Does online therapy work?
One of the biggest concerns about online therapy is that therapists don't have an opportunity to observe the patient—something that is usually integral to an assessment and diagnosis. The tone of voice, body language, and overall demeanor provide insight into an individual's well-being.
A major component of effective therapy involves the relationship between the therapist and the patient. As online therapy is impersonal (often, it's completely anonymous), many people have raised concerns about whether digital communication can provide skills, tools, and healing power to individuals staring at a screen.
Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:
A 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
A 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, "effective, acceptable, and practical health care." The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
A 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
The Potential Benefits of Online Treatment
Online therapy offers some benefits over traditional face-to-face treatment:
People in rural areas or those with transportation difficulties may have easier access.
Many online therapy sites allow users to sign up with "nicknames" which can entice people who are embarrassed about getting services under their real names.
Most online therapy services cost less than face-to-face treatment.
Scheduling is more convenient for many people.
Studies show online therapy requires 7.8 times less of a therapist's time than face-to-face treatment—meaning therapists can often treat more people online than they can in-person.
Clients don't have to worry about seeing people they know in the waiting room.
It can be easier for some people to reveal private information when they're sharing it online.
Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.
The Potential Drawbacks
Online therapy isn't for everyone. Here are some potential risks and drawbacks:
Online therapy isn't meant for people with certain problems or conditions (such as suicidal intent or psychosis).
Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren't conducive to treatment.
Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.
Sites that aren't reputable may not keep client information safe.
It can be difficult to form a therapeutic alliance with someone when meetings aren't face-to-face.
It can be difficult for therapists to intervene in the event of a crisis.
How to Find an Online Therapist
If you are interested in online therapy, there are many options to choose from. Think about what type of services you want most—phone therapy, video chats, live chats, audio messaging, or text messaging.
You may find a local therapist who offers online services, or you might find you prefer a large organization that offers a substantial directory of therapists to choose from.
But do your homework and shop around for the service and price plan that best suits your needs.
Find the full article here.
If you're looking for a therapist who provides online sessions, I invite you to contact me to schedule your free phone consultation today! Contact Me Here
COVID 19 & Teletherapy
Seeing a therapist used to imply being in the same room with them, but not any longer. Teleconferencing has made it possible to see a mental health professional from a distance.
With recent requirements for social distancing, many therapists and clients have had to either pause their work or make other arrangements, including meeting by video conference.
I've been providing teletherapy services for a few years now. Here are some common questions and issues that come up when thinking about making the transition.
Will My Therapist Agree to Online Sessions?
Some therapists (myself included) are enthusiastic about using teletherapy, some won't use it at all, and a large number of therapists approach it with some reservations. I've been surprised how many therapists are now moving to it with the COVID-19 outbreak and resulting social distancing. Most therapists generally seem to find that it's a very beneficial approach.
Even among therapists I know who were skeptical about online sessions in the past, the majority have opened to the idea. They seem to recognize it as a good option to avoid an untimely break in the therapy relationship, and to provide continuity of care.
Will It Be Weird?
If you're generally comfortable with communicating through a screen (e.g., Skype, FaceTime), you'll probably be comfortable moving to online therapy. If you can't stand this form of communication, you'll likely have a harder time with it. Of the dozens of clients I've treated through teletherapy, most seem to find the transition to be smoother than they expected. Therapy tends to be intense, and quickly enough you're likely to forget about the medium and focus on the work.
That said, expect some differences with teletherapy. It's different when you're not in the same room with someone, and you're experiencing them in two spatial dimensions instead of three. It can also be harder to pick up on body language through a video. And while most of my clients seemed to be comfortable with making the switch, a few were not, or found the transition to be quite challenging. Occasional tech issues come up (like a delay in the audio and video), but typically can be handled with a little patience and humor.
Is It Effective?
Research suggests that therapy by video conference can be very effective, which has also been my clinical experience. It depends on you and your therapist, of course, but in general you should expect it to be helpful if you were finding in-person therapy helpful.
