13th Congress of the European Association for Psychotherapy
"Widening Boundaries of Europe - Widening Boundaries of Psychotherapy?"
2005, July 7-10 Vilnius Lithuania

The rise of diverse modern media (telephone, internet SMS) used for counselling and intervention gives hope for better access to those that live in far away regions; it also raises concerns that should not dismissed. The lecture will report on some illustrative examples of intelligent applications and will discuss serious limitations as well.

Keynote lectures:

Psychotherapy via Internet ?
Horst Kaechele
Department Psychosomatic Medicine & Psychotherapy
University of Ulm

What is really new in online - communication ?

Letter writing:  temporal delay, non immediacy

Telephon: auditory presence only, immediacy

E-mail: fast response, no immediate feedback loop

Chat rooms: writing presence

- Letter writings - precursor of the newer media ?

Is the problem really new?

Let us look back a little bit

Has there not been for centuries a communicative culture by letter exchange ?
Distances - geopgraphic or or social - were bridged
What has been the function of this type of discourse ?  
Have there been written therapeutic letter discourses ? 

Letter to cousin

July, 27, 1560
Lionardo

A few days ago I received a letter from you giving the news of the death of your daughter  Lessandra. I felt great pain. But it would have been a miracle if she would had survived as in our famliy rarely more than one person has been available......
One has to have patience und to care the more for the living.. 

Luther´s letters

Consolation- and Love Letters

Letters for condolence have been the most usual category; but letters of love always have been around 

The topic "Letters of love" as a e-mail world already has been studied by Eva Lia Wyss (Zürich) :

"Metamorphoses of love letters in the Internet"

The 18 th century ist the age of letter writing. It discovers and cultivates private letter writing as a written form of social valued behavior.
Vellusig (2000)
The letter as medium of intimacy

The 18th century discovers  the poetic qualities of personal interaction and increases them in the culture of letter writing.

The private exchange of letters develops as an independent communicative practice .

Convention

In the 19th century to write letters and to receive letters even more so belonged to the necessity of bourgois life style

R. Baasner (Hrg): Briefkultur im 19. Jahrhundert. Tübingen, Niemeyer 1999
Private Letters in the 19th Century
Many of the private letters in the 19th century serve the assertion of identity.
Letter writing serves the recapitulation of lived experience.
The public idea of the letter as the true carrier of information about the private becomes the ideology of the time.

And why does the human being writes letters?

What was really new with the advent of internet communication ?

The advent of computer as typewriter plus telephon leads to high writing synchron and asynchrone connectivity.

Not surprising many internet-based counseling operations offer their service,

In the early days most of these operations were mainly interested to make money.

Quality of service was rarely evaluated.
Home page von CyberAnalysis
Cyber Analysis is Online Therapy
Cyber Analysis: E-mail Exchange

Use of E-Mails in Psychotherapy
• Student counselling-service (Brice, 2000)
• Treatment of Bulimia Nervosa via e-mail diary (Robinson & Serfaty, 2001)
• Adjunct to outpatient psychotherapy in anorectic women (Yager, 2001)
• Support in family therapy (King, 1998)
• Homework assigments via e-mail (Murdoch & Connor-Green, 2000)
• "Dream journaling" (Childress, 1999)
• Therapeutic writing via e-mail (Murphy & Mitchell, 1998)

The E-M@l Bridge: What Works in a Psychotherapeutic Maintenance Aftercare via Electronic Mail?

THE E-M@IL BRIDGE
Concept:

• Relapse prevention

• Structured writing approach (J. W. Pennebaker)

• Computer mediated communication (CMC)

THE E-M@IL BRIDGE

"Setting":

• Individual
• Asynchronous communication
• Continuity of therapeutic alliance
• Scheduled writing task e-mails, free e-mails
• Therapist reply within 24 hs.
• 8 to 12 weeks participation
• Crisis intervention (emergency therapist)
• Data confidentiality (password, username, encryption)
• Online outcome monitoring (Web-Akquasi System)

The Instruction:

"Please write ... *
* once a week 15 to 30 minutes
* about the emotionally most significant topic of that week
* concerning your actual situation or the future.
* Take into consideration central problems and change goals.
* Describe thoughts and feelings that accompanied your experiences and activities
* Write your E-Mail without disruption
* regardless of spelling, syntax and grammar."