Sex Therapy On Call

"You can't do therapy over the Web," she said. " . . . It would be very foolhardy to do that. I think the only thing you can do is offer some discreet information, some concrete information." While she retains a professional Web site, www.mindspring.com/~ debfox, she said she does not promote it, rarely gains clients through it, and has raised the price of an online consultation to discourage people from contacting her online.

Few states issue a sex therapy license per se, so most who specialize in this field are licensed in something else -- commonly, psychology or social work -- and then seek certification from professional organizations. Some have also attended one of the few graduate schools that offer degrees in human sexuality, such as at Widener University in Philadelphia. Most offer therapy in an office setting, incorporating sex therapy as part of broader psychotherapy sessions or using it to address specific sexual dysfunctions or perversions. Those issues can range from orgasm difficulties to sexual conflicts in a relationship to specific fetishes.

The Therapist Is In

Many sex therapists who offer distance therapy have an office practice as well, and typically set up a Web site to advertise their services. Some of these sites give contact information for the therapist, while others have online forms they ask prospective clients to complete. Clients find these sites through search engines or online catalogs of sex therapists, such as the one at sexualtherapy.com. Some patients pay a therapist for a one-time e-mail exchange, while others pay for weekly sessions, which are conducted in their medium of choice and can be held regularly for months or years.

At e-sextherapy.com, Florida-based sex therapist Earl Ledford has a cartoon traffic light that turns green when he's online and available for a live chat. For his single or ongoing consultations, he charges from $7.50 for an initial e-mail to $50 for a 50-minute phone, chat or video session via webcam. His hourly in-person fees can be twice that.

A clinical social worker, Ledford said he likes using the Internet to reach clients he knows won't ever walk through his door. Ledford said he's reported remarkable changes in the patients he's worked with by phone and e-mail, and believes they're often more prepared to help themselves than the patients who come into his office. He said many of the patients who seek out a therapist online have already researched their problems, and just need an extra push to overcome them.

"Look at the process of change," he said. "There's millions of people who change behavior or solve a problem without talking to anybody about it. . . I see myself as a facilitator of that with people. If you look at it and accept that, you can accept that someone online, that [patients] don't see, can be a facilitator for that process of change."

Other therapists widely affirm the value of online information in addressing some people's problems -- by providing answers to questions, for example, about erectile dysfunction and orgasm. But the relaying of such information, many contend, is entirely different from a clinical healing process.

Taking License

Distance sex therapy has also raised legal questions.

Some groups, including AASECT, are wrangling over whether such therapy sometimes violates state-issued counseling licenses, according to Barratt. Can a sex therapist licensed as a psychologist in Virginia, for example, legally provide therapy by phone to a person in Oregon, where the therapist is not licensed?

Ronald Coleman, who practices Internet law in New York, said almost every licensed profession has dealt with similar questions, which arose long before the Internet -- or remote sex therapy -- came into being. What if, he said, a client goes on vacation out of state, and then calls to talk with his therapist? Or suppose the therapist travels with the client to another state? Since sex therapists are not even offered licenses by most states, he said, the legality of distance sex therapy is "murky as hell."