Personally, some of the most powerful clinical experiences I've witnessed have occurred through teletherapy. In my own practice, I've seen it work for people dealing with things like depression, anxiety, obsessive-compulsive disorder, insomnia, relationship issues, grief, and trauma.
Will Insurance Reimburse Me?
A growing number of insurance providers seem to be willing to cover online therapy sessions. They'll probably require the standard things for reimbursement: your identifying information, the provider's license and so forth, a diagnostic code, and a session (CPT) code. Check with your insurance provider before starting your sessions if you'll depend on reimbursement to cover the sessions.
How Does It Work?
You and your therapist will agree on a platform to use (or in some cases may decide to forego video and simply speak by phone). Some rely on Skype or FaceTime, although those options are not HIPAA compliant. More secure platforms include VSee, Zoom, and Doxy, among others. There may be a fee for your therapist to use the technology depending on the service, but it should be free for you (aside from your therapist's session fee, of course).
How Should I Prepare for My Sessions?
Some important and finer points about the logistics of teletherapy:
Do a test of the software beforehand for your own peace of mind and to be sure it will work, and verify that you have your therapist's contact information (e.g., VSee username).
Find a place in your home where you'll have as much privacy as possible. This could be a challenge if kids are out of school or other family members are always home (or work from home).
Along those lines, I recommend ear buds for privacy and also better sound quality. That way your therapist's voice won't feed back into your microphone and out their speakers.
Make sure you're sitting somewhere you'll be comfortable for the length of your session.
Have your screen on a stable surface, since excessive movement can create a feeling of seasickness for your therapist. If they're new to teletherapy and their screen is bouncing around, ask them to do the same.
A finer point: try to have the top of your head near the top of your video screen, rather than in the bottom half of the screen. That way when they're looking at your face they'll be looking more or less into their camera (assuming it's at the top of their computer), so it will feel like they're looking at you.
Be sure to close email and turn off notifications that could be distracting and dilute the experience for you. You'll want to have your full attention focused on your session.
Also close programs that could slow down your computer's processing ability and interfere with the quality of the video.
You may also need to work out payment arrangements with your therapist if you generally pay in person. Some therapists will keep a credit card on file for you; others will ask that you mail a check. Find out what they prefer.
Are There Other Advantages to Online Therapy?
One plus of online therapy you'll notice right away is that there's no travel time involved, so your sessions will probably take up much less of your day. With that in mind, you may want to build in some transition time into and out of therapy, since travel time often provides a buffer before and after your session. It might be challenging, for example, to return directly to childcare after an emotional session. Even a 10-minute break to process and digest the session can make a big difference.
You'll also never have to cancel for weather (assuming you have electricity and Internet), and there are no concerns about whether you could pass along a sickness to your therapist (or vice versa) if you're well enough to meet but possibly contagious. It's also possible to see your therapist when you're traveling, just as I've been able to see clients when I've been on the road.
What If My Therapist Won't Do Online Sessions?
If your current therapist isn't open to doing teletherapy, you might consider speaking with a new therapist who does offer online sessions. Obviously it's not ideal to have to start over with someone new, especially if you've been seeing your therapist for a while. But it may be your only option if you're committed to continuing therapy with as little interruption as possible.
If you don't want to start with a new person, consider other resources during the hiatus from seeing your therapist (and work with them on the plan, if possible). For example, there may be books, brief online courses, or other resources that will help you to continue the work. Your therapist might be open to having brief phone check-ins during this time.
Seek out additional support from loved ones, as well, and be sure to take care of your basic needs like sleep, nutrition, and movement to keep your body and mind healthy. You might find journaling to be helpful during this time, as it's been shown to be an effective way to process thoughts and emotions.
Keep in mind that there could be unexpected benefits to taking a therapy vacation. While it may not be ideal, an unplanned break from therapy can lead to surprising growth, as the work you've done settles in and takes hold.
The Bottom Line
If you're considering teletherapy, talk it over with your therapist and see if it's worth giving a try. You don't have to know in advance if it's the right decision for you—you can always plan to do a limited number of sessions to see how it goes. If it works well, it could be a convenient and time-saving way to continue the important work of therapy.
