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man suffering will, like it does every
day, march on. Now more than ever,
we as psychiatrists need to focus on
our role as medical doctors diagnos-
ing and treating pathologies that
plague and cripple our patients. Our
journals should reflect these efforts—
not the trials and tribulations of
“moving.”
Let’s take ourselves seriously, and
others will follow.
Michael Farell Massa, M.D.
Dr. Massa is in private practice in Chicago.
Reference
1. Kagan I, Kigli-Shemesh R, Bar-Tal Y: Reac-
tions of staff members to the relocation of a
psychiatric department to a new building.
Psychiatric Services 55:717–719, 2004
SSaattiissffaaccttiioonn WWiitthh eeGGrroouuppss
AAmmoonngg PPeerrssoonnss WWiitthh
PPssyycchhiiaattrriicc DDiissoorrddeerrss
To the Editor: Patients with psychi-
atric disorders may benefit from on-
line groups, often called eGroups.
However, few researchers have inves-
tigated factors related to the satisfac-
tion of eGroup participants. In March
2000 we established a Web-based self-
help psychiatric group (http:// groups.
yahoo.com/group/psychpark-friend).
Most participants were patients of a
virtual psychiatric clinic called Psych-
Park (1) and had a diagnosis of de-
pression or an anxiety disorder. The
virtual clinic, which is operated by
members of the Taiwan Association of
Mental Health Informatics, has been
described in detail elsewhere (2). The
eGroup consisted of a discussion fo-
rum and mailing list. Posted messages
were sent to the forum and to all
members anonymously. The authors
moderated the group by filtering and
deleting unrelated messages and ad-
vertisements.
A Web-based interactive yes-no
questionnaire based on Yalom’s 12
therapeutic factors (3) was designed
to evaluate satisfaction with the
eGroup; space was included for com-
ments and suggestions. The partici-
pants were invited to fill out the on-
line survey form when they logged on
to the PsychPark Web site.
Approximately 1,300 members
logged on to the Web site during the
study period—March through No-
vember 2001. On average, 152 mes-
sages were posted each month; 281 of
the 1,300 members (22 percent) post-
ed messages over the nine-month pe-
riod. A total of 262 members (19 per-
cent) completed the survey. Their
mean±SD age was 25.7±5.5 years.
Most were female (194 respondents,
or 74 percent). A large proportion
were students (113 respondents, or
43 percent), and 131 respondents (50
percent) had at least an undergradu-
ate education.
A total of 198 respondents (76 per-
cent) reported that they were satis-
fied with the eGroup. Three factors
were most commonly endorsed as ac-
counting for satisfaction: 182 respon-
dents (92 percent) cited “imparting
information”; 172 (87 percent) cited
“universality”; and 168 (85 percent)
endorsed “instillation of hope.” Only
two factors were endorsed by less
than 70 percent of respondents:
“catharsis” (115 respondents, or 58
percent) and “existential factors” (131
respondents, or 66 percent). From a
list of suggestions for improving satis-
faction with the eGroup, the most
frequently endorsed items were “in-
troduce more professional guidance”
(90 respondents, or 34 percent), “pro-
vide specific solution methods” (77
respondents, or 29 percent), and “es-
tablish specific diagnosis-related
groups” (72 respondents, or 27 per-
cent).
To our knowledge, our survey is the
first to evaluate the satisfaction of
participants in a Web-based group by
using Yalom’s therapeutic factors.
Our results indicate that an anony-
mous eGroup is useful for clients with
psychiatric disorders. Our findings
are consistent with those of Davidson
(4), who determined that a large
group can function effectively on the
Internet. Participants in such groups
value the information, positive feed-
back, and encouragement that they
receive from other group members,
as suggested by the items in our sur-
vey that were cited as most related to
satisfaction. The factors that were
least cited as being related to satisfac-
tion—catharsis and existential fac-
tors—may have to do with the virtual
nature of our group, whereby mem-
bers do not meet face to face. How-
ever, large groups have some limita-
tions. Weinberg (5) compared a large
group to a fishbowl, where only a
small number of members participate
while the larger membership quietly
watches. This phenomenon was ap-
parent in our group. About a fifth of
the participants posted messages
while the other members observed
the online interaction quietly.
The generalizability of our results is
limited by the relatively low response
rate and possible selection bias relat-
ed to characteristics of members of
our virtual clinic.
Jen-Yeu Chen, M.D.
Chao-Cheng Lin, M.D.
Ya-Mei Bai, M.D.
The authors are affiliated with the depart-
ment of psychiatry at Yu-Li Veterans Hos-
pital in Hua-Lien, Taiwan. Dr. Lin is also
with the Graduate Institute of Medical In-
formatics at Taipei University. Dr. Bai is
also with the Institute of Public Health at
National Yang-Ming University in Taipei.
References
1. Bai YM, Lin CC, Chen JY, et al: Virtual psy-
chiatric clinic (letter). American Journal of
Psychiatry 158:1160–1161, 2001
2. Bai YM, Lin CC, Chen JY, et al: The char-
acteristic differences between clients of vir-
tual and real psychiatric clinics in Taiwan.
American Journal of Psychiatry 158:1160–
1161, 2001
3. Yalom ID (ed): The Theory and Practice of
Group Psychotherapy, 4th ed. New York,
Basic Books, 1995
4. Davidson B: The Internet and the large
group. Group Analysis 31:457–471, 1998
5. Weinberg H: Group process and group
phenomena on the Internet. International
Journal of Group Psychotherapy 51:361–
378, 2001
PPaattiieenntt PPeerrssppeeccttiivvee oonn
CCoollllaabboorraattiivvee TTrreeaattmmeenntt
To the Editor: Little is known about
patients’ understanding of collabora-
tive treatment and the role of profes-
sionals involved. We conducted a
study among 50 patients at an inner-
city academic clinic who were receiv-
ing ongoing collaborative treatment
from a psychiatrist and a psychologist.
PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦August 2004 Vol. 55 No. 8
LETTERS
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