San José, Costa Rica, since 1956

Online Counseling Cheaper, Private

ROBERTO Alonso works most of hisday as a professional counselor at his cozySabana Oeste office on the western edge ofSan José, filled with plush chairs, a couchand a secretary in the front room.But about two months ago, the 32-year-old’s office hours began to decreaseas he increased the number of patientscounseled from his home, in front of hiscomputer, in the comfort of his shorts.Alonso is one of the first professionalcounselors in Costa Rica to take his practiceinto cyberspace. About 95% of Alonso’spractice is still made up of conventional,face-to-face counseling, but a growingnumber of patients are turning to otherforms of counseling – such as by telephoneand his fledgling Internet practice.“I think it’s a great way to reach out topeople that might not usually look for helpor for people who feelthat they have no one totrust,” said Alonso fromhis first-floor office.Alonso, tall and slim,looks several years hisjunior. He completed hiseducation in the UnitedStates. He earned a bachelor’sdegree fromWittenberg University inSpringfield, Ohio, followedby his master’sdegree in professionalcounseling fromColumbia International University inColumbia, S.C.ALONSO first offered Internet counselingjust over two years ago when heestablished his practice in Costa Rica. Sofar, Alonso’s online patients are all men,ages 25-55, and all are from outside thecountry.“Men are not usually as open aboutgoing to counseling so they might be morelikely to seek counseling online,” Alonsosaid.The procedure is actually quite simple.To make an appointment, a client goes toAlonso’s Web site and fills out an intakequestionnaire. The questionnaire includesbasic information like name and age, ifthey have ever taken medication, or contemplatedsuicide.The questionnaire also asks for a briefdescription of the problem or why the personis seeking counseling. Once the clientcompletes the questionnaire, they agree tomeet online (at his Web site) for a chat at ascheduled date and time. Since Alonso hasalready collected a patient’s basic information,they can jump right into the session.A number of reasons drive people toseek counseling online, according toAlonso.“One reason people seek counseling onthe Internet is that it’s a lot cheaper,” hesaid. “Counseling in New York City canrun between $250-350. In smaller towns,you can find $75 and up.”Alonso charges $50 per hour for onlinecounseling through PayPal, an Internetpayment service that accepts credit cardsand bank withdrawals.Flexibility is another factor.“You can do it from your house,” hesaid. “you don’t have to leave.”ACCESS is also an important issue forpeople seeking counseling online.“I’m going to be doing counseling withpeople in other countries, say, Americans inAfrica,” he said. “They might not be able toget their hands on, or have access to professionalcounseling. Orpeople that move or aretraveling. You don’thave to be in the city inorder to do counseling.”Lastly, privacy is abig advantage foronline counseling.“Some people don’tlike to actually come inbecause they might runinto someone in thewaiting room, or someonemight find outthey’re going to counseling,”Alonso said. “Especially when itcomes to issues like drugs, infidelity orhomosexuality. They’d rather just makesure there is absolutely no way anyone canfind out.”Also, the fact that Alonso is based inCosta Rica and does not take paymentsthrough American insurance companiesensures that his clients’ counseling historiesare kept confidential. Alonso pointedto the fact that while American insurancecompanies will often cover most of thecost of counseling, a patient’s history cancome up in court, when a person is seekingemployment, and it may cause a person’sinsurance premiums to go up.ONLINE counseling does have itscritics. Lack of personal contact, lowprices and a higher possibility of improperlytrained counselors at work are all concernsthat have been expressed by thecounseling community.There is a code of ethics for onlinecounseling (most notably, it states that asuicidal person should be referred to someonelocal for face-to-face counseling), butno one regulates whether or not counselorsfollow them.Alonso concedes that Internet counselinghas its disadvantages. Despite his effortsto get a sense of a person he is counseling(Alonso asks for pictures of his patients andtheir children, for example), he doesn’tmake out Internet counseling to be exactlythe same as conventional counseling.“It’s different,” he said. “You lose a bitof the personal part. You can’t pick up onthe non-verbal communication, so that’sone of the drawbacks.”But he also said the negatives are balancedby the positive aspects of Internetcounseling.“THEY might not warm up as quickly,I can’t offer them a bottle of water whenthey come in, or a tissue if they’re cryingor a tap on the shoulder as they are walkingout,” he said. “So it takes a little bitlonger for the person to feel that warmth.On the other hand, they usually open upquicker because they know they are notgoing to run into me at the mall.”A patient of Alonso’s, a man in hismid-30s from New York, first heard ofAlonso through word of mouth. Neverhaving tried other more conventionalforms of counseling, he started communicatingwith Alonso weekly by phone withfollow-ups through e-mail. He said hechose this type of counseling mainly forcost and convenience.“The Internet use, the long distancephone calls and counseling fees combinedwere much less expensive than visiting aNew York City counselor,” said thepatient, who wished to keep his anonymity,through an e-mail. “Also, I didn’t haveto drive or wait in an office and could relaxin the convenience of my home.”The client admitted that sometimes,when having a session from home, it iseasy to get distracted with reminders ofchores and a television nearby. But all inall, he explained he prefers the type ofcounselor-patient relationship that is fosteredthrough Internet counseling.“An anonymous counseling relationshipmay actually be better and allow more freedomfor the patient to open up. I personallyfelt comfortable and developed a rapportwith Roberto,” he said.For more info, contact Alonso at 291-1490 or e-mail or visit his Web site at

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