The Bay Area has some of the worst traffic in the country. A recent study found drivers there spend 83 hours a year sitting in traffic. This happens to be where C. Barr Taylor practices psychiatry.
Taylor, a professor emeritus at Stanford University and a research professor at Palo Alto University, said many mental health patients face traffic, time and convenience problems to see therapists. However, the rapidly expanding field of online therapy might provide relief.
Online therapy emcompasses a variety of ways to deliver mental health counseling over the internet, rather than face-to-face. Instead of sitting on a couch in an office, patients get treatment on their smartphones or computers. Some programs involve no human interaction, though Taylor said programs that pair patients with real people tend to get stronger results.
People who use Talkspace, an online therapy app, download the app and get a consultation before picking a payment plan and therapist.
"From there they'll hear from their therapist, hopefully within 24 hours and get started working with them on the app," said Amanda Rausch, a licensed marriage and family therapist and clinical experience manager for Talkspace.
Talkspace is mainly text-based. A patient and therapist periodically trade messages in a chatroom throughout the day. There is also an option for audio and video sessions.
The content of an online therapy sessions is usually not much different than a face-to-face meeting, said Michelle Newman, a professor of psychology and psychiatry at Penn State University. In person, a therapist might try to teach someone a coping skill, assign homework and help the person with any obstacles. Some forms of online therapy is more like self-help, though users may be able to ask questions if they have access to a coach.
Help at your own pace
Studies have shown online therapy can be effective in treating anxiety, depression and eating disorders, Newman said. It's usually cheaper and more convenient.
"You have a little bit more flexibility than in-person therapy," she said.
But it's also better for people who are self-motivated and able to impose structure on themselves, which isn't always the case for people seeking therapy. Perhaps because of this, the population of people who use online therapy seems to be different than that of people who prefer one-on-one therapy. Online therapy fans tend to be younger and more digitally savvy.
The advantage of online therapy is that it can reach a wider audience of people who might otherwise not get help, Newman said.
Online therapy could be well suited to treat problems with depression or anxiety, which are common but seldom treated, Taylor said. They may be of less help for people who have multiple issues at once, like depression, drinking and relationship problems. For more complicated problems, it may be better to see a therapist in person, he said.
Online programs also rarely integrate medication. It's tough to prescribe to people you haven't met, Taylor said. Online therapy tends to focus on specific disorders, while a face-to-face session might yield more general solutions.
In addition, online programs tend to be written more for educated people, though that is changing, Taylor said.
Rausch feels her Talkspace clients skip sessions less often. They're also more honest.
"There's something about being on a computer that helps people open up," she said.
She has clients who are too busy with work or kids, have severe anxiety or chronic illnesses to make it to the office. She has clients who live in rural areas far from mental health centers. They wouldn't get help without online apps like Talkspace, she said.
How much is it?
Seeing a therapist costs anywhere from $125 to $175 a session, Rausch said. Talkspace plans start at $128 a month. The company recently partnered with Magellan Health, a health insurer, and hopes to get more insurers to cover treatment, she said. Many clients have also been able to talk to their insurers to get reimbursed for using Talkspace, Rausch said.
"More and more insurers are looking into covering text-based and app-based therapies," she said.
Most online therapy companies charge on a monthly rate like Talkspace, Newman said. The monthly rate is usually cheaper than a month's worth of face-to-face sessions.
Insurers have been slow to cover online therapy. There's no organization like the American Psychological Association to lobby for it, Taylor said. Rather, it's "nerdy scientist types" like himself.
That is changing, however. Insurers are beginning to take interest in online therapy because of the lower cost, Taylor said.
Cathryn Donaldson, a spokeswoman for America's Health Insurance Plans, an industry group, said insurers are "proactively adding" online mental health options to their plans and seeing positive outcomes.
An expanding field
The study and use of online therapy is growing "at an exponential rate," Taylor said. There's no estimate of how many people use online therapy, but there are hundreds of mental health apps available on Google Play and the App Store. Talkspace has 15,000 active clients who have access to 1,500 therapists in 50 states, Rausch said.
Most studies show online therapy is just as effective as face-to-face therapy for many problems, though some evidence shows people who use online therapy tend to drop out of treatment more often, Newman said. Online options are particularly effective for delivering cognitive behavioral therapy, a type of treatment that's more about teaching coping skills for specific symptoms.
The biggest issue online therapy faces is privacy, Taylor said. Patients may be comfortable using email and text to talk about their problems, but therapists might struggle with keeping their health information private, as is required by federal law. Companies are beginning to develop messaging systems that comply with privacy laws.
Many online programs simply upload techniques used in face-to-face therapy, like cognitive behavioral therapy. Taylor believes future programs will incorporate gaming and artificial intelligence.
"I think all therapy is going to be done by virtual avatars," he said.
For now, Rausch said anyone interested in online therapy should do their research, find a reputable company and take the dive.
"Just try it," she said. "The hardest part of getting therapy is starting and we try to make that really easy for people."