Just two decades ago, the thought of chatting to your therapist via a video call would have been instantly dismissed. But online therapy has seen a meteoric rise over the past 10 years, and this has only been exacerbated by the coronavirus pandemic.
Even in 2017, three years before the pandemic hit, the UK was seeing a surge of people going online for their therapy sessions. Babylon, the doctor app, had 150,000 active users using its online therapy tool, while PlusGuidance, a digital counselling service, had 10,000 users. Last year, the mental health app Calm became the first of its kind to be valued at $1 billion.
The pandemic has seen a surge in people turn to online therapy - as this was the only option for most regular patients.
“I began online therapy purely by chance,” Laura, who works in PR in London, tells the Standard.
“I’d been planning on starting for a while, following a tough few months, and had been waiting for an available slot. My first appointment was on March 10 and unbeknownst to me, that was the first and only appointment in-person.”
Laura adds that she and her new psychologist tried their second appointment over the phone ‘which didn’t really work’ before resorting to Skype.
“I’m lucky in the sense that I haven’t had to experience any upheaval with my therapy in addition to also going through a global pandemic. I actually feel very grateful that I started when I did as it’s been a real help with navigating lockdown and the additional emotional strain that brings.”
Ella, a freelance writer from West London, found herself in the same boat when lockdown began. Having previously had face-to-face therapy through the NHS, she had to swap to online therapy in March.
“I enjoyed the switch as I am now able to be in my own environment, comfortable with a hot drink,” Ella says. “Afterwards, I can deal with my emotions that the session brought out in private, rather than having to commute home and navigate the streets with what is usually a blotchy and mascara-streaked face.”
Laura finds her at-home sessions appealing too, but worries about her privacy living in a shared house.
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“Being able to do it from my own bedroom allows a certain level of comfort that maybe I wouldn’t have had from an unfamiliar room,” Laura says. “Although having my appointments at home equally brings its own negative aspects, as I often worry that my housemate or a neighbour could overhear me talking about things that should be kept private between me and my therapist. So perhaps I’m not as open as I could be if I was in a neutral space.”
During lockdown, online therapy provider Talkspace said it has seen a ‘huge increase’ in demand for sessions, while meditation app Headspace also reported a spike in downloads.
In May, a study found that lockdown made existing mental health issues worse, and a separate study from the Mental Health Foundation found that a quarter of UK adults, (24 per cent) have felt loneliness due to the pandemic - which rises to 44 per cent in the 18-24 age group.
Last month, research from Bupa Health Clinics said 65 per cent of Brits are anxious about returning to the workplace. Dr Arun Thiyagarajan, Medical Director at Bupa Health Clinics, said at the time: “The mental health problems associated with Covid-19 are likely to significantly outlast the physical impacts of the pandemic, so it’s vital that we’re doing all we can to prevent them.”
Brits in lockdown have had a lot to contend with: redundancies, furlough, uncertain job security and not being able to see family and friends - all on top of important global issues like George Floyd and Breonna Taylor’s deaths, the subsequent Black Lives Matter protests and an impending global recession. It’s no wonder our stress levels have been rising. A study from University College London found that one in six Brits are worried about their finances, with those under 60 being the most affected as well as those living with a mental health condition.
“I think we can expect increased anxiety, a possibility of increased low mood and, depending on individual circumstances, a sense of loss and grief, because you actually lost a loved one either from coronavirus or from something else and you haven't been able to be there,” consultant clinical psychologist Emma Citron says.
“An adjustment reaction can bring on anxiety and depression and in fact any surveys that have been done have said that at least half of the population is reporting some struggle with low mood and anxiety currently which is obviously much higher than usual incidents of mental health presentations.”
As we ease out of lockdown, Brits will now be looking to address the issues that have built up during the pandemic and, with social distancing still in practice, some may be seeking online therapy. But where to start?
Vicki Nash, Head of Policy and Campaigns at Mind, says: “The pandemic has had an overwhelming impact on our lives, especially for people with mental health problems. NHS figures suggest that there has been a decrease in people accessing therapy. And our research highlights that many people have struggled to access mental health support during the pandemic. But, as we begin to come out of lockdown, it's crucial people feel able to ask for help, and when they do, they can get the support they need.”
Traditional one-to-one therapy has gone digital, and some therapists may choose to make this the new normal. Below, is a handy guide on how to go about starting online therapy and how to get the most out of it.
I’ve never been to therapy, how can I get a referral?
The first option would be looking into a free set of therapy sessions with the NHS. You don’t even need a referral from your GP, you can refer yourself directly to a psychological therapies service, although you will need to be registered with a GP in England to access this. You can find a NHS therapy service local to you here.
The other option is to look into private therapy, which will cost money, but could offer a broader range of options.
Nash says: “Services must adapt to make sure everyone experiencing a mental health problem gets the right treatment and range of treatment they need, this includes making sure that everyone has access to online support if they need it, and if they don’t, making sure that alternatives are in place, as we begin to recover from this devastating pandemic.”
