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Teletherapy works, and it is vitally needed

Research shows that the use of teletherapy by psychologists increased from about 7.1 percent of their work pre-pandemic to 85.5 percent of their work during the pandemic. (iStock)

As I drove my husband of 18 years 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 been struggling with sleeplessness, depression and anxiety for months. Persistent negative thoughts plagued him, until they crowded out everything else. He was suffering from the second epidemic that’s raging throughout the world right now: the mental health crisis.

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

That virtual intervention saved his life, but the stress of helping my husband began to wear on me. I needed a therapist for myself, but I didn’t want to see one in person. I have always been anxious about going into doctors’ offices, a condition often referred to colloquially as “white coat syndrome.” My blood pressure rises and my heart pounds when I need to see any medical professional. Besides, I have a busy schedule with work and parenting.

After months of searching, I found a provider who offered the option of online therapy. I decided to give it a try, even though 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 right away, I began to notice the benefits. For the first time in my life, I felt no anxiety before a therapy appointment. I found it comforting to talk to my counselor while wearing fuzzy house slippers. And to my surprise, I was able to share my emotions through a screen much more easily than I’ve ever been able to with an in-person psychotherapist.

I realize that my experience pushes back against prevailing cultural ideas about the “return to normalcy” and the need to reestablish analog experiences. It’s true that many therapists and patients have been eager to get back to in-person sessions. Others who would prefer to continue telehealth appointments, however, are finding the option being curtailed. Emergency orders established by states as the pandemic took hold, which mandate coverage of telehealth visits and allow out-of-state providers to participate, are expiring. And some private insurance companies have begun rolling back telehealth coverage.

But now is the time that the teletherapy option, in particular, is vitally needed, many experts say. The prevalence of anxiety and depression has increased by 25 percent worldwide since the start of the pandemic, while, at the same time, there’s an alarming shortage of therapists taking new clients.

The use of teletherapy by psychologists increased from about 7.1 percent of their work pre-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. And research indicates that it can be as effective as in-person treatment, said Ashley Batastini, a psychologist and assistant professor in the counseling, educational psychology and research department at the University of Memphis.

Batastini analyzed two decades’ worth of data comparing teletherapy and traditional treatment, for a range of diagnostic criteria that included depression and eating disorders. “We didn’t find any evidence that there’s a difference between videoconferencing and in-person mental and behavioral health interventions,” Batastini said. In fact, based on the data, some women appear to have better outcomes using video therapy than in-person treatment, although Batastini says that further study is needed.

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

Bufka added that the organization was “advocating that telehealth should continue to be an option that is paid for equivalently, since there’s no difference in the quality of the services that are delivered.”

Timothy Heckman, senior associate dean for research and faculty affairs at the University of Georgia, co-authored a study that found that teletherapy produced large improvements in patient outcomes that persisted for several months after treatment ended and were no different than the reported outcomes from clients who received in-person therapy. However, more research is needed with a more diverse group of clients, including those with post-traumatic stress disorder, Heckman said.

The efficacy of teletherapy is not the only reason it should continue, patients and practitioners say. The convenience of teletherapy is also a lifeline for people who have challenges getting to in-person appointments — such as people who live in rural areas where practitioners are scarce, those who live in traffic-choked 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 a quadriplegic because of a spinal cord injury. Before his 2019 injury, the result of gun violence, he attended therapy in person, both in New York City and Los Angeles. In New York, he often commuted an hour and half by subway to get to his appointments.

Now, Ventura doesn’t have to spend time getting to an in-person appointment, and he also doesn’t have to worry whether his therapist’s office is too small to comfortably accommodate his wheelchair. “You don’t think about it when you’re not in a chair,” Ventura said, “but accessibility in an office is not always a given.” Finding a new therapist was also easier online, because he didn’t have to travel to multiple offices to interview potential counselors.

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

Los Angeles-based therapist Maria Evans sees all of her clients remotely, in part because she wants them to avoid the hassle of traffic. At the start of the pandemic, Evans helped train more than 10,000 therapists and social workers who needed to transition to teletherapy.

In some cases, Evans believes that clients would be better served going to an office to meet — if they don’t feel safe in their homes, for example, or don’t have privacy. But in most cases, she thinks teletherapy will suffice; she has even had long-term patients she has never met in person. When they parted, she said, “there were a lot of tears. This shows we’re still able to build as in-depth connections as we would in person.”

Although convenience is a huge factor, another important benefit of teletherapy is the increased comfort patients feel, which may allow them to open up even more. For me, it’s my fuzzy slippers; Santa Monica, Calif.-based therapist Ashley Graber said she has clients whose companion animals join them for sessions. She also said online therapy helps her have better insight into a patient’s home life.

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

I, however, will continue my therapy online as long as my insurance reimburses for it, choosing healing from the comfort of home.

Amy Ettinger is the author of “Sweet Spot: An Ice Cream Binge Across America.” Find her at amyettinger.com.

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