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Digital Therapy Is Quick and Convenient. But Can it Replace the Analyst's Couch?

A new crop of services offers a mental health treatments through text messages, video chat, and even photos, geared toward the digital generation.

In therapy for seven years, a 25-year-old actress we'll call Celine was comfortable rattling off a week's worth of emotional ups and downs to her counselor in the comforts of a Los Angeles office. (Celine spoke on the condition of anonymity, out of concern that publicizing her treatment could hurt her career.) Then she made plans to move across the country to New York. "I was so attached to my therapist, I didn't want to see any other therapist," she explained. So Celine and her health professional kept their weekly appointments—over Skype. With 2,700 miles between them, Celine and her therapist used digital contact to make emotional progress. 

For about two decades, therapists have been offering services through various media aside from in-person—phone calls, video conferences, chat, and audio messaging—and some types of this so-called teletherapy been found to be as effective as traditional face-to-face counseling in certain settings. A May 2014 pilot study by researchers from the Rotman Research Institute, published in the journal Clinical Interventions in Aging, compared telehealth-based and clinic-based group cognitive behavioral therapy for adults suffering from depression and anxiety; it found both methods had comparable results. The study's sample size was small, at only 18 adults. “Our results indicate that the video conferencing format did not compromise outcomes with regard to mood or thematic content of the sessions,” the researchers wrote. An October 2014 report from a group of Swedish researchers, published in the Official Journal of the World Psychiatric Association, compared guided internet-based vs. face-to-face cognitive behavioral therapy and found similar results. It determined that the technology-based treatment “has the promise to be an effective, and potentially cost-effective, alternative and complement to face-to-face therapy.” Given the millennial generation's love of technology, modern therapy services are hoping to build a customer base by dishing out digital, cheap, and effective counseling. 

New York-based Talkspace offers the unlimited services of a therapist with over 3,000 hours of clinical experience via audio and text messages for $99 a month and live video sessions for $49 per half hour.The company says 71.7 percent of its users are aged 18-36. "Talkspace's mission is to democratize mental health care," said co-founder Roni Frank. "The therapist will respond in a timely manner up to a few times a day, based on the client's specific needs."

The service was built with millennials in mind, targeting a generation saddled with the emotional and fiscal burden of student debt and often stuck living with parents. Unlike Celine's long-distance experience with her therapist, Talkspace's patients never meet their counselors in person. The vast majority of Talkspace users rely on text messages to communicate with their therapists, though 26 percent have also sent audio messages, 23 percent have sent photo messages, and 6 percent communicated via videos.

More research needs to be done to determine whether exclusively text-based therapy is effective, said Dr. Lynn Bufka, associate executive director in practice research, and policy at the American Psychological Association. Bufka sees challenges with video therapy. "As a psychologist, we are very attuned to the relationship we have with the other individual. Sitting in the same room with someone, you can really see their body language, hear the inflection in their voice, most of which you can see through a video conference, but some of it you'll lose," she explained. "I think many of us are used to making phone calls when we walk the dog, wait for the bus. As a therapist, I cannot ever imagine providing psychotherapy under those kinds of circumstances." 

The distance that a phone call creates is familiar to Celine, who experimented with phoning her therapist when Skype wasn't an option. "I could get away with not being present. It was easy for me to avoid feeling feelings because I was in my bedroom and she was sitting across the country. Then my anxiety got really bad, my depression got really bad, so it was like, why am I spending this money to spend this time on the phone in therapy that's not really helping me?" 

Talkspace co-founder Frank said her company's service is more effective than traditional therapy because, despite being digital, it is more frequent. Where a traditional therapy patient might meet with their counselor once a week, face-to-face, or on video chat, Talkspace's clients maintain never-ending threads of conversation remotely. "Immediate feedback, on-demand therapy," she said. "Users can also go and reread the conversation with the therapist." The $99 monthly model does not put a cap on messages that can be sent or received, meaning the therapy is—if the client wants it to be—truly never ending. 

Rather than promising time with a licensed therapist, the website 7 Cups of Tea offers “an on-demand emotional health and well-being service” that's delivered entirely via chat. The company, whose users are anonymous, has a network of volunteer “active listeners" who complete an online class that teaches them when to refer a user to a licensed therapist or emergency medical professional. Founder Glen Moriarty said 7 Cups has about 800,000 monthly users, 65 to 70 percent of them millennials. The company initially offered audio and text chat but now offers only text. "The first big clue it was going to be big among millennials was 99.5 percent of users wanted messaging, not voice," Moriarty explained. 

The company's 150,000 listeners are unpaid; they are typically people who have used the service and say they want to give back to the community. The company's basic service is offered to users without charge. "We are trying to build a free global mental health system," said Moriarty. The majority of 7 Cups users opt for the free service, though more personalized care is available for $12.95 a month, $95 a year, or $419.95 for a permanent membership. In late May, 7 Cups launched an option to find a therapist through its platform. Seventy therapists are currently  listed on the site, and their unlimited digital services run $150 a month. The company hopes to add therapists to the platform. In the meantime, the listeners are providing some support: A study published in the Journal of Mental Health by Amit Baumel at the Feinstein Institute for Medical Research  in October 2015 examined how satisfied 7 Cups users were and determined that those experiencing emotional distress could be helped by listeners.

"We would love to see partnerships between our listeners and therapists as sort of treatment teams, where listeners refer people to therapists and they just get better help," said Moriatry. "We need care. We need people to listen to us. It's a universal human impulse."