Millennials and the false allure of online psychotherapy
My new patient, B., a 23-year-old graduate student, began our session by pulling out her iPhone. She had diagnosed herself with an anxiety disorder by taking a brief online questionnaire "Are You A Worry Wart?" - and eagerly showed me the results. Before I could explain them, she asked if I texted with my patients and told me about a therapy app she liked called Talkspace. (I'm only identifying B. by the first initial of her middle name to protect her privacy.)
This is the problem I encounter working with millennials in my practice as a psychologist. Selling face-to-face talk therapy to them is like trying to convince them to listen to the Beatles when Beyoncé is en-vogue. They live their lives by relying on apps, such as Google Maps, where each step toward a goal is magically dictated to them. While fast, convenient, and inexpensive, the technology can end up eroding a person's own self-confidence in problem solving, causing anxiety to spike when they face the unknown.
That may partially explain why millennials are the most stressed out group in the country. A recent survey conducted by the American Psychological Association reveals that millennials ages 18 to 33 report the highest stress levels of any age group in the country. Work, relationships and financial concerns are among their top worries, which lead to mood disorders, such as anxiety and depression. Nineteen percent of millennials suffer from major depression compared to just 14 percent of middle-aged adults.
With Talkspace, for just $25 per week, clients can purchase "Unlimited Messaging Therapy" that allows them to text with a therapist whenever emotional problems arise. The website for the app states, "just like texting with a close friend, you can now message your therapist every day, for an entire week, writing as many times as you want." Initial sessions for In Your Corner cost as little as $25 dollars for "instant expert support when you need it." That might include online therapy, written coaching plans and stress-reduction techniques from a meditation instructor.
As a psychodynamic clinician, I firmly believe healing takes place by way of relationships. Research about the effectiveness of psychotherapy supports this belief. There are subtle nuances that are only revealed through in-person connections. Sitting with my patients, some of whom I have treated for years, I gauge how they feel by the rise and fall of their voices, and the glances we exchange during the hour. These forms of communication illuminate our sessions, offering clues for interpretation and insight.
Mental health apps are more like a therapy "snack" and, in my experience, often fail to instill long-lasting change. One of my patients tried text therapy for a month, hoping it would help manage her eating disorder. When she forgot to answer her therapist's messages, she realized that she needed to work harder in therapy, which meant leaving the house for an office appointment.
With that patient in mind, I told B. that while I don't offer text therapy, patients often show me text messages from family and friends when they want my perspective about a certain relationship dynamic. Then, stretching myself to speak B.'s language, I asked if she had ever used Tinder, the mobile dating app.
Perking up, she told me that she had.
"Sorry, but therapy is not like Tinder," I explained. "Unlike the fast connections that Tinder promises, therapeutic relationships develop over time."
"If you continue therapy with me, I hope this is a place where you can unplug from your technological life and plug into your emotional one."
There was a silent pause and I wondered, Would she swipe right and choose me? And if she did, could I transform her need for a quick fix into something more meaningful and curative?
"How will therapy work?" B. asked.
I told her our first job was to understand her pain. I asked her to tell me what was causing distress.
She disclosed that a ticker tape of worries ran through her mind and she couldn't get them to stop. She was struggling in school and felt that anxiety had hijacked her joy.
"Our feelings are like emotional traffic lights that indicate when something is safe or dangerous. Your anxiety tells me that your light is glaring red," I told her.
I said we would create our own Google-type map, one that would guide her out of danger. I told her to begin by asking herself these questions: When did she feel the most anxious? What triggered her worries? I asked her to record these answers before our next session.
B. looked at me and joked, "So, you're like old school?"
"I guess I am," I said, "and think of it this way, vintage can be cool."
She agreed to give "old fashioned" therapy a try.
The following week, back on my couch, she pulled out her iPhone once more. This time, instead of showing me another self-help quiz, she shared some notes about her anxiety and how it affected her. With a more realistic view about how therapy works, she began to realize that we couldn't zoom through her troubles, but together we could find a way through them.