The changing landscape of Therapy and the advent of Online options.

When “going to see a therapist” lacks having to go or see the therapist, can you still work through life’s challenges and improve your mental health?  Going even one step further, can you not only feel better but can you actually become your best self with the help of telemedicine’s online therapy?

Millennials and Gen Xers already consider in-person doctors to be secondary sources of information. So as we shift to getting more information more readily online the piece of healthcare pie grows for the telemedicine category.

Talkspace, the preeminent online messaging therapy service, has sought out to not only reduce the cost of therapy but also to eliminate the “fear factor” which keeps others away from the care they need.  While cost prevents some from engaging in therapy, the initial hurdle of reaching out to find a therapist also stalls the process for many.

Traditional face-to-face therapy doesn’t always fit into the budgets, schedules, and comfort zones for a significant segment of the hurting world.  The world is hurting  (no news flash there, just look around) and when you are in a helping profession, as a therapist, that is what greases the gears; reaching across the gap to assist those otherwise out of reach.   I want to help others and when those in need can’t find me or approach me, therein lies a call to action to reduce the barriers to traditional counseling. To address this, I have been a Talkspace therapist for over two and a half years. I am so glad I expanded my practice to online clients.   As I reflect I know I have been helpful as well as helped in fine-tuning my skill set.

Originally, I gravitated for the convenience of the interface as well as the potential to engage clients from a much larger contact area.  For me, this means clients statewide including NYC. The therapy for the client and for the therapist is different, without question.   With the lack of face-to-face greeting, connecting, and bonding, which we tend to do more readily in person online therapy feels strange at first.  Things that jumped out at me as possible hindrances to this way of working were the lack of body language cues,  lack of vocal inflection,  as well as no margin for shifting in your seat or theatrics.  Yes, I said it.  At times therapy borders on performance art.  This would be missing in online therapy and words,  very carefully chosen words for that matter, would have to tell a very precise story and apply the emphasis and targeted inquiry needed.  Clients are in therapy to change whatever they have decided isn’t working, but in turn are also afraid of said change. Therapy is an art as much as a science because it takes both prongs to support the difficult change process clients pursue.

Online therapy, at first, was like performing to an audience of one on a darkened stage. Imagine a truly blind date.  I mean what if you weren’t even sure if they were there. There would be no “ooh and aaaa” or energy to feed and focus the therapy.   So, if you are wondering if this challenge; the pursuit of online therapy mastery made me a better therapist? Well, it sure did.  It helped me figure out quickly my intentions and the “why” behind my practical therapeutic strategy.  This cautious intentionality worked not only for online clients but for my face-to-face clients as well.  It fine-tuned my skill set and broke down my own barriers to getting to the essentials of the work.

Online therapy disposes of so many esthetics that what is left is the core of the therapy and what therapy can do.  It quickly, and possibly at times too quickly, gets right to the heart of why a client is seeking help.

Slowing clients down long enough to put in the scaffolding necessary to construct a foundation or therapeutic alliance is the first hurdle.  While the technology age has brought forth telemedicine with all its clean lines and “cut to the chase” fixes, what can be missed to the detriment of the therapy is the building of a relational foundation.  The therapy I provide is centered on expanding the story and making it all count.  Conversely, a medical modeled therapy reduces the whole discounting the features and breaks the target down to find a root cause.  I’m on the other hand looking to dissect the layers of life only to add them back together to create a sum.  A sum that is greater than its parts.

Online therapy requires clarity, intentional communication, and checking in with the client often.   It is hard to keep clients engaged as they busily navigate their day-to-day as well as dip into the therapy they sought.  The arc of relationship building to kick off the therapy is integral and while online clients may push for immediate symptom relief even more strongly than face-to-face clients, the truth is that everyone wants to feel better, now.

Online therapy with Talkspace includes text-based messaging; audio messages, and for some plans video sessions.  Messaging in these forms, for the most part, does not function in real-time.  Video sessions are available for some plans which would be video in real-time but for the most part client messaging is done on their schedule and responses are asynchronous, twice a day five days a week.

Talkspace, as the platform for the online segment of my private practice, operates to set the fee structure and with that, you can have more messaging or more video sessions based on a monthly subscription.

For some client text messaging operates as an online journal where they can leave messages to help them work through moment-by-moment struggles or an end of the day entry.  Text messaging correspondence at certain times of the week also provides a good foundation for self-reflection and identifying and processing feelings. Audio messages provide a free-flowing stream of consciousness feel and help keep the momentum of therapy moving especially when used as a journal.  With any endeavor that includes the personal work of therapy, one gets out what one puts in.  Talkspace invites clients to message in modes to fit each client as much and as often as they wish.   The Talkspace app on a client’s phone reinforces an “anytime, anywhere” invitation which is unparalleled in the therapy world.

As I explain to my Talkspace clients in therapy, the client will talk or message more than the therapist, as they would in face-to-face therapy, so try to get comfortable and start typing and talking.   As in face-to-face therapy, the client is primary and brings the content and process to the therapist.  “You are who you say you are and I only know what you tell me”. That is rather than the client brings their story and internal state and that is the data I have. This, after all, is not a reciprocal relationship so the client will contribute as much as they wish to, but it should always be the largest contribution.  Therapy is the perfect time to be selfish about the who, what, why, where, when as well as how you have been influenced, hurt, affected, impacted, or challenged in life.  It is your therapy after all.  You set the goals and pace. The more a client messages the more they are putting into the therapy and the more we will connect and consequently see the work move along.

This new online access that clients have to therapy and their therapist is unprecedented.   The cost is much more affordable for clients, while the access and convenience goes up considerably.  It truly is astounding.  My therapist colleagues probably think it is hard, weird and maybe even wrong to offer what we do.  But when you have answers in the form of affordable, convenient, and effective therapy that can help those seeking it to alleviate their suffering or pain; you can reach a much wider client base and do the most good.