusetts General Hospital in Boston.

Today, even with the rise of the Internet, virtual therapy hasn’t been widely adopted. But several start-up companies in Canada like and, are trying to make Dr. Dwyer’s decades-old vision a workaday reality.

Therapy delivered over the Internet, says Lynn Bufka, a psychologist and staff member of the  American Psychological Association, “may open access to those who might be reluctant to go to an office or to those who might be physically or psychologically unable to.”

Proponents of Internet-based therapy point to some research suggesting that it is effective for certain kinds of conditions, like depression and anxiety. Reporting in The Lancet in 2009, a team of researchers found that cognitive-behavioral therapy delivered remotely to depressed patients in Britain continued to show benefits eight months later.

But companies promoting online therapy in the States must deal with uneven or absent support from insurance companies, Medicare and Medicaid. Most states don’t require insurers to pay for “telehealth” services (those not delivered in person). And any reimbursements can be less substantial than for in-person treatment. Medicare offers reimbursement only if providers are very scarce, as in rural areas.

One disadvantage of online therapy through teleconferencing is that it can be harder to ‘read’ each other’s cues that are not visible, like body language. Humor can misfire, and some people may really benefit from having the personal relationship of therapy.       

Counselling and Mediation Services ( uses skype to provide a virual therapy room experience where visual cues and nuances are easier to observe. These services are also extended for providing Family Mediation services, primarily for couples who are going through marital separation.

Professor Turvey, who is also the vice chairwoman of the telemental health group of the American Telemedicine Association, says her group does have concerns about how prepared online therapists might be for a crisis.
When patients came to a clinic in the earliest days of telepsychiatry, in the 1960s, someone was on hand who was trained to follow an emergency protocol. But homes and offices are “clinically unsupervised settings,” Professor Turvey says. She recommends that the therapist collect emergency contact information at the first e-consultation.

Patients with a strong desire for anonymity might log off, however, before providing such data. Ms. Malik, of CopeToday, says the therapists she represents — 90 percent of whom have private practices in traditional offices — do not collect personal contact information from their online patients. “If you’re counselling and it escalates, we would call 911,” she says.

Almost 40 years have passed since Dr. Dwyer, the psychiatrist, wrote of how he had initially been skeptical of the efficacy of telepsychiatry. His research showed him that it could be effective. But reimbursement policies were not a part of his experiment’s design.