When the coronavirus took hold in New York in March, therapy was among many things that made a hasty transition to online practice. For people who already have a therapist, the past five months involved unexpected problems and constant adjustments. For those who are looking for mental health care during this disturbing time, connecting and establishing trust with a licensed professional can seem more daunting than ever. 

From In-Person Meetings to Skype Calls

On an evening in the second week of March, my therapist sent out an email, letting me know that she would be working remotely in an effort to help contain the virus. Ever since then, I take a deep breath before opening Skype every week, trying to focus solely on the upcoming conversation and bracing for disruptions that may happen on both sides. While we have been able to communicate on the same emotional level as before, the transition from in-person communication to video chat comes with quite a few challenges and interesting observations.

Prior to the pandemic, I constructed a routine on days I went in for therapy – taking the R train uptown before the session and getting some work done in a nearby coffee shop after. Although it doesn’t sound like much, it was a process that created much-needed space for an emotionally draining activity. Now that the commute to attend or leave therapy has been reduced to one click, I find it difficult to simply shift my mood when I am sitting at the same desk where I do my work or FaceTime my friends. Gillian Isaacs Russell, certified psychotherapist and author of the book Screen Relations: the Limits of Computer-Mediation in Psychoanalysis and Psychotherapy, echoes the need to get ready for the emotional work as well as to give time afterwards for the session to resonate. She suggests leaving a 15-minute window before and after the session to move around, even just to do some stretches or wander around your place.

Gone with my routine was a calming meeting place – a carefully curated office with a long sofa, lavender aromatherapy, and some abstract art I could never understand. The responsibility has now fallen on me to construct a quiet and comfortable environment without distractions. After the first few hectic sessions at the beginning of the pandemic, I have learned to quit all the messaging apps on my laptop, leave my phone out of sight, and put away all the school or work related materials. 

For those who live with other people, finding privacy can be a major problem without the sanctuary of the therapist’s office. “In search of privacy, people were talking to me from closets and cars, laundry rooms and bathrooms,” psychotherapist Lori Gottlieb writes in an op-ed for the Washington Post.

Amid the chaos of trying to figure out the best practices of teletherapy, one thing that holds constant is disruptions. On our better days, we get one or two unstable connection signs throughout a 45-minute session, if at all. On one of our worse days, it took me five attempts to reconnect with my therapist after her laptop froze, only for her fire alarm to go off. While it feels great when I am able to immerse myself in the conversation, technological and physical interruptions can easily shatter the illusion that is telepresence. From the perspective of a practitioner, Gottlieb notes that “More than once I’ve been unsure if a pause in the conversation has meant that the screen froze, or if we were sharing a meaningful silence.”

Although I would prefer in-person sessions once it becomes safer to do so, the temporary shift to remote therapy has been a unique experience that brings newfound closeness. In the face of collective trauma and uncertainties, mental health care professionals are also under great personal strain. It has become customary that I check in with my therapist at the beginning of each session, asking if she’s doing ok. Psychologist Maggie Mulqueen acknowledges that “It’s always interesting in my field when, as a therapist, I am going through the same experience as my patients in real time.” In addition, as opposed to being in a more controlled environment, webcams barge into our private living spaces, loosening professional boundaries that used to define therapist-patient relationship. My therapist’s cat, which I did not know she owns, has become a regular guest sitting in on our conversations.

Despite the challenges that came with the transition to teletherapy, it is an absolute privilege to be able to access mental health care regularly with a licensed professional. As depression and anxiety roil the nation, many more who struggle with mental health issues are having trouble securing adequate help. 

Challenges of Accessing Mental Health Care in the Pandemic

With the coronavirus pandemic, the United States’ vastly underfunded mental health system now faces “a historic wave of mental health problems”. A poll conducted by the Kaiser Family Foundation found that almost half of adults say the pandemic has affected their mental health. In the month of April alone, about 20,000 texted the federal government’s disaster distress hotline, an increase of more than 1,000 percent compared with the same time last year.

While some claim that therapy has become more accessible, the sudden transition to virtual therapy has complex implications for marginalized groups who suffer from psychological disorders. A position paper written jointly by an international group of clinicians and mental health experts points out that “people with pre-existing mental health disorders have reported increased symptoms and poorer access to services and supports”. For instance, recovery measures in schizophrenia are associated with social support and broad community support, which have been disrupted by social distancing. Dr. Jeanie Tse of the Institute for Community Living in New York City further notes that when it comes to remote therapy, “for people who are socially disadvantaged and have mental illness, it’s just a lot to ask,” she told ABC News.

For those who are actively seeking help, the pandemic presents unique challenges on top of the already intimidating process of looking for mental health care in the United States. Ananya Cleetus, a college student at the University of Illinois at Urbana-Champaign, suffers from bipolar disorder. After she moved back with her parents in Pittsburgh, Ananya lost access to her therapist who is forbidden from treating her across state lines. American Psychological Association’s Chief of Professional Practice Jared Skillings also highlights that whether a college student can continue to see their therapist depends on the state law. He recalls that only about half of the states relaxed such restrictions. In addition to licensing rules, it is also crucial to keep in mind that not all virtual therapy is reimbursed by insurers. One silver lining is that many insurers have begun to pay for telehealth visits more broadly and consistently, including the Centers for Medicare & Medicaid Services, Cigna, and Blue Cross Blue Shield.

Besides traditional therapy sessions, more people are turning to “fast therapy” – apps specifically designed for online therapy via texts and video chats. TalkSpace, for instance, offers out-of-pocket subscriptions that start at $260 per month and connect users to licensed therapists. TalkSpace co-founder and CEO Oren Frank has noticed an increasing demand for services, which “follows exactly the geographic march of the virus across the United States.” While there is research that shows teletherapy is just as effective as traditional therapy, Jared Skillings cautions that some of the mental health apps are really good, but some could potentially be harmful if the user is not careful. He elaborates that for people who are working through more common concerns, apps can serve to provide general information and even some specific instructions. However, apps tend to be less helpful if the user is experiencing a more unusual circumstance.

Whether you are adjusting to virtual therapy or looking for help, it can be a challenging and oftentimes frustrating experience. As coronavirus ravages the nation, it leaves a trail of psychological traumas that will outlast the pandemic. However, only a tiny portion of the trillions of dollars Congress passed in emergency coronavirus funding was allocated for mental health. With surging demands for mental health care, it is of utmost priority to improve the accessibility of service for all groups as well as to have a more systematic guide in place.