Therapy Via the Web: What Would Freud Think?
Telepsychiatry — psychotherapy via video teleconferencing — has been around for 40 years, as a 1973 article in the American Journal of Psychiatry attests. Debates continue about its effectiveness versus traditional psychotherapy when a patient has actually to get dressed, get out of the house and get themselves into a therapist’s office. On the other hand, telepsychiatry has its benefits, as patients who might be ashamed to be seen seeking psychotherapy — remember Tony Soprano’s wary posture while sitting in waiting room at Dr. Melfi’s office? — are able to get help in the privacy of their home.
A 2009 study in The Lancet in Britain found that patients who receive cognitive-behavioral therapy via teleconferencing had benefits after eight months. For those in rural areas where access to a psychotherapist is limited, telepsychiatry is better than no therapy.
Psychotherapy over the Internet has been found to be helpful in treating depression and anxiety. As the New York Times notes, coverage from insurance companies, Medicaid and Maedicare for such digital psychotherapy is spotty and this may be another reason patients don’t seek such:
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.
Cope Today is Raleigh, NC-based online company providing therapy from licensed counselors, therapists, psychologists, and psychiatrists. Prospective clients can see a list of providers in their state — 90 percent of whom have traditional practices with offices — and receive an initial 30 minute counseling session for free. After that, the first 10 minutes of a session are free, with clients paying $35 for each 15-minute increment. The company’s chief executive, Tania S. Malik, says the average session is 43 minutes long; she did not reveal to the New York Times how many patients return for repeated sessions which would enable to build up a relationship with a practitioner over time.
Another purveyor of online therapy, Sacramento-based HealthLinkNow, is currently seeking to provide services for institutional clients. Hospitals or large companies could provide rooms for employees to seek teletherapy, though I would wonder about employees being comfortable going to “the therapy room” and thereby possibly letting colleagues know they were seeking mental health services.
Such tele-services can also benefit those with other conditions besides psychiatric ones. Therapists have developed websites such as Rethink Autism to provide training and supervision services for those unable to find autism therapists in their immediate vicinity; Rethink Autism also offers webinars to train parents and therapists in techniques to teach autistic children.
The jury’s still out about the effectiveness, or not, of telepsychiatry; the main issue is how to pay for it, especially if the likes of health insurance companies, Medicaid and Medicare remain wary. While there is no substitute for seeing and interacting with a live human being in traditional psychotherapy, such therapists can charge over $100/hour. A 40-minute session from Cope Today costs a patient $70 (first 10 minutes free, then two-15 minutes sessions for $35/each). If insurance companies get more wind of telepsychiatry as most cost-effective, might they not only reimburse patients for it, but even start to see it as preferable option?
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