The Therapist Is In, Online

Whoever knew being stuck at home could be so stressful?

No commute, no decisions about where to go to eat, what movie to go see, what outfit to wear — it would seem that social distancing could be the most relaxing time of our collective lives — the forced slowdown we all needed to take a step back, take a deep breath (at least six feet away from the nearest living human being) and exchange running for sitting.

But of course, it’s not. A little less than two weeks in, and the thing we all know: There is almost nothing even remotely relaxing about the coronavirus pandemic. Between the concern for our health, the supply shortages, the stock market hemorrhages, the business closures and the ongoing uncertainty about what’s going to happen next — everyone is on edge.

That means the last few weeks have been very busy for Talkspace, said Chief Medical Officer Neil Leibowitz to Karen Webster in a recent conversation. The company is as a telehealth startup that links patients with therapists they can “see” remotely.

Talkspace’s patient ranks have swelled, Leibowitz noted, as has the number of providers applying and joining the platform. And even the therapists who aren’t signing on to Talkspace are signing on to something as of now — be it a different telemedicine platform, or a DIY offering via Zoom, Skype or another video conferencing app.

People can’t go out right now, he noted, but that hasn’t left them needing to talk to their therapists less; quite the contrary, they want to talk to them more as their anxiety is growing. Additionally, people who’ve never seen anyone before are beginning to feel like maybe they’d like to start.

“I think people are coming to terms with this isn’t going to be a week or two or even three,” he said. “I think they are now understanding this could be many weeks, even months, and almost overnight they’ve gone from 100 miles an hour to 0, and now have a lot more time on their hands than they’ve ever had before and a lot less to do with it. That can be a very dangerous thing for some people.”

Talkspace, he noted, is like many digital businesses stepping up in a world where their services are suddenly in demand. The crisis is likely to change the trajectory of telemedicine’s future.

Alleviating A Lot Of Anxiety All At Once

In the last three weeks, Leibowitz has seen anxiety breaking down into three major categories.

The first, and the one that is receding most quickly as information is becoming more available, is health worries. Will people get sick? How sick will they get? Are they at risk of dying? However, as some anxiety is receding on those points concerns in the other two areas are mounting.

Economic worries are becoming increasingly pressing for consumers of all kinds — both workers who are getting a lot of attention right now in the restaurant and service industries as well as white-collar workers. Attorneys, accountants, even physicians not working in emergency rooms, hospitals and primary care — their business is all down, too.

And while consumers have some flexibility in their spending, everyone is buying a lot less Starbucks and avocado toast all of a sudden — the big expenses like housing, insurance and car payments are fixed and continuous. They can be paused or forgiven for a while, but they will mount up, and the worries about making ends meet are very real. They are also, Leibowitz said, the hardest thing for a therapist to handle head on.

“And this has been an age-old theme with therapists,” he said. “The reality is no therapist can help someone directly get out of debt, for example. They can put you in a better position to handle the situation, react when the time comes and not make bad decisions.”

Those things can be extremely helpful he noted, as people rarely make good decisions in periods of totally unchecked anxiety.

But the place where Talkspace has seen the biggest upswell of genuine worry, he noted, is around the social changes that are happening to them faster than they know how to react. Whole families are suddenly trapped under one roof that serves as a workspace, school, entertainment center and refuge from a turbulent outside world, and they are learning entirely new ways to navigate their relationships. Others, he noted, are alone and learning to live radically secluded lives that they really weren’t expecting to be living.

“We live in a very, very busy world where we actually set out to work with people who were so busy, they couldn’t go to therapy,” he said. “Now, they're coming to us for a totally different reason, and it's not because they're too busy,” but because they need help adjusting to a world where they aren’t.

While all of these concerns can be difficult to deal with, Leibowitz said he also believes in some way, some of the adjustments people are making now might just be for the better overall.

The Upside To A Down Time

Among the things that have most impressed him, Leibowitz told Webster, are the vast reserves of generosity breaking out everywhere. Talkspace decided to donate 200 months of therapy to first responders during the COVID-19 outbreak to help lessen the load on them. What it has found, he said, is people are coming for the therapy — and then asking to pay for it. Those who seem to still be drawing paychecks and benefits are asking to pay their free session forward to someone else who maybe needs the donation more.

People are also calling their parents more, spending more time with their families, getting more exercise and staying in touch with the more intimate touchpoints of their lives.

“We had a mental health crisis in this country before this outbreak started because people were cut off from so many of these things,” Leibowitz said.

And, he noted, the crisis might just make it easier for people to consider talking to someone online for therapeutic purposes when all this is over, and everyone is going out into the world regularly again. Talkspace’s biggest hurdle is getting people to try digital therapy for the first time. After that, he noted, Talkspace sees return rates of 80 percent to 90 percent.

The last few weeks have started to change those rates though, and the next few seem poised to change them even more as consumers find they may need a bit of help getting used to the new normal, he said.

“I don't believe that once this ends, most treatment providers, therapists and psychiatrists are going to cancel their subscription with whatever platform they're using,” he said. “I think that they will go back to their office … but digital service will be part of what they do from here on.”



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