Find the fill article here.
If you're looking for a therapist who provides online sessions, I invite you to contact me to schedule your free phone consultation today! Contact Me Here
Accepting Unwanted Emotions
Emotions: according to the dictionary, the definition of an emotion is, “a conscious mental reaction (such as anger or fear) subjectively experienced as strong feeling usually directed toward a specific object and typically accompanied by physiological and behavioral changes in the body”.
But emotions serve us in a variety of ways. For example, they give us valuable messages (e.g., fear in an unsafe situation), reveal how important something is to us (e.g., you have stronger emotions in your romantic relationship than you do when you’re shopping for cereal or having a casual conversation with a stranger), and prompt us to act (e.g., you stroke a partner’s face with love or turn away from spoiled food in disgust).
But the story of emotions is a bit more delicate and complex, as it isn’t simply about what we feel in response to what happens around us. We tirelessly size up our inner world and place value judgments on it. Depending on the circumstances we’re in and the messages we’ve received along the way about what we’re allowed to feel, emotions (or at least certain ones) may get tagged as acceptable, healthy, or reasonable, or they might get labeled as wrong, crazy, or threatening. For instance, researchers at the University of Oxford highlighted the following categories of disapproving beliefs when it comes to painful emotions:
Emotions are too powerful and can’t be managed.
Emotions are bad and/or ridiculous.
Emotions are defective and make no sense.
Emotions are unproductive.
My emotions could sabotage me or other people.
My emotions might spread to other people and I can’t let that happen.
What’s thorny about this is that if we have a negative outlook on our emotions, we’ve got a whole new load to carry—we’re more likely to have another negative emotion layered on top of the one we’re already experiencing. The emotions we have about how we feel are known as meta-emotions. For example, let’s say we see sadness as a sign of personal weakness and inadequacy. Because of this viewpoint, we might feel shame or fear in response to our sadness. And it’s not just uncomfortable emotions that get a bad rap. People can feel nervous about pleasant emotions too.
Our ideas about our emotional life don’t just impact how we feel about our emotions, but the steps we take to respond to them as well. To illustrate, let’s stay with our example of sadness. We regard it as a signal that we’re weak and defective in some way, and this idea stirs up intense shame. The big question now: What do we do with all of this? Considering that we’re treating sadness as intolerable and we feel ashamed of it, we’re relatively unlikely to talk about it with someone else, to be kind to ourselves in the face of it, or to allow ourselves to feel sad and see what happens. No, instead we’re probably going to be more inclined to react to sadness in other ways, such as:
Mentally beating ourselves up for feeling it
Racking our brains over why we feel this way and why we can’t get over it and feel happy like everyone seems to feel
Trying to cover it up when we’re around other people
Self-medicating with alcohol or other substances
How we choose to respond to our emotions also has an impact on how we feel and on our quality of life. If we criticize ourselves all the time, that harsh voice gets stronger and we’ll continue unintentionally manufacturing more shame. We could mull over why we feel the way we do and question why we can’t make it go away, but this approach is more likely to leave us feeling even worse. If we try to hide our sadness and mask what feels so unspeakable, we’re liable to bear the cost of this strategy, experiencing more distress, less comfort, and more detached relationships. And although we can try to escape through alcohol and other substances, this opens the door to use disorders and other problems.
There are a variety of other ways in which rejecting what we feel sets the stage for giving us more of the very thing we don’t want. For instance, when people are scared of emotions, this forecasts difficulty managing anger, feeling more upset, drawing from pleasant memories to feel better, and symptoms of posttraumatic stress disorder (PTSD). Moreover, people who view uncomfortable emotions as bad are also less likely to be empathic toward themselves. And the idea that painful emotions are hazardous is related to lower odds of naming such emotions for one’s children, a valuable step in emotional skill-building.
So if it doesn’t serve us to treat our emotions as off-limits, what’s the alternative? When we accept distressing emotions as being a universal, natural part of life, it’s ironically linked to experiencing them less and, in the long run, having better emotional health.
