Therapy Works Better Than Antidepressants, But People Won’t Go
Stigma, inconvenience, a hurdle? Video chat now widely available
Pandemic. Economic upheaval. Political polarization.
Little wonder reported levels of anxiety and depression have more than tripled, from 11% of Americans in early 2019 to some 40% in July of this year.
The coronavirus, however, has oddly accelerated a positive development: the availability of therapy via video chat and phone call, or tele-sessions. Driving to and from counseling sessions too inconvenient? Afraid you’ll run into someone you know in the therapist’s waiting room? Feel safer talking about your personal concerns from your own home? Tele-therapy addresses these barriers to treatment.
It also removes the distance barrier for people who live far from urban centers where mental health professionals tend to cluster. And it opens up a new world of choice to all — why be limited to a local shrink when you’d prefer counseling from one you used to see in another city or state, or one recommended by an out-of-area friend?
The bottom line is that the world of therapy is expanding its delivery system. And it could help encourage more people who could benefit from therapy to seek it out. That might be a good thing. A recent study found about 13% of adults had used an antidepressant within the past month; only 3% had employed the services of a therapist. Yet, the same study, published by the National Bureau of Economic Research, reports that therapy is considerably more effective.
Tele-therapy could help smooth out local shortages of counselors. New England has more than 55 psychologists per 100,000 population, yet the combined states of Texas, Oklahoma, Louisiana and Arkansas have fewer than 15 per 100,000, according to GoodTherapy, a listing of psychologists.
In case you’re wondering, while many more people in New England visit with therapists, no, the region’s mental health is no worse than the South’s. By the way, there is an acute shortage of counselors of all types, from psychiatrists to school counselors to social workers.
The NBER study, written by economists not therapists, sought to understand why, when therapy works better, people don’t go. Economists, of course, are famous for expecting people to make rational choices.
Is it the cost? A therapist might charge $150 an hour, and let’s say $50 of that isn’t covered by your insurance. Yet, the researchers found that when the cost to the patient is lowered or removed, uptake still doesn’t increase.
Stigma still exists, though it is abating. An American Psychological Association survey in 2019 reported that around nine in 10 adults at least 35 years old said mental illness is nothing to be ashamed of. Interestingly, it was slightly lower for younger adults; 78% rated it as nothing to be ashamed of.
But the same survey asked people if they found people with any type of mental health disorder scary. More than four in 10 people who had never had a disorder, or never known someone who has, said it did scare them. Of people diagnosed with a condition or knowing someone who has been diagnosed with a mental health disorder, fewer than three in 10 found it scary.
Tele-therapy may be a workaround for anyone struggling with concerns about being stigmatized. Dialing in for a session with a therapist over the phone is easy to pull off without anyone knowing. As is a Zoom chat. Getting help on your terms is far better than not seeking out the help.
Every person’s psyche, of course, is unique, as is the approach of every therapist. So know ahead of time that a poor fit isn’t unlikely. That doesn’t mean therapy isn’t a good idea, just that one hasn’t yet found the right person. The NBER study noted, discouragingly, that nearly half of therapy-goers give up after two sessions. But people often quit antidepressants, too, based on a bad experience with a single drug, failing to try others.