Stop the presses! Randall Stross over at the Digital Domain at The New York Times has just discovered online therapy.
Acknowledging that the idea has been around for a long time, Stross begins the piece by digging up an American Journal of Psychiatry article from 38 years ago, written by Thomas Dwyer describing one of the first telepsychiatry systems ever devised (at Massachusetts General Hospital). How quaint. (Confusing telepsychiatry/telehealth systems — which have been around for decades utilizing private networks and closed video systems, and that are well-researched — with online therapy is a common mistake made by journalists who explore this area.)
The hook, apparently, is to highlight yet some more companies who’ve decided to take the plunge into exploiting this modality:
Today, even with the rise of the Internet, virtual therapy hasn’t been widely adopted. But several start-up companies are trying to make Dr. Dwyer’s decades-old vision a workaday reality.
Despite having little new to say or to add to this topic — for instance, where’s the consumer demand for these services? — I found the article somewhat interesting nonetheless. If for no other reason, to point out how these articles all follow the same tired template: offer a unique hook, point out the opportunity, quote the research, highlight a new service offering a solution, quote some naysayers, and end with a tie-in to your opening hook.
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In an age of psychotherapy where the nature of the therapeutic alliance between therapist and patient is seen as far more important than any particular psychotherapeutic paradigm or approach, here is where Skype therapy could be most helpful:
Those cases where a patient relocates, a therapist relocates, or there are extenuating circumstances like extended illness, injury, changes in employment circumstance, etc. that prevent one or the other from getting to the therapist’s office.
Take the simple case of a shift worker in therapy whose employer changes her shift from nights to days. She’s been in therapy for eighteen months and wants to continue, but it’s now impossible for her to leave the hospital to see her therapist, and the therapist doesn’t normally do weekend office hours. Nor can the therapist find an after-work slot to accommodate her. They have a strong therapeutic alliance, and the shift worker doesn’t want to end therapy or change therapists. With Skype, rather than terminate the therapy, the therapist and patient could more easily find an therapeutic hour to work — maybe even on the weekend from home.
Skype is potentially the best tool to help maintain ongoing therapeutic alliances. So many therapies that would have been forced to end by outside forces can now continue.
I’d like to see therapists offer it as a matter of course in appropriate situations.
Your readers may be interested in a free online program called MoodGYM which is based on Cognitive Behavioural Therapy. Trials have shown a reduction in symptoms of depression and anxiety even when users complete only one or two modules. These benefits last at least 12 months after use.
MoodGYM was developed by the Australian National University in conjunction with other leading researchers and mental health experts, but you don’t have to be an Australian to participate – it’s estimated that over 200,000 people worldwide have used the program thus far.
For the record, I’m not affiliated with MoodGYM or it’s creators, in fact I haven’t even used this particular program. I’m just an Aussie with treatment-resistant depression who has recieved some benefit from CBT (and DBT for that matter). Because while I still have severe depression (it appears to be mainly biological), I am now equipped with skills to challenge the bombardment of suicidal thoughts. And having twice attempted suicide, I’m pretty sure I’d be dead otherwise.
Any way, here is the link for MoodGYM: http://moodgym.anu.edu.au/welcome
On line services are an adjunct to mental health care, not a substitute. You start rationalizing you can either treat or be treated over an internet service, you are in the end dumbing down the intrinsic value of psychotherapy for the one to one interaction it is.
They told me in my residency only about 20% of the patient population really will utilize and find treatment maximally efficacious for mental health. For a good portion of my career I really resisted believing that statistic, that providers would grow weary of working with a sizeable percentage of patients who would either test the process or just tire of the real committment of treatment that really is about time, money and energy.
But, for me, both the false sale of widespread psychopharmacology and the intrusion of the internet really has been dumbing down the value of mental health care in the end. So, that number is more likely true. How unfortunate that of the 10 people who come into mental health care, only 2 of them will realize some substantial impact into their lives.
But, I am willing to continue to work to maximize I will interact with that 20% that will comprise a larger percentage of my practice in the end. Because I do not sell quick fixes, but solid and effective interventions.
Skype away providers and patients. I am sorry to say you probably will sour on the outcomes sooner than if you interact with the person at the other end of the room directly. Just my opinion.
$140 per hour is nonsense. At iCouch.me we charge $99 per hour for single sessions and have 4-session block discounts available. CopeToday has to charge so much because they have to pay their PR people so much money! Interestingly, also in the Times article it mentioned that CopeToday’s PR flack wouldn’t comment on how many clients return for follow up sessions. At iCouch, we have over 86% of clients return for at least a second session. While there are other good providers (Breakthrough is certainly one,) at iCouch.me, we take online counseling much more seriously than your average venture-funded ‘dot-hope.’ Online platforms have a duty beyond getting press — their focus should always be on client service first, then financial rewards second. We all remember that in the early days, google and Twitter were non-revenue companies. They focused on product first. That’s how it should be with online psychology — making counseling affordable, accessible and convenient. Profits will come — PR flacks or no PR flacks!
