When Shirley Velasquez's husband was relocated to Paris, she quit her job and bid their friends and New York City apartment good-bye. But there was one thing the 36-year-old journalist couldn't leave behind: her weekly therapy sessions. So at the same time each week, Shirley pops open her laptop, and via live-streaming video, she unloads the week's emotional highs and lows while her shrink listens carefully from across the Atlantic.
Sure, Shirley could have found a new doctor (she's fluent in French) but, she says, "after five years together, my therapist knows me. The way we work through issues feels comfortable and safe."
Streaming Your Shrink
Ever since the debut of Lisa Kudrow's Showtime series Web Therapy (which premiered on the Internet, natch), people have been buzzing about the viability of transferring couch sessions to the computer. Though the show is a spoof, it's based on a very real trend: Therapists are reporting a rise in the number of patients requesting video sessions, says Mary Alvord, Ph.D., presidentelect of the American Psychological Association (APA) Media Psychology Division. Sites such as Cope Today, TherapyLiveCare, and NowClinic have sprouted up to meet demand by providing the technology (and, in some cases, the therapists as well).
This counseling 2.0 is booming in part because so many people are suffering from mental-health woes such as stress, anxiety, and depressionÃ¢â‚¬”and women are at higher risk, says David Muzina, M.D., of the Medco Neuroscience Therapeutic Resource Center in Dallas. "Psychological counseling should really be the first method of treatment for most of these conditions," says Muzina.
And although a new APA study found that women are five times more likely than men to seek help from a mental-health professional, many of those women don't have the time or money to spend on traditional therapy sessions. Add the fact that plenty of people are now at ease communicating online, and the door opens for video therapy. Many find that it's more convenient (you can do it from your home, office, or anywhere you have a Web connection), faster (it eliminates time spent commuting or sitting in a waiting room), and more affordable (therapists typically charge about $20 less per session).
Research has found that Web therapy can work just as well as the face-to-face kind. Patients feel satisfied and have reduced symptoms after video treatment, according to a 2011 study, and a handful of other studies show the medium can be effective in dealing with post-traumatic stress disorder, social anxiety, depression, and obsessive behavior. "After all, it is still therapy," says Alvord. "Nothing about the therapists' clinical training or skill level changes when their care is delivered via the Internet."
No skill level, however, can make up for technical glitches. A frozen or dropped connection can interrupt a session at a crucial moment, says psychologist Marlene M. Maheu, Ph.D., executive director of the TeleMental Health Institute. But a bigger concern is that important off-screen nonverbal behavior can be lost in translation. During an in-office session, a shrink will be on the lookout for telling signs such as finger fidgeting, foot tapping, or frequent shifting around (all potential anxiety flags). Via video, neither party can see much below the other person's neck, and therapists could miss other physical cues like odors (if, for example, a patient has been drinking or let her hygiene slide). Therapists also have little control over the situation if, say, an angry spouse walks into the patient's room. "Many things can go wrong," says Maheu. "A therapist must be clinically and technically prepared."
In other words, Web therapy makes finding a qualified professionalÃ¢â‚¬”who you feel a comfortable connection withÃ¢â‚¬”even more crucial. Though many sites, including Cope Today, provide instant access to therapists, you should do your own due diligence: Search for providers who are trained in telemental health or distance counseling, says psychotherapist DeeAnna Merz Nagel, cofounder of the Online Therapy Institute. Always confirm that a therapist is licensed by your state's board of mental health practitioners (after all, anyone can hang up a "therapist" shingle online) and have at least one face-to-face assessment before going live. Also, be sure the process is lawful: In some states it's illegal for a therapist to treat an out-of-state patient.
A skilled, trained therapist, says Maheu, will know if Web therapy is appropriate for you. Though it can be a huge help for many patients, it's rarely the right choice for assessing a drug or alcohol addiction, for instance, or treating those who live in relative isolation with little social support. A Web shrink should also know to use a video platform that's compliant with the Health Insurance Portability and Accountability Act (HIPAA), a federal law that ensures your personal details stay private. Though many well-meaning shrinks use Skype, says Maheu, it's not HIPAA compliant or totally secure.
Once you find an ideal therapistÃ¢â‚¬”or confirm your current one is Web-trained and willingÃ¢â‚¬”set up guidelines for what to do if a connection drops, if you don't "show up," or if some sort of emergency occurs, says Nagel. With a reliable therapist and video platform, the process can be a big helpÃ¢â‚¬”whether you need long-or short-term care.
Putting It in Writing
When you can't voice your concerns, there's always e-mail.
More therapists are beginning to offer e-mail therapy, whichÃ¢â‚¬”though it has many of the same shortcomings as video sessionsÃ¢â‚¬”can eliminate the on-the-clock feeling of a real-time appointment.
A decent option for patients with jam-packed daily schedules, e-mail counseling can be used in conjunction with traditional therapy (if, say, you'll be traveling and can't make your regular appointment) and allows you to take your time describing an issue or formulating thoughtful questions.
Here's how it works: First, set up an encrypted e-mail account through a free service such as Hushmail (never use your regular personal e-mail address!), advises psychotherapist DeeAnna Merz Nagel. Next, type out what's bothering youÃ¢â‚¬”it works best if you stick to a single issueÃ¢â‚¬”and then hit send. You and your therapist will work out a timeframe in advance (for example, you'll each respond to e-mails within two days).
Most therapists charge $35 or more per exchange, which encompasses the patient's initial e-mail and the therapist's first reply. Theoretically, you can e-mail back and forth as many times as you'd like, assuming you're willing to pay.
Before you start typing, though, it's still a good idea to start with a face-to-face session. And, just as you would in traditional therapy, be sure there are clear boundaries: Don't e-mail your shrink outside of your agreed-upon exchanges. This is a professional relationship, not a friendship.