Kimberly Young, licensed psychologist, executive director of the Center for On-Line Addiction and editorial board of CyberPsychology and Behavior, is Adjunct Professor of Psychology at the University of Pittsburgh. Her recent work includes: the treatment of cybersexual addiction, the impact of cyberaffairs on couples, the prevention of Internet abuse in the workplace and in colleges, the influence of the Internet on the family, the development of Internet Safety Programs designed for schools, libraries and parents. She published many articles on CyberPsychology and Behavior, and Caught in the Net, a book about the treatment of Internet addiction, translated in different languages.

The physiology of the life online

D: I think that cyberpsychology is an important academic theme. In Italy, in the recent past, this issue wasn't holden in due consideration and the ones who studied it were looked suspiciously and, sometimes, margined. With reference to this, I'd like to know how it is considered the study of the Net, in your socio-cultural background, in the past and nowdays and what was your experience on this matter.

Young: I am a clinical psychologist and evaluated the issue based upon diagnostic criteria utilized among psychiatric professionals for addictions. Initially, the field was surprised that addictions to technology existed, but today, the concept is accepted in journals and legal systems.

D: What did allow this acceptance?

Young: Basically, the professional literature has accepted research articles that outline the ramifications of Internet compulsivity, which appear consistent with other previously identified compulsions such as to alcohol, gambling, sex, or food. This literature has replicated my earlier work and the growing body of peer reviewed studies has shown that Internet compulsivity is a growing problem. Further, papers presented at national conferences such as the American Psychiatric Association and the American Psychological Association also have shown case studies that outline diagnostic variables, risk factors, and treatment implications associated with the disorder. Finally, the legal system has accepted Internet addiction as a legal defense and clinical disorder within American courts.

D: The Net has many advantages we have to take in the right consideration. I refer for the MUDs, for example: assuming one or more online identities can lead to a deepener self-knowledge and to self-fulfilment. There are some risks too. What do you think about this issue? Can you tell me one or more clinical cases you experienced?

Young: Yes, I see many positives as you. In terms of negatives, divorce, child loss, job loss, social isolation, depression, and family instability all result of excessive or addictive Internet use.

D: Do you think that there are any ways to prevent this addictive Internet use? If so, which ones?

Young: The best way to address prevention is to review how we have focused on prevention for other clinical disorders. To date, early educational programs that raise awareness seem to be the best method. Consistently, I have conducted prevention programs for Internet addiction within school systems, colleges, parent groups, corporations, that appear to show positive results.

D: Do you think that life of online communities is different from face to face ones? Why?

Young: Yes virtual relationships differ from real life relationships. Anonymity, removal of geographical barriers, cultural blending are the major differences that are noted. In my book CAUGHT IN THE NET, I also discuss how people are more idealized online, being given attributes that may or may not be accurate.

D: Do you think that the online emotional manifestations are more intense than in 'real life'? If it is so, why do you think it happens?

Young: Yes, the anonymity coupled with the act of writing intensifies online relationships. What might take months in offline relationships for bonding to occur might just take days online.

D: Do you believe that the online relationships estabilish and break off more rapidily than the face to face ones? Why? Have you any examples of them?

Young: Yes, online relationships are transient, often without warning can end abruptly.

D: According to you, why these relationships are so fragile and precariuos?

Young: They are formed among virtual strangers with a large basis of the relationship based upon anonymity from behind the computer screen. These relationships are fragile because often deception is associated with them (for example, someone lies about their age, gender, race, or vocation) to impress another online user. For instance, I have seen many men, pretend to be women online just to engage other men in cybersex. Or, a janitor may pretend to be a CEO of a hi-tech firm to impress a woman online. There is little way to verify facts online, so users often utilize online personas to enhance deficits in their lives. They may even scan in older pictures of themselves during a time they were younger, thinner, or more attractive, just to impress other users. They may even scan in a picture of a complete stranger just to impress others. Thus, these relationships should be entered into very cautiously.

The psychopathology

D: According to the statement that there isn't a common agreement on the diagnostic criteria of the IAD, in your opinion, which are the clinical symptoms of the IAD?

Young: The main criteria that I have used is posted at www.netaddiction.com/whatis.htm. I am not sure of others use of the criteria and I believe the field as a whole is trying to evaluate a uniform set in the future.

D: Will the IAD be inserted in the next DSM' s edition, as it already seemed possible in 1993?

Young: The issue wasn't identified until after the last version of DSM came out. Future revisions over the next decade or two might include a category for this. You would really need to address this to members of the APA committee that deals with DSM.

D: Can you tell me one of the most representative clinical cases of IAD you know, focusing on the patient's history and socio-cultural background?

Young: Well, the best thing to do is read http://www.netaddiction.com/articles/stereotype.htm as a case example.

D: Are there any scientific pubblications containing IAD' s clinical cases?

