Teletherapy works and is badly needed

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When I drove my 18-year-old husband to the emergency room last November, he apologized for the inconvenience. “I’m sorry,” Dan said. “I just can’t believe this is happening.”

Dan had struggled with insomnia, depression and anxiety for months. Persistent negative thoughts plagued him until they crowded out everything else. He suffered from the second epidemic currently raging around the world: the mental health crisis.

After several weeks of minimal sleep, Dan finally got an emergency telemedicine appointment with a psychiatrist. After talking to him for 10 minutes, she let me join the zoom call and told me I needed to take Dan to the nearest emergency room for a psychiatric evaluation immediately.

This virtual intervention saved his life, but the stress of helping my husband was starting to wear me down. I needed a therapist for myself, but I didn’t want to see one in person. I’ve always had a fear of going into doctors’ offices, a condition that’s often colloquially referred to as “white coat syndrome.” My blood pressure rises and my heart is pounding when I need to see a doctor. I also have a busy schedule of work and education.

After months of searching, I found a provider that offered the option of online therapy. I decided to give it a try, although I was skeptical about revealing my feelings through a Zoom call. I worried that virtual sessions would ruin the intimacy of one-on-one counseling and that a therapist would be just another talking head on a screen.

But immediately I began to notice the benefits. For the first time in my life, I wasn’t afraid of going to therapy. I found it comforting to talk to my advisor while wearing fluffy slippers. And to my surprise, I was able to share my feelings through a screen much more easily than I could ever do with a personal psychotherapist.

I realize that my experience bumps against dominant cultural notions about “returning to normal” and the need to recreate analogous experiences. It’s true that many therapists and patients have been dying to return to the in-person meeting rooms. However, others who would prefer to continue telemedicine appointments are finding that the option is being narrowed. Emergency orders issued by states during the pandemic mandating coverage for telemedicine visits and allowing out-of-state providers to participate are expiring. And some private insurance companies have started rolling back telemedicine coverage.

But now is the time when the teletherapy option in particular is badly needed, many experts say. Anxiety and depression rates have risen 25 percent globally since the pandemic began, while there is an alarming shortage of therapists to take on new patients.

Research shows that psychologists’ use of teletherapy has increased from 7.1 percent of their work before the pandemic to 85.5 percent of their work during the pandemic, according to a national study led by researchers at Virginia Commonwealth University and published in American Psychologist has been published. And research shows it can be as effective as in-person treatment, said Ashley Batastini, a psychologist and an assistant professor in the Department of Counseling, Educational Psychology and Research at the University of Memphis.

Batastini analyzed two decades of data comparing teletherapy and traditional treatment for a wide range of diagnostic criteria, including depression and eating disorders. “We found no evidence that there is a difference between video conferencing and in-person mental and behavioral health interventions,” said Batastini. Based on the data, some women appear to have better results with video therapy than with in-person treatment, although Batastini says more studies are needed.

The American Psychological Association supports the continued use of telepsychology in a safe and confidential manner, said Lynn Bufka, associate chief of practice transformation for the APA. “We’ve had the big experiment for two years and we’ve seen it work.”

Bufka added that the organization “advocates that telemedicine should continue to be an option, paid equally, as there is no difference in the quality of the services provided.”

Timothy Heckman, senior associate dean for research and faculty affairs at the University of Georgia, co-authored a study that found that teletherapy resulted in large improvements in patient outcomes that lasted several months after treatment was stopped and did not change reported outcomes of patients who received personal therapy. However, more research is needed with a more diverse group of clients, including those with PTSD, Heckman said.

The effectiveness of teletherapy isn’t the only reason it should be continued, patients and doctors say. The convenience of teletherapy is also a lifeline for people who have trouble getting to an in-person appointment — such as people living in rural areas where doctors are few, those living in congested urban areas, those who have been exposed to or have symptoms of Covid-19 and those who are disabled.

Pedro Ventura lives in Los Angeles and is quadriplegic due to a spinal cord injury. Prior to his gun violence injury in 2019, he personally attended therapy in both New York City and Los Angeles. In New York, he often commuted an hour and a half by subway to get to his appointments.

Now Ventura doesn’t have to spend time making it to an in-person appointment, nor does he have to worry if his therapist’s office is too small to comfortably fit his wheelchair. “You don’t think about it unless you’re in a chair,” Ventura said. “But accessibility in an office doesn’t always come naturally.” Finding a new therapist online was also easier because he didn’t have to travel to multiple offices to interview potential counselors.

Ventura said he doesn’t miss being in physical space with his therapist. “I feel like I can open up about the same on screen. A good therapist is a good therapist.”

Los Angeles-based therapist Maria Evans sees all of her clients from a distance, partly because she wants them to avoid the hassles of traffic. At the start of the pandemic, Evans helped train more than 10,000 therapists and social workers who had had to transition to teletherapy.

In some cases, Evans believes it would be better for clients to go to an office to meet — if, for example, they don’t feel safe at home or lack privacy. But in most cases, in their opinion, teletherapy is sufficient; She even had long-term patients that she never met in person. When they split, she said: “There were a lot of tears. This shows that we are still able to form the kind of deep connections that we would if we spoke face-to-face.”

While convenience is a big factor, another important benefit of teletherapy is the increased comfort patients feel, potentially allowing them to open up more. For me, it’s my fluffy slippers; Santa Monica therapist Ashley Graber said she has clients whose service animals join them for sessions. She also said that online therapy helps her get a better insight into a patient’s private life.

And it doesn’t all have to be one way or the other. Some patients benefit from hybrid treatment. For example, my husband prefers to see his therapist in person because he feels he benefits from the connection. But he still has many behavioral health appointments online, which saves him hours of driving each week.

However, I will continue my therapy online as long as my insurance will reimburse it and choose to heal from the comfort of my home.

Amy Ettinger is the author of Sweet Spot: An Ice Cream Binge Across America. Find them under www.amyettinger.com.

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