Dr. Rafael Richman speaking online with a patient from his home in Jerusalem earlier this month.
Dr. Rafael Richman speaking online with a patient from his home in Jerusalem earlier this month. Photo by Michal Fattal
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A quick Google search is enough to reveal that Dr. Rafael Richman is a psychologist based in the German Colony of Jerusalem. But many of his online patients would rather not know that.

Take, for example, the women from neighboring Arab countries who wait until the coast is clear to contact him over cyberspace and vent their frustrations about their husbands. Or the young Muslim men from around the region who have no one else nearby to confide in about their attraction to other members of the same sex.

Why would a wealthy woman in Qatar, Lebanon or even Syria reach out over the Internet to an Israeli psychologist when her husband is gallivanting around with a dozen young mistresses? "Because where they come from, therapy is frowned on," responds the Canadian-born clinical psychologist. "When she contacts me, she doesn't have to go out of the house, and no one has to know. Money's not an issue. She can just take her husband's credit card and make the payment online. And as far as she's concerned, I'm not based in Israel but in the United States because she needs to dial a number in America to get through to me."

And the price for this therapy, at $2.85 a minute, is certainly not prohibitive if your husband happens to be a wealthy oil sheikh.

Richman, who hails from Vancouver, belongs to a growing cadre of English-speaking Israeli therapists who are taking advantage of advanced communications technologies - conferencing, chat, Skype and other applications - to internationalize their client bases as they work from the comfort of their own home offices or wherever else they may happen to be with laptop in tow.

Another pioneer in the field is Dr. Arthur Trotzky, who for the past three and a half years has been running both private and group online therapy sessions with patients scattered around the United States.

"I understood that this was where the future was a few years back, when I was sitting in Atlanta and communicating over Skype with two of my children - one who happened to be in Hungary and the other in Ecuador."

A key advantage of online therapy, he says, is that you can keep your appointments wherever you are. "You don't have to worry about traveling or about bad weather. All you need is an Internet connection."

Trotzky, who moved to Israel from the United States in 1976, worked for many years as a child and family therapist before he began specializing in addiction treatment. Today, in addition to his private patients both in Israel and the United States, he runs online group therapy sessions for recovering addicts in both countries - those in Israel paid for by the Anti-Drug Authority. "Today, about 60 percent of my work is with patients in the U.S. and 40 percent with patients in Israel," he says.

And the disadvantages of distance counseling? A major challenge, notes Trotzky, who does most of his work from his home at Kibbutz Mitzpeh Shalem near the Dead Sea, is working in two separate time zones at once. And of course, there are always those cases where physical proximity is important. "There's not much I can do from here when someone from the U.S. calls in the middle of the night and says he wants to kill himself."

Eli Shine, a trained psychologist from Britain, decided to use his training and experience as a therapist to branch out into the field of online coaching when he moved to Israel five years ago. Today, from his home in Ramat Beit Shemesh, he coaches clients, mainly small business proprietors, in the United States, Britain and Austria, using Skype. "Once you can work on Skype, then it doesn't really matter where you're located. What matters is who can help you," observes Shine. "It's all about finding a good fit for yourself."

Shine says he prefers Skype to other voice-based applications because it allows him to pick up on body language while observing the patient on his screen. "That's where my background in psychology comes in handy," he remarks.

For Richman, the transition into online therapy began when he moved to Israel in 2004 and was told he would need to wait a year to obtain registration to practice. To help pay the rent in the meantime, he hooked up with LivePerson, an online expert advice company based in New York, with offices in London, Tel Aviv, San Francisco and Atlanta, which offers, among other services, online counseling. "I put myself online," he recalls, "and it completely took off."

In addition to his clients in the Arab world, Richman also treats patients in the United States and Australia via LivePerson. Many, he says, prefer this sort of service because it allows them to maintain anonymity and distance.

"For others, the attraction is the ability to get online at any hour and receive help," he notes. "And there are still others who contact me because they live in remote communities where no psychological services are available."

Now that he's registered to work as a therapist in Israel, Richman also runs an offline, face-to-face practice in Jerusalem. Some of his traditional patients, though, eventually join the ranks of the online clientele. "I have people who are here in Israel for a year and start therapy with me, who want to continue when they go back home, so we just move our sessions online."

Among his anonymous online patients - those who access him via LivePerson and who communicate with him either through texting or voice-based applications - about half are one-timers who never come back for another session.

In some cases, the reason is that one session was enough to solve a certain problem. In other cases, the reason is that someone's been caught. "When it's a Muslim woman, I tend to think that it's the husband who's seen the credit card bill," says Richman.