Many things are virtually unrecognizable from when they began. Over one hundred years ago, most people still didn’t own cars, while today, folks are zipping around in their gas-free, futuristic-looking, self-driving contraptions. However, therapy in many ways has remained unchanged from the days of Freud (for reference, our good buddy Sigmund also conducted therapy around the first time cars were released to the public).
Before the naysayers chime in, yes, collectively, there has been a shift in therapeutic methods from outdated forms of psychoanalysis to behaviorally focused, solution-oriented evidence-based practices that seek to arm consumers with values-consistent skills and actions.
However, the format of therapy through the looking glass hasn’t changed. If anything, therapy has become more complicated to deliver given the red tape around large organizations, risk management issues that bog down providers with needless paperwork instead of offering genuine human connection when it’s most needed, questionable reimbursement practices by insurance companies, abysmally low wages in any system outside of private practice, and lack of organizational resources to support providers in their work.
This has led highly trained therapists to feel overextended and burnt out at a time in history when they are most needed societally. Therapy has also become more difficult to access by the everyday person, who may not know the difference between the largely unregulated space of coaching, a prescribing psychiatrist (MD), a social worker (LCSW) specializing in connecting patients to needed community services, and a psychologist (Ph.D. or PsyD), or marriage and family therapist (MFT) providing therapy.
Moreover, prior to the Covid-19 pandemic, few therapists were providing services virtually due to constraints around billing “face to face” visits, organizational rigidities of companies for which they worked, and a general sense of unease around “how” virtual therapy might evenwork. Many providers are still of the mindset that unless a consumer is “in the room” physically with them, there is no way to impact behavior, though many consumers don’t have the time, resources, or inclination to show up “in the room” ” in the first place.
Research on the common factors that make therapy “work” shows this is not the case. Aligning with the client, a true empathy for someone’s difficulties without comparison, genuineness, and managing expectations are necessary but insufficient components of therapy, though we now know these components can and do convey on virtual platforms quite successfully.
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Complicating matters, we know therapy is not a one-size-fits-all solution, and different types of therapy will be more effective for different types of consumers. For example, dialectical behavior therapy, which teaches consumers skills in the areas of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness alongside family-based therapy, has been shown to be particularly effective for eating disorders.
Meanwhile, exposure and response prevention therapies are the gold standards for anxiety disorders, including obsessive compulsive disorder, hoarding, and even perfectionism. However, for consumers with chronic medical conditions like asthma, COPD, diabetes, pain, or cancer, acceptance and mindfulness-based approaches like acceptance and commitment therapy are usually most effective. Moreover, the same principles of behavior change that make therapy “work” for certain groups of people also translate to the general population through harnessing the science of behavior.
Entrepreneurial businesspeople and venture capital investors have observed these gaps in care alongside the snails’ pace at which behavioral health has kept up with the times and transformed it into a lucrative opportunity. In a recent poll of over 100 therapists nationwide who are looking to work in the technology space, nearly half stated they are looking for roles where they do not provide any clinical services whatsoever.
This preference points to the same crisis that exists with the nationwide teaching shortage, in that teachers are flocking to other professions that provide a more stable, supportive, balanced career option with reduced barriers to effectiveness. Highly trained providers seek to use their expertise in behavior change in novel ways that move entire systems of care rather than continuing to operate within the broken system.
Unfortunately for these experts in behavior and consumers alike, most of these therapists aren’t seated in the positions of power (read: C-suite executive teams) to produce the type of change they know most needs to happen. There is more hope for health technology companies with behavioral health leaders or former therapists within their executive teams. And for the therapists who join these companies to continue offering services as a provider, on its façade, these companies appear to be a godsend for consumers who have been hopelessly trying to connect to therapy and for the therapists who are able to offer the skillset they know best, all while increasing their job satisfaction.
However, the dark side of these mental healthcare technology companies is that many (not all, of course) only offer contract positions, they do not vet or train their providers in evidence-based practices, and they tend to target newer providers with the lure of virtual work, and continue to pay substandard wages while businesspeople at the top are reaping profits off your friends and family members.
While this may seem quite bleak, the good news is that behavioral health systems are noticing. Leaders are noticing. Providers are notifying. Change is happening to mental healthcare, and it’s here to stay. Accessibility is increasing at a lightning pace (still not fast enough), with mobile healthcare technologies being offered directly both to businesses and consumers. Outdated care systems will collapse if the system doesn’t flex with the times because therapists know they can go elsewhere to offer their expertise, and consumers will follow.
Perhaps another 100 years from now, we will be able to look at pandemics as the catalyst for change in healthcare, and technology spaces will have increased representation by the therapists they rely on to make their offerings available and profitable in the first place.
To find a therapist near you, visit the Psychology Today Therapy Directory.