Young: Yes, the one I just mentioned published in Psychological Reports, plus several other articles that appears in CyberPsychology and Behavior, Sexual Addiction and Compulsivity, the American Psychologist. You might do a lit search to find the articles and I have posted my own online (with citations included) at www.netaddiction.com/articles/articles.htm

D: What are, if there are, the psychopathologies that induce the IAD?

Young: Risk factors include multiple addiction history, psychiatric conditions such as depression, ocd, bipolar, sex compulsivity, pathological gambling, or situational issues such as job burnout, marital discord, or child abuse.

D: In your opinion, are more frequent the IAD's cases or a pathological Internet use resulting from an associated psychopathology?

Young: Yes, a little over half the cases

D: So, are IAD' cases more frequent?

Young: Studies show that Internet addiction, like other established addictions, are related to comorbid factors such as clinical depression, multiple addiction history, or OCD. Situational factors may also contribute to the addictive behavior such as unemployment, job burnout, marital discord, or loneliness.

D: What are the Internet' s chatacteristics that are able to lead to psychopathology?

Young: You can read the basic issues of my ACE Model for Addiction at: http://www.netaddiction.com/net_compulsions.htm

D: Which are the characteristics of the subjects' personality at risk?

Young: See question above.

The online psychotherapy:

D: Which are the most effective therapies to cure the IAD?

Young: Cognitive behavioral, traditional 12-Steps Group Support, and marital or family therapy as needed. Pretty much the same for any other addiction.

D: Some persons feel addicted to the Net, even if they don't spend so much time online. How do you consider the amount of time spent online as a criteria to define Internet addiction? Do you think that it is necessary spending much time online and increase this amount to speak abuot addiction?

Young: Time online is not a variable that I have used in diagnosis. It really is more about a set of behaviors that specify compulsivity (loss of control, cravings, tolerance, withdrawal, etc).

D: Which are the ethical standards for an online psychotherapy?

Young: APA does not address online therapy, and therefore, I subscribe to the National Board of Certified Counselors Web Counseling ethics.

D: Which are the necessary changing of the setting for an online psychotherapy? And which are the consequences on the therapeutic process?

Young: I have been doing online consultation since 1997, and the benefits include:

1. direct access to knowledgeable professionals

2. an initial step towards recovery

3. immediate advice

My practice evolved due to the demands on my time and the battery of emails and letters and phone calls I received from online addicts and their families.

D: In an online psychotherapy, do you think that it is possible to estabilish a therapeutic relationship? If so, which are the differences with the relationship in a traditional psychotherapy?

Young: No, I specifically state on our FAQs that online consultation is not the same as long term psychotherapy.

D: In your opinion, do you think that psichotherapy online is possible?

Young: It depends upon what is meant by psychotherapy. I think from a cognitive-behaviorist viewpoint, which is a large part of the brand I utilize, it is a practical medium because the relationship with a client is less of a factor for treatment.

D: Which are the pathologies that are curable and not with an online psychotherapy?

Young: I really only focus on cyber-triggered issues, so I can't really answer this. You might consider talking with professionals whose online services range to broader topics.

D: According to you, which are the characteristics of the professional background necessary for an online psychotherapist?

Young: In short, my professional guess is someone with online background and mastery coupled with advanced clinical skills and abilities.

D: Which are the possibilities to understand the sexual perversions, that are so difficult to approach in the traditional psychotherapeutic setting?

Young: Not sure these are difficult to approach in traditional settings, but I would imagine that the anonymity of online conversation allows e-clients to feel more comfortable describing their online sexual proclivities. The expression of thought is much deeper and more reflective.

D: Do you think that individual's anonymity have any negative effects for online counseling? Which ones?

Young: The positives certainly are apparent, but the risk of anonymity is that the therapist may be unable to note non-verbal cues that point to deeper psychological issues.

D: Which are the consequences for the client of this inability of noting non-verbal cues?

Young: Misinterpretation is perhaps the largest concern – because of the lack of non-verbals, misunderstandings may develop. Also, missing important cues that underlye deeper conditions (e.g., not picking up clinical depression because you can't hear the flat affect in the person's voice via chat rooms).

D: Do you believe that the absence of face to face interaction between counselor and client, as a way to convey nonverbal cues, is a limit for developing a good interpersonal communication?

Young: Not sure, it may open up communication because writing is less threatening than talking ftf, however, it may also lead the therapist to miss certain sublties.

D: Are there any ways to find a remedy for this missing elements?

Young: Asking probing questions and clarifying statements is how I typically deal with the issue to reduce miscommunication.

D: Could the absence of direct contact between counselor and client limit the couselor's ability to show care and positive regards or the perception of counselor in that regard?

Young: Not in my experience, I think it depends upon how well of a writer the therapist is. Luckily, I have been able to effectively convey care and regard for eclients.