In the face-to-face environment, a therapist will typically begin by performing a careful assessment of the client's mental status and presenting complaint. That assessment yields a diagnosis: a statement of the nature or cause of the client's problem. Therapists are trained to notice more than the offered verbal report of a client; how a client appears, sounds and comports his or her self all become part of the initial assessment. Therapist: Good morning, Mr. Doe. And what brings you to my office this fine morning, wearing your chicken suit? Client: What chicken suit? The point, here, is that the face-to-face environment supports sufficient information for the therapist to perform a thorough assessment and meaningful diagnosis.
Things are rather different in the online world. The email therapist has no direct way of knowing how the e-client appears, sounds, or acts. Instead, we must rely exclusively on the written information we receive in an email... supplemented only by the infallible wisdom of the magic 8-ball. Of course, the e-therapist is continually assessing how the e-client is faring, but that assessment is based on limited data. Because the e-client is the only one in possession of the required breadth of information, it falls to them to perform ongoing self-assessments. That clearly implies that individuals who are incapable or unwilling to report meaningful self-assessments will most likely do better in face-to-face treatment where the therapist can assume that responsibility.
In practice, self-assessment is usually not an insurmountable issue. E-clients self-select. That is, those who are interested in using e-therapy usually possess a basic ability and willingness to notice things about themselves, and to share the relevant aspects of that information with their online therapist. The therapist helps this process by asking questions that direct the e-client's attention to key elements of their ongoing experience and by explaining to the e-client what makes these elements so important. The thereby educated e-client is in a much better position to report vital information to the therapist. In other words, the e-client and therapist work together as a team to maintain an ongoing assessment of the e-client's current conditions and goals.