About 20% of people who make an appointment with a mental health professional never show up, and another 20% never come for a second visit. Forty percent of patients who start taking an antidepressant drug quit within a month, and most get no follow-up.
Statistics like these indicate why patients and therapists alike have expressed interest in long-distance psychotherapy, which could eliminate travel and waiting time, and allow more flexible scheduling. It could make psychotherapy available to patients who are unreachable now, including many of the physically disabled and those whose symptoms ? depression or agoraphobia, for example ? make them reluctant to leave home.
The research so far is preliminary, but studies indicate that psychotherapy can be effective even if the patient and therapist are not in the same room.
A study at a Veterans Administration Medical Center in Maryland, for example, found that patients could benefit from virtual face-to-face encounters with a therapist. In the study, more than 100 depressed veterans were divided into two groups. Half were randomly assigned for six weeks to in-person supportive counseling. The other half received "telepsychiatry." Instead of coming to the clinic where the patient was located, psychiatrists used computer video to make contact from their own offices, sometimes more than 20 miles away. All patients received antidepressant drugs as well.
The outcome was the same in both groups, and so was patient satisfaction, although most therapists preferred to work with patients in person. In this study, patients had to come to a clinic to use the technology, but the authors hope it will soon be available for home use.
Another study, conducted at an HMO in Seattle, provided evidence that psychotherapy could be effectively phoned in. Six hundred depressed patients who had begun treatment with an antidepressant drug were divided into three groups. For two months, one-third received standard care from general practitioners; one-third also received several telephone calls to check on their medications and provide extra help as needed. The third group, in addition to these calls, had eight sessions of cognitive behavioral therapy by telephone, along with a workbook to encourage homework practice.
Six months later, the researchers found that the cognitive behavioral therapy (although not the telephone checkups alone) was more effective in reducing depressive symptoms than standard care. It was not clear whether a specific therapy or the extra attention deserved credit for the success.
British researchers explored the possibility of leaving the psychotherapist out of the picture entirely. They divided 274 depressed patients in a general medical practice into two groups. One received standard care, which in some cases included psychotherapy; the other received two months of computerized cognitive behavioral therapy from a specialized video program. Six months later, the computer therapy proved superior to standard care in reducing depressive symptoms and improving social functioning.
Patients who completed the program (about two-thirds of them) were satisfied, and although it was expensive, the program paid off by lowering the number of work days lost to depression.
Although some therapists have reservations about psychotherapy that is not conducted face-to-face, the early studies indicate it may be useful for some patients. Personally, I'm in favor of exploring this option further, so that people who need treatment will have one more way of getting it.
What do you think about long-distance psychotherapy? Have you ever tried it, or know someone who has?
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Comments: 17
Did you ever see the program used on Apple C computers in the early 1980s--I think it was called Elsie? It was meant to be a therapist, but was pretty much a joke. Whatever you typed to it, it recycled back to you. It was mostly used as a game to laugh at by my colleagues, including the mental health counselors, in the university student services department where I worked at the time.
You both put your finger on an essential problem in mental health care. There is simply not enough opportunity for personalized attention. So the "long-distance" option or telephone option is a practical response to that.
I think the economics of it are one factor, as you suggest, Donald, but from my point of view the reality is that it really takes a lot of time and energy to provide that kind of personal, one-to-one assistance. That's true whether it is managing medications or providing psychotherapy.
Where the almighty dollar comes in: Training enough people well enough, so there are enough of them who actually have the time to spend providing the kind of care we all think would be great. There are just so many hours in the day, so it is a real challenge to figure out how to give everyone what they need!
You and others seem to be comfortable enough, and even see the advantages of psychotherapy or support over the phone. I have always been a little mixed about it. I find that it is tougher to really respond helpfully over the phone when compared to face-to-face. But sometimes the phone is the only way to manage things, especially if -- for example -- someone is required to travel for their job or they have physical or emotional limitations that make it difficult for them to travel to an office for a session with a therapist.
I recently got a computer that has a built in camera and was able to do a videochat with my family from thousands of miles away. The technology has become almost commonplace, but it's quite amazing (and it was "free" because it was all over the internet).
So maybe the future will allow for more use of this kind of technology and maybe we won't be losing too much by not being in the same room.
I too am more than a little concerned that a computer could replace a therapist.
Dorine is remembering correctly that there was an early computer program that mimicked the interchange a person might have with a therapist. It was called ELIZA, and was developed by a professor at MIT named Joseph Weizenbaum in 1966.
ELIZA was not really meant to be a psychotherapist -- and it wasn't exactly a joke, though it was humorous! To the best of my recollection, Prof. Weizenbaum was using this as a first effort to develop "natural language processing" for the computer. It's more an early precursor to the kind of voicemail systems you find on the phone when you're asking for flight information than a precursor to psychotherapy.
But having played around with ELIZA many years ago, I did find it very funny. It made playful fun of a certain kind of psychotherapy.
I can see computer programs being helpful if they can provide information to specific questions. As we've learned, many people are more comfortable asking questions of their computer than asking an individual, if they're shy, or a little embarrassed by their question. And there is so much stigma about mental disorders, that computer-based information makes a lot of sense.
A computer program may also be helpful for reviewing practical techniques, as a way to facilitate self-help. But a computer can't provide human support! Nor can it respond to unique circumstances.
But we still have a lot to learn about how technology can support treatment.
I worked in the mental health field, at a Crisis Stabilization Facility..... Safe House, as it were. Now that I'm no longer working, due to health issues and depression, I have no desire to be seen going into the office as a "patient". Living in a small town, as compared to most large cities, makes it even tougher, when suddenly you are thrown into the patient category and know a large portion of the local therapists.
I've sat through numerous interviews with patients in crisis. I've seen some of them pumped in and pumped out, due to ridiculous scheduline and "money" reasons. I've seen our Dr. spend an extra hour with patients who are genuine and desperate. Basically I've seen "it all".
I know I could use therapy, myself. But, after helping other people for so many years, giving advice, encouraging activities, and the whole spectrum of following up with tx plans and goals ... it seems I should be able to help myself, as I have for so many years. I take my meds... prozac.. religiously.. but it only helps my mood swings be a little easier to control. When I feel depression coming on, I always try to redirect. Most of the time it works, if I catch the "feeling" in time. If I'm too late, too down, too stressed...to give a "poop", it'll hit bigtime and last for only God knows how long.
No insurance. No money. Fighting with our oh so helpful Social Security. I have no choice but to keep helping myself, until I no longer can. I've no suicidal plans, but there are days when you just don't wish to be here anymore. Sigh.
My last visit here, I guess. Whoopy doo.