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Psyber Psychiatry, Commentary

Instant messaging: The right call for your practice?

‘Instant e-mail’ can speed office communication and facilitate online psychotherapy, but beware of security issues.

Vol. 3, No. 1 / January 2004

If you cannot get to a phone and you need to make immediate contact, instant messaging (IM) may be the right call.

IM, the equivalent of ‘instant e-mail,’ allows almost real-time communication and exchange of information over the Internet. IM is most popular among teenagers and college students, but medical providers and other professionals have begun to recognize its potential for speeding communication.

How IM started

Before the World Wide Web existed, electronic bulletin boards (BBS) were a popular mode of communication. Users would log in and browse various message topics, posting comments and questions for others to answer. Users also could check who was logged into the BBS and post messages to one or more of those contacts. This was done in a Telnet session, which is a method for connecting to another computer on the Internet. Telnet sessions hark back to mainframe computing, when computer terminals without processing power provided access to the central computer.

In 1996, Mirabilis released ICQ, which enabled Internet users to locate each other on the Internet without connecting to a BBS-by creating direct peer-to-peer communication channels. Companies such as America On Line, Microsoft, and Yahoo! also developed IM systems, but none could connect with one another because there is no common standard. AOL later purchased Mirabilis and incorporated its technology into the AOL Instant Messenger (AIM).

Doing IM: What you need

To do instant messaging, you need an Internet connection and the appropriate client. Keep in mind that your client should be:

  • compatible with several systems
  • or the same client that your messaging partner uses. New users typically choose an IM system that a friend or colleague is using.

Choosing an IM client is a matter of preference because all systems offer similar features (E-therapy: Alerting patients to the benefits, risks,“ November 2002).

Because IM is a direct communication channel with visual references to previous dialogue, it creates the environment of an active conversation. One drawback is that a participant’s typing speed typically limits the conversation’s pace. Using the voice feature overcomes this limitation, but this feature will not work properly without a broadband Internet connection, such as over a cable modem or digital subscriber line.

Risks of IM-based therapy

The IM communication channel’s lack of security poses a significant risk, particularly when used for psychotherapy. This active connection broadcasts its availability over the Internet, making it vulnerable to hackers. What’s more, the IM client may change your security settings for your Web browser1 or allow remote access to your computer by a hacker.2

Making your IM system secure

On the corporate level, vendors such as Yahoo!, Microsoft, AOL and others have created products to secure public IM systems, such as Akonix and Endeavors Technology. These products are gateways that maintain corporate data within the company network, encrypt information, specify and limit certain features, and log conversations. This level of security does not exist over major public IM networks for individual users.

Secure Shuttle Transport, DBabble, and PSST provide encrypted communication to individual users.


Instant messaging clients




Operating systems


Yahoo only

Windows, Mac, Unix, SMS



Windows, Mac, Linux, Palm, Windows Mobile, SMS


MSN only

Windows, Mac, Windows Mobile



Windows, Mac, Windows Mobile, Palm, SMS


Yahoo, AOL, MSN, ICQ



Yahoo, AOL, MSN, ICQ

Windows, Mac, Linux, BSD


Yahoo, AOL, MSN, ICQ

Windows, Java

Easy Message

Yahoo, AOL, MSN, ICQ



PalTalk only


If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail him at:


Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

REFERENCES (accessed Dec. 16, 2003)

1. Langa F. More instant messaging security holes. Information Week Oct. 1, 2001. Available at:

2. Saunders C. Yahoo! faces messenger flaw. Instant Messaging Dec. 3, 2003. Available at:

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