What can I do if I’m on a waitlist?
For those who are currently on waiting lists for therapy, Nash says you can try Mind’s telephone support service, GP-recommended self-help books, peer support, relaxing and keeping active.
How do I know if I’ve picked the right therapist?
Finding the right therapist is like finding the right job - it has to be a good fit for both parties involved. Even if you’re getting free therapy through the NHS, and it’s not the right fit, you can ask to be referred to a different therapist, although this might take a bit of time.
If you’ve decided the private sector is for you, and you’re willing to pay for your therapy time, it’s essential you do some research while picking a therapist. Most therapists specialise in particular types of therapy - so if it's cognitive behaviour therapy (CBT) that you’re after, be sure to pick someone who specialises in this.
If you don’t know what type of therapy you’re looking for, you need to identify where you need help. Think about what you want to gain from the sessions. If it's coping strategies you’re after or if you simply need a safe space to talk.
If you’ve gone down the private sector route, ask if you can have a short introduction phone call before you commit to sessions. This way you can get a feel for the therapist and see if they are right for you.
What should I do if I’m nervous about online therapy?
While many counselling services have been offering remote sessions during the pandemic, Nash says that these can cause extra anxiety - especially for those not used to speaking on the phone or over video chat.
She adds: “We might also feel anxious sharing personal and confidential information relating to our mental health. If you’ve got a video call scheduled with a healthcare professional, it’s a good idea to do a dummy run beforehand, to make sure you have the right software installed. If you’re worried about this, ask someone to help such as a friend, family member, carer or neighbour ahead of your appointment.
“If you live alone, ask someone if they can help you by emailing or texting you instructions for example. If the technology is going to be problematic for you, or if you feel more comfortable using the phone rather than an online platform, ask your healthcare professional if your appointment can take place via the phone.”
How can I ensure my privacy when I’m speaking to my therapist remotely?
One of the biggest issues for those currently undergoing online therapy is privacy and ensuring your conversations remain confidential when you live with others.
Nash says: “It’s important to ensure that you are in a confidential space during a remote counselling session. If you live with others, go to a different room if possible so you won’t be overheard. It is the responsibility of the healthcare professional to ensure that any digital platform they use is secure. If you have any concerns, talk this through with your healthcare professional.”
Or take a cue from actress Busy Philips, who recently shared she’s been doing therapy in her car.
What can I expect from my first virtual therapy session?
Your first virtual therapy session should be similar to a face-to-face session, just in the comfort of your own home instead. It's ok if the first session feels a little awkward, as you and your therapist are getting to know each other. Let the conversation happen organically, and you should leave the session feeling like you’ve been heard, are supported and hopeful, as well as excited for your next session to continue digging through issues. At the end of the session it’s likely your therapist will lay out a treatment plan so you have a good idea of what to expect in the coming weeks.
Is virtual therapy as effective as face-to-face therapy?
In a study from Northwestern University in the US, 325 adults with depression were assigned 18 sessions of either face-to-face CBT or telephone-based CBT. The participants in both groups showed a decrease in symptoms and those receiving telephone therapy were more likely to continue with treatment while those who received face-to-face sessions were less depressed six months later.
A similar study from the University of Leipzig in Germany looked at 62 adults who had depression and offered face-to-face therapy sessions for half of the group and internet-based therapy for the other half. In the three month follow-up, the online group had made significant progress while the face-to-face patients showed a resurgence in symptoms.
Nash says online therapy shouldn’t be seen as a replacement to in-person therapy. “We still want anyone to be able to access face-to-face therapy, when safe to do so, as for many people face-to-face treatment is crucial for building a trusting relationship between the therapist and the individual. We know that digital appointments work particularly well for some groups, for example children and young people, such as young men and BAME communities.”
She adds that it can be ‘unfairly difficult for those in BAME communities to be referred to therapy in the first place. “For example, there is evidence to suggest that Black people are less likely to be offered talking treatments, and more likely to be given medication to manage their mental health problem. GPs and other healthcare providers must offer culturally relevant support, including making the right referrals rather than relying on medication for certain demographics.”
There are also 1.9 million people in the UK who are ‘digitally excluded’ from partaking in online therapy, as they have no access to the internet.
Other than going through the NHS, what other options are there for anyone seeking access to free therapy?
Nash says: “Some community and charity sector organisations may offer free or low-cost talking therapies. Some local Minds, for example, are offering remote counselling during the coronavirus outbreak. You can contact Mind’s InfoLine to see what services are available in your area. The Mind Infoline can be reached Monday to Friday 9.00 am - 6.00 pm on 0300 123 3393.”
So is online therapy the way of the future? It should be an option, yes, but so should in-person sessions. Whether virtual or face-to-face, if you need help - ask for it. Go to your GP, call one of the helplines Nash suggested or simply confide in a friend. Speaking to someone and unburdening yourself could do wonders.