Sex Therapy On Call

However, Coleman said, license jurisdictions are rarely called into question unless a therapist is charged with some form of abuse, or a local professional guild launches an investigation. " . . . What you have is a regime that is in place to punish people after the fact but that for all practical purposes does very little in almost any profession," he said. He said he's unaware of any cases that stemmed from a distance therapy relationship.

Privacy is also a concern. As with any Internet-based exchange, there is always the risk that personal information will appear in the public domain.

Brame, Michael's therapist, who works often with clients by e-mail, said her clients are less concerned about the threat of broad privacy breaches than about the possibility that a spouse or child would accidentally open a sensitive e-mail. Nonetheless, she said, she always advises clients against using a work-based e-mail account, which can be filtered or monitored.

Barratt complains that online sex therapy provides little accountability, for the therapist or the client. Therapists don't know if a client is following advice. Clients don't know if a purported therapist is qualified. Clients, he said, "don't really know what they're getting. They know somewhere in their minds that the therapist doesn't really know them. This is not really therapy."

But some distance sex therapists say the lack of physical contact sometimes makes therapy easier, because clients are more comfortable in their own environment and therefore more willing to share information.

"Although it may seem that the face-to-face is important, I actually find that people are much freer when they're not distracted," said Brame. She's a sexologist -- an umbrella term used to describe a range of sexuality-related professions, including therapists and educators -- certified by the American College of Sexologists and a doctoral graduate of the Institute for Advanced Study of Human Sexuality, in San Francisco.

"I know that for sex therapy," she said, "the hardest step is going. The hardest step is actually facing somebody and speaking about this stuff, because sex is such a private issue. It's just the most intimate domain."

A Stranger Who Cares?

There are few published studies of distance sex therapy, and no sources interviewed for this story were aware of any randomized, controlled, double-blinded studies -- the gold standard for science. But one unpublished study, conducted nearly two years ago as part of a doctoral dissertation at York University in Toronto, suggests that online therapy of various kinds may help some patients.

Stephen Biggs, a PhD candidate in clinical psychology, surveyed 44 people who said they had received therapy strictly over the Internet. Among these respondents, 16 percent said their therapy involved sexual issues; ages varied and women outnumbered men. Eighty percent (35) said they found the therapy experience somewhat or very positive, but all said they would use online therapy again and "reported that the therapist was empathic," he said.

"It's sort of funny," said Biggs, "but people get this feeling of being cared for from this person they've never met."