If such a case did come up we would refer the patient to a local counsellor

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If such a case did come up, we would refer the patient to a local counsellor and would help with that transition."An initial session with Dr Razzaque costs approximately £40, with subsequent sessions available at a similar price. In addition to the one-to-one, real-time chat, counselling sessions also include "homework" in the form of e-diaries, which are mailed to the counsellor for input in between sessions.Even proponents of online therapy are careful to stress its limitations. Most online psychiatrists, Dr Razzaque included, are quick with disclaimers that "e-therapy" can never substitute for traditional counselling. A patient's body language and voice can provide a therapist with vital clues about motives driving subconscious behaviour – clues that are either absent or impossible to detect in internet-based dialogue."The lack of body language does present a challenge, and this is one reason why e-therapy is not appropriate for people with serious psychological problems," Ainsworth explains. "In certain situations, a therapist needs visual information.

However, for many of the 'walking wounded' who are trying to cope with everyday change and loss, e-therapy can be a good first step."The lack of e-mail confidentiality is another often-cited risk in e-therapy. But Ainsworth says, "That's no more an issue online than it is for face-to-face counselling. The majority of e-therapists today use bank-like safeguards to protect their electronic communications with their patients. There are human-error risks, but these are pretty much the same as for face-to-face therapy and can be minimised with appropriate cautions."Dr Razzaque believes that the future is bright for e-therapy "Just look at NHS Direct," he says. "Medical advice is now available online from the National Health Service, and it is just a matter of time before this general advice is extended to cover a range of specialities, including psychiatry. As things progress, face-to-face counselling will continue to have a major role to play, of course, but it will eventually just be one part of the overall process."As the technology and bandwidth improves, Ainsworth believes that the use of internet video-conferencing for e-therapy will increase. "I think that will be a fundamental change," she says."Many people will continue to prefer asynchronous, text-based communication, but video-conferencing will open e-therapy for those who want visual contact and talking as opposed to writing.

Video-conferencing has already proved effective in hospital settings, where there is access to expensive equipment. Most of us who just have a little webcam on our PC can't achieve a good enough result at the moment, but it will happen eventually.". For UK profitability, the culprit is labour costs, which have risen by 17 per cent since 1995 For UK profitability, the culprit is labour costs, which have risen by 17 per cent since 1995 Football's coming home, perhaps, but manufacturing's rapidly heading for the exit. Britain's manufacturing output fell 3.0 per cent in July on a year-on-year basis. This represents the worst performance since the tail-end of the last recession in the early 1990s. To put the decline in context, the maximum decline in manufacturing output during the Asian crisis was only 1.8 per cent.Even worse, the rate of decline in recent months has become faster and faster. On an annualised basis, manufacturing output is now down 7.3 per cent since the end of last year.