Psycho-web: a survey on the links between on-line psychological service and diagnostic categories.


Alessia Cuccurullo,  Sara Garbucci, Daniela Lemmo, Emanuela Rodriguez, Anna Cannata, Irma Maritato, Stefano Manzo

 Anima Research Institute, Naples – Italy


This contribute is a part of a more large research, carried out by Anima Research Institute, with the aim of mapping sites that provide psychological performances online in Italy (The psychological services into the cyberspace; a first census on the services offered in Italy, Manzo et al., 2015). From a few years the scientific universe questions about these online performances and their implication (Murphy and Mitchell, 1998; Collie et al., 2000; Hsiung, 2002; Tyler and Sabella, 2003; Kraus et al., 2004; Mitchell and Murphy, 2004; Derrig-Palumbo and Zeine, 2005; Murphy et al., 2008), but it seems not to be many researches about web-sites that offer psychological services online (Ordine Psicologi Lazio 2014, Kierkegaard 2015, Carretero 2015).

This analysis specifically focuses on the survey of these web sites with the use of specific keywords, which belongs to the DSM IV diagnostic categories. The choice of a so precise point of view originates from a question: “in which way, the potential user comes to find web sites that provide psychological services online?”. The starting hypothesis is that user can use, as search terms, keywords related to the most known diagnostic categories. At the same time, we hypothesized that professionals have used these keywords to describe the services that provide this type of performance: does a link between the pathology used as keyword and the online service exist? In which way do the websites use these keywords to describe themselves? Therefore, literature seems to be focused on the relationship between psychological online intervention and psychic symptoms, in the way to identify links between individuals with specific diseases and the use of such services  (Mallen et al 2005; Australian Psychological Society, 2004; Chang, Chang e Kim, 2002; Klein & Richards, 2001; Robinson & Serfaty, 2001; Manhal-Baugus, 2001; Roehlen et al, 2004; Suler, 2001). Also it focused on the effectiveness (Robinson & Serfaty, 2001, Lange et al., 2000, Lange, van de Ven, Schrieken, & Emmelkamp, 2001) and risks of such performances towards taking charge of patients with overt disease (Abbott et al., 2008).

This paper intends to propose a new point of view. This research, that aims to describe those websites traceable through diagnostic terms, comes from the idea of understanding the way mental-health professionals – who provide performance online – advertise their service, and how many of these services aim to specific consumers, identified through the different pathologies.


Objectives and Methodology

This paper intends to monitor the online psychological services supply, traceable by the use of specific keywords which refer to the main diagnostic categories currently used. The last goal of this survey is understand the currently italian situation about the psychological online service currently used in environment to diagnostic categories, in order to stimulate reflection on the mode of presentation and distribution of this services, to promote new “good practice”, about specific ethic and moral criteria. The assumptions underling this paper are as follows:

  • To explore the possible correspondence between diagnostic category and description of website that provide online psychological service.
  • To understand, though exploration of all website identified the specific offer and characteristics of each service and to identify the presence of a specificity connected at the specific keyword whereby it was traced the website.

To achieve own objectives, we included in the major Italian search engines different keywords related to diagnostic category of I and II axis of DSM IV. (Tab. 1). This preliminary research has produced about 350 results, using a criterion of maximum inclusiveness than website that had relevance to online. At a leather stage, in a second step, we analyzed each site and we made a further screening of survey, through an careful exploration of each website and the use of more stringent criteria for inclusion. (for a research material on the criteria for inclusion and exclusion reference to The psychological services into the cyberspace; a first census on the services offered in Italy, Manzo et al., 2015). This research by keywords led us to the selection of 208 websites that constitute our sample analysis. These websites were then analyzed through a grid built ad hoc, with the aim of exploring the main aspects of these services including supplier, region, target, type of service, tools, it device, service delivery, payment method, specialization. The data collected and entered in the grid were processed through the software  SPSS, with aim to carry out a comparison between the different categories identified for each service. Specifically, it was carried out a thorough analysis on the correlation between keywords, professional’s specialization and type of service.



Results and Conclusions

This analysis has allowed to carry out a map of existing websites related to diagnostic categories, favoring the identification of multiple types of services and a first monitoring. The investigation has also facilitated a reflection on the current situation of the offer of on-line psychological consultation in Italy, highlighting, among other things, the use of specific categories and labels only rarely connected to equally specific services. The first step, realized to carry out the research, has been the work on keywords. This work has enabled to underline which terms, connected to diagnostic categories, produced main results in terms of websites.

The sample is mainly composed from sites created by freelance professionals (86%); a small percentage is composed by Third sector (7%) and also by Private centers (6%). 36% of the total is geographically collocated in North Italy, 31% in Center Italy and 18% in South Italy. About target, the most part of these websites (42%) is for everyone, 27% is only for those people who has accessibility difficulties, and 15% to specific age range or lifetime cycles.

Although our research has been realized using keywords clearly referred to diagnostic categories and psychopathology, only 8% of the sample addresses services to a related target. This fact highlights an excessive vagueness of the websites; we can assume the use of keywords connected to diagnostic categories as a strategy to attract much clients as possible, without the existence of specific services connected to those keywords.

As regards the analysis conducted by SPSS Software Analysis, some interesting correlations between keywords and characteristics of websites emerged. In particular, correlations between some keywords and target shows an high match between “Eating disorders” and “Accessibility”. This match could be connected to the idea that any eating disorders could cause difficulty in movement; this fact could point to online services. There is also a match between “New addiction” and “Psychopathologies”, maybe related to the recent increase of new addiction, also enclosed in the last edition of DSM-V.

Another work hypothesis was that some keywords were used because of the specializations of professionals. In this regard, the analysis highlights strong correlations between “Sexual Disorders” and “Systemic” specialization; “Anxiety Disorders” and “Cognitive” specialization and also between “Somatoform” e “Short Therapy”. These correlations shows how some professionals of our sample are interested in specific disorders, correlated with their work specializations.

The last interesting correlation in between keywords and type of service, that is the type of performance offered by the supplier or professional. Also in this case the use of specific keywords appears not exclusively connected to the performance. The only emerging correlations are between

“Expert advice” with “Dissociative personality disorders” and “Eating disorders”. These correlations could be caused from the curiosity connected to these pathologies, that generates the search of answers on the web.

In conclusion, the analysis carried out could open the way to a biggest reflection on Italian websites that offers online psychological services and refers to diagnostic categories, lifting both ethics and deontological questions. In particular, seems to be important understand why the use of these specific keywords are not connected to specific services or target. This work could represent a starting point for the creation of specific services directly connected to diagnostic DSM categories.  



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