But why might this be? Why would accepting the emotions we don’t want generally be connected with them dwindling rather than growing? Researchers have proposed several possible explanations:
Rumination can make people feel worse, and individuals who accept upsetting emotions don’t tend to ruminate over them as much.
Efforts to avoid what a person feels can go awry and have a boomerang effect, furnishing them with more of what they tried to push away.
Individuals who accept their emotions may be spared an extra layer of emotional pain by not having to feel upset about feeling upset.
Disquieting emotions that we meet with acceptance are less likely to have as much staying power.
Acceptance is a mindset, an approach of giving ourselves permission to experience our emotions and taking the perspective that they’re human rather than silly, weak, crazy, wrong, dangerous, or beyond our power to ever be able to manage. It’s about challenging that self-critical inner voice that says we can’t feel what we do, or that an emotion will harm us or be a badge of our inherent fault or shame. Acceptance is about giving ourselves the space to listen to ourselves in a nonjudgmental way.
Read the full article on Psychology Today.
If you live in the Los Angeles or Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Check out my services to see which one might fit your needs. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
Becoming an Active Listener
Body language and unspoken attraction are some of the most fun parts at the start of a relationship. As you can probably imagine, those traits do not make for a healthy, lifelong partnership. One of the main reasons couples divorce is because they lost the ability or never had the skills to communicate with one another. Poor listening skills lead to the breakdown in communication in a marriage. Here are some tips on how to be a more effective and life-giving listener.
don’t interrupt: Let your spouse finish what they are saying. If this is a problem and you interrupt a lot, find some way to remind yourself to keep quiet. Some people put their chin in their hand as a sign to themselves to not speak until their mate is finished talking.
keep an open mind: Don't judge. Jumping to conclusions or looking for the right or wrong in what is being said prevents you from listening. Think before you say anything in response, especially if it is an emotional reaction.
make listening a priority: Listen without planning on what you are going to say in response. Let go of your own agenda. Be aware that you need to listen. Make eye contact. Pay attention by not looking at the TV or glancing at the newspaper or finishing up a chore.
use a feedback technique: Let your partner know that you heard what they said by using a feedback technique and restating what was said. Say something like "I hear you when you say that..." Be open to the possibility that you didn't hear clearly what your spouse was saying, and give them space to say so if that is the case.
pay attention to their non-verbal signs: Be aware of non-verbal signs and clues—both yours and those of your mate. These include shrugging your shoulders, tone of voice, crossing arms or legs, nodding, eye contact or looking away, facial expressions (smile, frown, shock, disgust, tears, surprise, rolling eyes, etc.), and mannerisms (fiddling with papers, tapping your fingers). Over half of your message is delivered through non-verbal signs.
understand what blocks you from listening: Try not to fall into these patterns of listening: mind reading, rehearsing, filtering, judging, daydreaming, advising, sparring, being right, changing the subject, stonewalling, and placating.
stay focused: Focus on the main points that your spouse is talking about. It's okay to ask questions to clarify what you thought you heard.
understand the differences in your communication styles: You may just communicate differently. Being aware can enhance your listening skills. One of you may often share because you want to give information or solve a problem. The other may tend to talk to connect with someone or to get information. Some folks talk more about relationships than others. You may be more concerned about details than your spouse. But don't attribute all your listening differences to your gender.
show respect: Respect your spouse's point of view, even if you disagree with what is being said.
know the difference between advice and talking: Don't give advice unless asked for it. You can't listen and talk at the same time. Feelings are neither right or wrong.
Read the full article on MYDOMAINE.
If you live in the Los Angeles or Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Check out my services to see which one might fit your needs. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
Demystifying Couples Therapy
There’s a stigma around couples therapy, we don’t end up having those conversations, and we can wind up feeling alone when, of course, that couldn’t be further from the truth. People associate it with divorce. However, most people who come to couples therapy are not getting divorced—they’re building a healthier relationship.
