By KRISTI EATON
VIEW ON HEALTH
When therapist Vikki Stark saw the women she was treating in person, she was surprised. Stark, a psychotherapist and family counselor based in Montreal, had been having regular therapy sessions with the woman for the past two years. During that time, the client had shared intimate details about herself and her family, and Stark knew the client and her life very well. But when it came to her appearance, Stark knew very little. That’s because Stark had been counseling the client, who hailed from a small town in northern Quebec that had no therapists, for two years by phone.
“We set up a regular time every week. She’d give me call and we’d talk about her issues,” Stark explained.
Although Stark had met the client at the very beginning of their relationship, it was two years before she saw her person, despite speaking to her every week on the phone.
“The funny thing was, about two years later, she came to Montreal. I’d totally forgotten what she looked like. She came to my office, and we started having a session. I ask, ‘Is this is as weird for you as it is for me?'”
Stark is one of a growing number of therapists who are replacing traditional therapy in an office with phones and computers. As the world becomes smaller thanks to technology, teletherapy helps reach people who otherwise might not have access to certain health professionals.
Stark has been at the forefront of the movement, having used telephone-based therapy for about 15 years. In 2008, Stark, the author of “Runaway Husbands: The Abandoned Wife’s Guide to Recovery and Renewal,” started a group-therapy session to connect women from around the world experiencing divorce. Titled Bouncing Back Better, the group, made up of six to eight women, met every Thursday for an hour and a half. The women came from all over the world — Alaska, Australia and Texas, to name a few. Time difference was no problem, but a bit more logistically challenging than normal. The group met at 7 p.m. Eastern time, which was 11 a.m. the following day in Australia.
“It was amazing because everyone got to know each other over the course of eight weeks. It was very therapeutic,” Stark said.
After the release of Stark’s first book, “My Sister, My Self: Understanding the Sibling Relationship that Shapes Our Lives, Our Loves and Ourselves,” she was contacted by a family in Sweden for counseling services. With the advances in technology, especially improvements in computers, Stark said she anticipates teletherapy expanding. Soon, your doctor might not be down the street, but across the world.
And, according to several studies, teletherapy is just as effective as traditional face-to-face therapy.
A March study conducted by the University of Montreal looked at 17 post-traumatic stress victims from the Outaouais region who underwent 16 to 25 sessions via teleconference with Montreal therapists. A control group consisted of patients receiving face-to-face therapy. Both groups benefitted equally from their respective therapies, said Stéphane Guay, a psychiatry professor at the University of Montreal.
“The same number of patients in both groups saw a significant decrease in their post-traumatic stress, depression and anxiety symptoms,” Guay said in a release. “In fact, 75 to 80 percent overcame their chronic post-traumatic stress.”
She said that patients were later asked about the distance between the therapist. None expressed discomfort about using technology to reach the therapist.
“In fact, comments were more in favor of teletherapy,” said Guay. “It seems patients appreciate a certain distance from their therapist.”
Moreover, a 2009 study from the University of Bristol in the United Kingdom showed that 42 percent of patients who received cognitive-behavioral therapy online recovered from depression after eight months, compared to 26 percent in the control group.
Stark believes the difference between therapist and patient can be better than traditional face-to-face therapy.
“If you think of the old fashioned idea of analytical therapy, the patient lies on the sofa and the therapists is behind them. The idea is that you’re not in the usual social conventional setting. It frees you up to talk about more intimate material,” Stark said. “I think in some ways, just having the voice, it makes it possible for people to be able talk about things they might be too embarrassed to talk about.”
Stark has yet to use technological advances like Skype or a webcam, instead preferring to remain simply auditory.
“The visuals are not really smooth. They’re a little jerky. I think it would interfere,” she said, although she admits that the absence of visual cues is one drawback but something that can be overcome. That’s one of the main reasons some oppose the practice. They say the lack of visual cues and face-to-face interaction can be less effective and cause problems with misdiagnosis.
However, Stark believes teletherapy can help people who might otherwise not be able to.
“Its just different from regular therapy. It fits the bill. If people are homebound and cant travel, they can do it. If they live in a small town and there aren’t other therapists in the area, they can use it,” she said, adding that people who have kids who are unable to get a baby sitter and leave the house can also benefit from teletherapy.
Doctors from Michigan State University have been using teleconferencing to reach people, particularly children and adolescents, in rural areas who need psychiatric treatment. On a typical morning, according to the school, doctors can see up to 10 patients from around the state through teleconferening.
“We are able to provide services to populations in a way that is timely and just as effective,” said Jed Magen, Department of Psychiatry chairperson. “It comes down to access to care, and too often, many families and children are forced to go without the vital care they need. Programs such as this can make a difference.”
The doctors treat a variety of psychiatric disorders, ranging from attention deficit disorders to childhood aggression to depression.
“This really was in response to a shortage in psychiatrists, which is seen not only in Michigan but nationwide,” Magen said. “The problem is especially acute in child psychiatry. This is the only viable solution.”
Breakthrough.com is a website that connects patients from across the country to counselors in a variety of fields who will treat them via secure video, phone, chat, email, and other mediums. Patients search for a doctor, set up an appointment and pay using the online payment method PayPal. The website works to check that all the therapists are licensed, but recommends patients separately check the state board to make sure the therapist is.
Besides licensing, patients should also find out if their insurance covers teletherapy. As it grows in popularity, more providers do cover the practice, but otherwise, treatment can cost around $90 to $100 per hour. Virginia is the most recent state to pass a law requiring insurance coverage for teletherapy. It does not, however, cover services provided using an audio-only telephone, e-mail message or fax transmission. Virginia becomes the 12th state to mandate that health plans cover telemedicine. In Nevada, there is currently no law requiring Medicaid to cover teletherapy. But private providers are an option as more and more are offering coverage.