July 16, 2024

Digital Domain: The Therapist Will See You Now, via the Web

SEE a therapist without leaving your home?

In an article in the American Journal of Psychiatry, Dr. Thomas F. Dwyer, a Massachusetts psychiatrist, says he has practiced “telepsychiatry,” via video teleconferencing, for five years. Its “adoption by psychiatrists and patients,” he predicts, “will proceed quickly if the organizers cope with the irrational responses of some users.”

But wait: That article appeared almost 40 years ago. It told how microwave television signals were used to connect a satellite clinic to Massachusetts General Hospital in Boston.

Today, even with the rise of the Internet, virtual therapy hasn’t been widely adopted. But several start-up companies are trying to make Dr. Dwyer’s decades-old vision a workaday reality.

Therapy delivered over the Internet, says Lynn Bufka, a psychologist and staff member of the American Psychological Association, “may open access to those who might be reluctant to go to an office or to those who might be physically or psychologically unable to.”

Proponents of Internet-based therapy point to some research suggesting that it is effective for certain kinds of conditions, like depression and anxiety. Reporting in The Lancet in 2009, a team of researchers found that cognitive-behavioral therapy delivered remotely to depressed patients in Britain continued to show benefits eight months later.

But companies promoting online therapy must contend with uneven or absent support from insurance companies, Medicare and Medicaid. Most states don’t require insurers to pay for “telehealth” services (those not delivered in person). And any reimbursements can be less substantial than for in-person treatment. Medicare offers reimbursement only if providers are very scarce, as in rural areas.

One company that is trying to match patients to therapists online is Cope Today, based in Raleigh, N.C. Tania S. Malik, its chief executive, said the company, which began in 2010, worked with the North Carolina National Guard for a pilot test of its service. It has since opened its service to individuals, whom it attracts primarily with search ads that are keyed to phrases like “online counseling” or “treating anxiety.”

Cope Today lets prospective clients view a list of therapists and their availability for consultation via video, phone or online chat. It provides the first 10 minutes of a session free, then charges $35 for 15-minute increments.

Ms. Malik says the average length of a consultation is 43 minutes. She declined to say what percentage of clients return for further sessions.

It is hard to sell the service to individuals who must pay for therapy themselves, Ms. Malik says. But she hopes to sign up employers who will pay for the service. “I don’t think we could be a success on a strict direct-to-consumer business, operating without reimbursement from insurance companies,” she says.

ANOTHER company offering online therapy, HealthLinkNow, in Sacramento, has decided to avoid the direct-to-consumer route, at least for now. The company, which started its service in May, is trying to sign up institutional clients, like hospital emergency rooms or large employers, rather than individuals online at home.

Barb Johnston, the chief executive of HealthLinkNow, says: “I think you’re going to see larger companies provide rooms in which employees can seek telemedicine services, including mental health services. That way, the employee won’t lose a half or a whole day of work for a consult.”

Because a range of health services would be provided in the privacy of that room, no stigma should attach to a patient who goes in for a private e-therapy session. “No one will know,” Ms. Johnston says.

One disadvantage of online therapy through teleconferencing is that “it can be hard to ‘read’ each other’s cues” that are not visible, like body language, Ms. Bufka says. “Humor can misfire, and some people may really benefit from having the personal relationship of therapy,” she says.

Videoconferencing technology has improved considerably in recent years, says Carolyn L. Turvey, an associate professor of psychiatry at the University of Iowa. The changes “make it less likely that the system will crash where a clinician and patient ‘lose the call’ — obviously, this could be very disconcerting to a patient who is describing personal and embarrassing material,” she said.

She notes one advantage of face-to-face therapy cited by clinicians: it encourages a depressed or anxious patient to get up, get dressed, get out of the house and go to a clinic. Then again, she says, some patients “describe feeling freer to explore deep feelings when they know they don’t have to drive a long distance home from the clinic.”

Professor Turvey, who is also the vice chairwoman of the telemental health group of the American Telemedicine Association, says her group does have concerns about how prepared online therapists might be for a crisis.

When patients came to a clinic in the earliest days of telepsychiatry, in the 1960s, someone was on hand who was trained to follow an emergency protocol. But homes and offices are “clinically unsupervised settings,” Professor Turvey says. She recommends that the therapist collect emergency contact information at the first e-consultation.

Patients with a strong desire for anonymity might log off, however, before providing such data. Ms. Malik, of CopeToday, says the therapists she represents — 90 percent of whom have private practices in traditional offices — do not collect personal contact information from their online patients. “If you’re counseling and it escalates, we would call 911,” she says.

Almost 40 years have passed since Dr. Dwyer, the psychiatrist, wrote of how he had initially been skeptical of the efficacy of telepsychiatry. His research showed him that it could be effective. But reimbursement policies were not a part of his experiment’s design.

Randall Stross is an author based in Silicon Valley and a professor of business at San Jose State University. E-mail: stross@nytimes.com.

Article source: http://feeds.nytimes.com/click.phdo?i=b5a59d0e57d2c0ee093d4e4511206acf

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