Thanks for the great analysis of the Times sudden realization of what we’ve been building for years. Great article!
Brian Dear
CEO, iCouch, Inc.
Brian, thanks for sharing some information about your services at iCouch; I’m glad to read of it. For the record, Twitter is still pretty much a non-revenue company because they have a valuation of something like $4 billion.
Joel, I respectfully disagree. We now a good set of research demonstrating the effectiveness of these kinds of interventions, so it’s not that they aren’t or couldn’t be effective on their own. It’s just that not that many people are interested in using them.
Given that up to 40 percent of patients never return for a second psychotherapy session, perhaps there’s a business model for helping those kinds of folks who are looking for (whether they consciously realize it or not) single session psychotherapy.
John,
I can’t agree more. It’s no longer about who is right or wrong in terms of where services should be delivered, but about looking at the public’s demand for help. The public is online, period. Our job is to be where they are so that when the need arises, they find a qualified person to help them.
IMO, as a profession we can do better at helping people access services at different points and not just when they are ready to pay full fee. There’s a great business model out there for people who want to have entry products for clients to help warm them up to therapy.
Perhaps if we started looking at the real needs our clients have then we can design a way for them to interact with us along the way to a face to face session and not just when they’re ready to commit to the full package.
I don’t know many other businesses that demand in the way many clinicians do that they only way to get involved if full fee. It’s no wonder that pop psychology is so popular. The statement there by the public is that they want smaller and less expensive ways to get involved. Would love to see someone research how many products, books, seminars, workshops, tele-classes, ebooks etc full-fee clients participated in before they actually bit the bullet to get in a relationship with a therapist.
Thanks for posting your thoughts, they reminded me to go back to my inbox and read the full article!
Melanie
Thank you for the reply, Dr Grohol, but please note I did not just pick on internet services as a cause to poor follow up, but the fact that psychopharmacology is oversold, and in my opinion as a practicing psychiatrist, overutilized until proven otherwise diminishes the pursuit of psychotherapy.
Behavioral cognitive therapy really is being minimized these days, or just sold as a quick fix by 3-6 visit committments by therapists, especially in EAPs from what I have seen and heard. Maybe a sizeable percentage of people with depression and anxiety do not need to see a therapist for 6 or more months at times, but to claim you can treat a person in 3-6 visits who have quantifiable psychosocial issues to their angst, 2 months of follow up does not cut it!
And having the internet be sized up as a resource, well, good luck with that long term for the majority of patients. Note I do not call people clients or customers.
Thank you again for the opportunity to comment.
I couldn’t agree with you more, Dr. Hassman. We need that personal connection, we need it for more than 6 sessions when we are in a serious depression. How does a therapist really read a person or see their emotion over a computer screen – they can’t. It’s important to keep the human aspect in therapy. I think this is such a large part of the problem in society today – we are becoming disconnected with each other and replacing personal interacation with gadets.
We are social creatures – that doesn’t change because technology comes up with a different idea.
As a former client of a modestly-priced online therapist (average cost was $25 a session; his prices have increased to $28 a session), this therapy was the best I ever had. It wasn’t just the cost nor the convenience; it was, perhaps, partly because I had a skilled therapist, but also because it overcame all the problems I had with face-to-face therapy: 1) Payment was required before services were received; with my face-to-face therapist (hereafter referred to as FtoF), we had disagreements about payments, mostly because he switched to treating me pro bono; 2) I can still refer back to therapy sessions, even though we ended therapy over 4 years ago, because it was email therapy and everything is in writing. With FtoF, I’d refer to something he’d said, and he’d deny that he said it; 3) My email therapist always seemed to remember who I was; he didn’t forget important details (of course, he could look them up if he needed to); 4) We had an excellent therapeutic relationship. Although my sessions are pretty disorganized because I’ve been scanning everything I own to get rid of paper and I’ve only partly completed the process, I’d be happy to share them with you if you’d like to see evidence of how email therapy can be efficacious.
Hi John, I agree with much of your post. (We were contacted for the New York Times article but my emails to the reporter were trapped by his spam folder so Breakthrough.com wasn’t covered! I joked that next time, I am sending emails, phone calls, smoke signals, and carrier pigeons.)
We see a growing number of companies entering the space and I think you’ve isolated the key issue: consumer demand. It exists but it’s not yet widespread and there are numerous risks that you know about to navigate, which makes succeeding in this market a lot harder than the typical consumer web or mobile application. I think we’ve had some modest success because we are very focused on where client demand is highest (and learned from plenty of mistakes along the way!).
It will be fascinating to watch this market evolve.
Best,
Mark Goldenson
Breakthrough.com
you’re right. online therapy is truly one of the best ways to get counselling without paying so much time. I for one had a wonderful experience with an online therapy provider and I must say that online therapy is such a great way to get counselled!