© Wiphop Sathawirawong
Wellness
Throughout the pandemic, record numbers of people have been seeking advice via online therapy, many of whom are talking to someone about their wellbeing for the first time. But is it as effective as face-to-face meetings and will it normalise asking for help?
The past year has been dominated by gloomy news. Billions of people around the world have had to cope with grief, economic meltdown, unemployment, boredom and loneliness. Much has been made of the impact on our state of mind, with reports of rising anxiety, alcoholism, depression, and worsening psychological health for many. It makes you wonder: are there any reasons to feel cheerful?
And yet, a quiet, worldwide revolution has been brewing. One that has received little fanfare, but is transforming the way we help those facing psychological distress.
In October 2020, the World Health Organisation (WHO) reported that around 70 per cent of countries have now adopted ‘teletherapy’—therapy session via video call—to overcome disruptions to in-person mental health services. New York City-based mobile therapy company Talkspace, for instance, has seen a 65 per cent increase in demand for its services since the start of the pandemic.
Meanwhile, researchers in the Netherlands report that the pandemic “has prompted a radical shift in how practitioners conduct their treatments and has led to a sudden upsurge in online psychotherapeutic sessions”. As American therapist Kristen Gygi puts it: “There has been a rise in online everything during the pandemic, therapy included.”
In China, WeChat, in particular, is being used to deliver online psychological counselling services, according to a paper published in The Lancet in February 2020. But, as the weekly medical journal reported in July, there are drawbacks associated with the use of remote therapies. Issues such as having the requisite technology, and internet access and data allowance costs, mean digital therapy might not be suitable for some of those most in need, such as older people, those with reading difficulties or on lower incomes.
The WHO also noted that there are significant disparities in the uptake of online help; more than 80 per cent of high-income countries reported deploying online therapy to bridge gaps in mental health services in person, compared to less than half of low-income countries.
Since many countries (the UK, France, New Zealand, Germany and Italy among them) started introducing lockdowns in March 2020, remote therapy has become more accessible, more available, and less stigmatised—fantastic news for anyone finding life difficult.
Once upon a time, you were thought odd if you had a therapist. When I first turned to therapy more than a decade ago, I kept my appointments quiet. It seemed self-indulgent to pay for psychological help. But the negative connotations around therapy are diminishing fast, accelerated lately due to the psychological havoc wrought by COVID-19, which has put mental health at the centre of public discourse. Now many of us are seeking psychological help for the first time.
“The so-called stigma may be less these days as our world is considered to be more and more stressful,” says Gygi. “We could see this as a sort of reverse peer pressure, where it's suddenly more OK to be afraid because everyone is doing it.” Louise Chunn, the founder of Welldoing, which matches therapists and clients, agrees: “Many professional men are coming for therapy and have decided to use the lockdown period to deal with longstanding issues. Couples are doing the same thing.”
Dr Carla Croft, who works for the UK’s NHS, says online therapy has many advantages for clients: “I often see people now by video on their lunch break, in their car or the work quiet room, and of course a high number are working from home so they have newfound privacy from colleagues and additional flexibility. This means that working people are potentially accessing therapy more readily.”
Meanwhile, consultant psychiatrist Dr James Arkell, of the Nightingale Hospital in London, has noticed online therapy suits younger people because they find texting and FaceTiming familiar territory and he can happily assess them over a smartphone.
I now work with a therapist online and prefer it. I feel more relaxed, sitting on my own sofa with the familiar smell of its faded cushions. Chunn told me this is called “the disinhibition effect”. “Even couples’ work and trauma work has been successful online,” she says. “People open up more easily without the drama of commutes and waiting rooms, and having support nearby in the next room.”
Several studies from around the world, including ones from the US’s Northwestern University and Germany’s Leipzig University (both in 2014) suggest that online therapy is just as effective as face-to-face work for clients, especially longer-term. More recent research, published in the Journal of Affective Disorders in March 2020, focused on the differences in quality of interactions between face to face and telephone psychotherapy. It found there was little difference in terms of how effective the therapeutic relationship was, how much clients disclosed or levels of empathy, attentiveness and participation. The only real difference was that telephone sessions were generally shorter.
Online therapy is also working well for therapists themselves in a way that was previously unthinkable. "The attitude to online therapy has utterly changed,” says Chunn. “Therapists had been rather sniffy about it in the past, but according to research we did with our therapists in July, the majority are happy to use it, and many think it has offered extra insights into their clients.”
Consultant clinical psychologists such as Dr Croft find that they can offer more sessions, welcome news both for the therapist and for those seeking treatment who often face waiting lists. Dr Arkell found that in some cases, he can glean a more emotional tone over the phone without the visual distractions, or in other instances seeing someone in their own home can also give the clinician more information.
Online therapy can sometimes be cheaper than a face-to-face session. More established therapists’ fees can be prohibitively expensive (rates range from Rs 1,500-3,000 an hour in India) and major insurers are paying the same amount per session however the therapy is delivered. Meanwhile, Kumaar Bagrodia, founder of Mumbai-based company NeuroLeap, which uses technology to help people improve their mental health, says that online sessions are available for as little as Rs 500 a session in India. "It’s always worth approaching a therapist to find out whether they operate a sliding scale of fees (according to your income) or a special rate for students or job seekers,” Dr Croft advises. “There has been so much goodwill among psychologists during COVID-19, I think we have all been simply helping where we can.”
Of course, some clients and therapists would rather be “in the room” and feel that something is lost by doing it remotely Bagrodia says: “Online therapy inevitably means a lack of physical connection. It can be difficult for therapists to pick cues and the body language of their clients. For many clients, the act of going for therapy was important in itself.”
It may be hard to spot some psychological difficulties online, especially if there is a psychotic element to a condition or a problem with body image. Dr Arkell adds that bad wifi can be a frustration and people with marital issues might struggle to find a safe space. But for others, it is a revelation that they can get teletherapy in such an easy way. It just might be the answer for anyone needing a reason to feel cheerful in 2021.
Rachel Kelly is a British writer, mental health advocate and author of Singing in the Rain: 52 Practical Steps to Happiness (Short Books Ltd, 2019)
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