Q: What can you expect to get out of therapy as a couple? And what can’t you expect?
A lot of people come to therapy thinking that they’re going to change something about their partner. When you come to couples therapy, you have to be prepared to make changes yourself. You can’t change another person. But you can influence another person. And that’s why it’s important to know that if you make changes, you will instigate change in someone else. Meaning you can’t tell someone to change, but if you change your behavior, they will change in response to you.
We think: How can we get them to do something that we want? But really, the way we can do that is by helping them first. If you can do something in a way that helps them, you will get back something that helps you.
Q: How do you take the first step?
By the time a couple gets into an office, there’s often some resentment. And because of the resentment they don’t feel generous toward each other. They have to remember that they do love this person, and that the person isn’t acting in this way to harm them; the person is acting this way because they are also struggling. If you can look at it that way, you might have more compassion for your partner, because you’re not the only one who’s struggling in this relationship. When you have more compassion, you can carve out a place of generosity for the fact that your partner is struggling, too.
Your partner’s reality doesn’t cancel out your reality. Just because your partner sees the situation differently from how you see it, it doesn’t mean that that person is wrong or that you’re wrong. It just means there’s room for both. Sometimes people don’t want to take the first step because they think: I need you to see it this way. I need you to see it accurately. I need you to see it my way. It’s important for both people to listen to how the other person sees it, but that doesn’t mean they have to agree with it.
Q: When is going to couples therapy a good idea?
Sometimes there’s a concrete issue, like you don’t see eye to eye on something like money or how much time you spend with the other person’s family. Or you have different ideas about how you are raising the kids. You want to go before it gets to the point where you’re both backed into your corner and you can’t listen at all to the other person’s point of view. A good time to go is when you can say, “Hey, there have been a few times when we’ve gotten really agitated when we talk about this with each other. Maybe we need somebody else to help us learn how to have this conversation, because it’s a really sensitive topic for both of us, and it’s hard for us to hear each other.”
Q: How do you approach the idea of therapy if your partner is averse to it?
It’s very important not to make it sound like, “We’re going to therapy because you have problems.” Some people even say, “We’re going to therapy because I can’t handle what you’re doing.” Or “I can’t handle something about you.”
Try something along the lines of: “We’re going to therapy because I love you so much, and our relationship is so important to me, and it breaks my heart when we argue. I would really like to go talk to somebody so maybe we can get some help with that.”
Q: How do you go about finding the right therapist?
Word of mouth is a great way to find a couples therapist, but if you’re hesitant to do that, you can look on Psychology Today. Look at therapist profiles in your area and see which ones have an approach that feels comfortable to you. But really, you won’t know until you get into the room and you see what it’s like when all three of you are sitting there.
“It’s tricky, because there’s so much shame around couples therapy—even more than with individual therapy. People associate couples therapy with divorce. But in my experience, most people who come to couples therapy are not getting divorced—they’re building a healthier relationship. The people who end up getting divorced are often the people who never got help.”
It’s really important to know that couples therapy is hard work, but it’s also very rewarding. You’re very exposed in a way you aren’t in individual therapy. In individual therapy, you can present yourself the way you want to present yourself. In couples therapy, your therapist is going to see you and your partner and the way you two interact with each other. You can feel very vulnerable. And you should—that’s largely the point, to be real with each other.
After your first session, did you feel like the therapist heard both sides of what was happening? Did you feel like the therapist understood some of the ways you two interact? That’s a good way to assess initially.
(Also, take a look at my post about how to find the right therapist)
Q: What else can you expect from that first session?
You should feel that the therapist can hold both of your realities at the same time. You should also walk out knowing there’s a definite possibility that you have some flawed assumptions about your partner’s motives, and maybe some of those will come out in the first session. And that he or she has some flawed assumptions about yours. The therapist can help point out that maybe you were thinking that the reason your husband is never home for dinner on time is because he doesn’t want to be, or because his work is more important than you, or vice versa. But your assumptions are often wrong. A good therapist can help you learn something new—even in that first session—about the way your partner thinks and feels about you that isn’t as harmful or hurtful as you had imagined.
It’s always helpful for the therapist to reframe for people: “Hey, the reason that this or that might be happening is not because your partner doesn’t care about you. The whole reason that you’re both here is because you care about each other. If you didn’t care, nobody would be sitting in this room right now.”
Q: What kind of commitment is couples therapy, emotionally and timewise?
It depends on what’s going on and how long it’s been going on. That’s why people need to come in earlier, because if something is a relatively new issue between a couple, that can be resolved pretty quickly. If something has been going on for decades, it can’t be undone in four sessions. That might take a little bit longer.
The good news is that once you start seeing the underlying patterns, it changes most of your interactions. It won’t just change the one thing that you came in to talk about; it will change the way you see each other. You’ll see each other with more generosity and more compassion. You will take what your partner is doing less personally, and you will feel less injured by the other person’s behavior. That helps globally in the relationship. You don’t have to keep coming back every time you have a problem, because now you know more about each other in a way that helps you to resolve your own problems.
Q: How does couples therapy work in conjunction with individual therapy, if one partner already has a therapist?
Lots of people do that. You get different things out of them. You learn a lot about yourself individually in couples therapy, but sometimes people need extra support, or they’d like the extra support. Or they’re working through something personally that they need an individual therapist for. A couples therapist will generally not see either member of a couple for individual therapy, because we want that relationship to be clean. We don’t want any perception of the therapist favoring one person over the other. There’s often a lot of sibling-like rivalry in couples therapy, where people feel like they want the therapist to take their side, or they want the therapist to like them better. It’s not really in their awareness. People want the therapist to validate their position, but we’re not there to do that—nor would that be helpful.
Q: What are some tools that couples can try using to resolve conflict?
A lot of people say, “You’re not listening to me. You’re not listening,” as they’re talking over somebody else. Before you say you don’t feel heard, consider how well you listen.
People don’t realize they do that. They feel so unheard that they don’t realize that they’re making the other person feel unheard. You will be heard much more expansively by the other person if you truly listen to them. A lot of people don’t realize that they’re terrible listeners; they really just want to get their point across.
One of the most important things is to realize that you’re two separate people: You’re going to have different ideas and perceptions. And you don’t have to convince the other person of the truth of your perception. It’s important only that they understand how you feel about it. But neither perception is more valid than the other.
Q: How do you know when you can pause on couples therapy?
When the couple feels like they’re relating to each other better. When they feel like whatever they came in for isn’t really happening anymore, or at least it’s not happening to the same degree. Or even if it’s happening, they are able to stop before it escalates and not go down that rabbit hole the way they used to. It’s about changing the pattern between them.
All couples do a dance. If one person changes the dance, either the other person is going to fall flat on the floor or they’re going to have to change their steps. Usually what happens is the other partner changes their steps, too. And now the couple’s doing a different dance, and if they’re doing a different dance and it’s working for them, then they don’t need to be in therapy anymore.
Sometimes people are scared to leave couples therapy because even though their problem has gotten better or is mostly resolved, they fear that if they leave therapy, they will backslide at times. But that’s to be expected. I say, “Go out there and try it, and if you backslide, come back in. You know you can come in for a tune-up.”
There’s nothing wrong with coming in for a tune-up, but I do want clients to learn to trust themselves, to trust that they can do this and that they are going to backslide. We all have longstanding reactions that are very visceral, and sometimes we screw up. But that’s okay—nobody’s perfect. It doesn’t have to be very significant. It’s kind of like when people go on a diet and they eat two pieces of cake and feel like their entire diet is ruined. It’s not—you ate an extra piece of cake, and you move on.
You can always come back to therapy. It’s a conversation that you have with the therapist and with each other. But it’s not as though everything needs to be perfect for you to stop. No couple is perfect.
Read the full article on Goop.
If you live in the Los Angeles or Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a 15-minute complimentary consultation. Check out my services to see which one might fit your needs. Contact me now to see if we might be a good fit to work together! Or book your appointment here!