Many things are unknowable from the time they were created. A hundred years ago, most people still didn’t own a car, but today people are getting around in gas-free, futuristic, self-driving contraptions. However, therapy has not changed in many ways since Freud’s time (for reference, our good friend Sigmund Cars first did therapy when it was released to the public).
Before the cheaters came in, yes, collectively, treatment methods moved from outdated forms of psychoanalysis to behavior-oriented, solution-focused, evidence-based practices designed to equip consumers with values-consistent skills and actions.
However, the treatment format through the looking glass has not changed. If anything, it’s becoming more complicated to provide therapy given the red tape surrounding large organizations, risk management issues that bog down providers on unnecessary paperwork rather than providing real human contact when it’s most needed, questionable expense claims by insurance companies, extremely low wages out of private practice. Any system, and the lack of organizational resources to support providers in their work.
This has made highly trained therapists historically feel overwhelmed and burned out at a time when they are most needed in society. Therapy has also become more difficult to access for the everyday person, who may not know the difference between a largely unsupervised coaching position, a presiding psychiatrist (MD), a social worker (LCSW) connecting patients to the community services they need, and A psychologist (Ph.D. or PsyD), or a marriage and family therapist (MFT) providing therapy.
Additionally, prior to the Covid-19 pandemic, few therapists were providing services due to billing “face-to-face” visits, the organizational rigidity of the companies they worked for, and a general sense of uneasiness about the “how-to” of virtual therapy. Even work. Many providers assume that there is no way to influence behavior unless a consumer is physically “in the room,” even though many consumers “don’t have the time, resources, or inclination to be in the room.” “When he started.
A study of the common factors that make therapy “work” shows that this is not the case. Adaptation to the client, non-comparison to a person’s problem, realism and control of expectations are important but insufficient elements of therapy, although we now know that these elements can be successfully transmitted on virtual platforms.
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Complicating matters, we know that therapy is not a one-size-fits-all solution, and that different types of therapy will be more effective for different consumers. For example, dialectical behavior therapy, which educates clients on mindfulness, emotion regulation, stress tolerance, and interpersonal effectiveness alongside family-oriented therapy, has been shown to be particularly effective for eating disorders.
Meanwhile, exposure and response prevention therapies are the gold standard for anxiety disorders, including obsessive compulsive disorder, hoarding, and perfectionism. However, for consumers with chronic health conditions such as asthma, COPD, diabetes, pain or cancer, acceptance and mindfulness-based approaches such as acceptance and commitment therapy are usually effective. Furthermore, the same principles of behavior change that make therapy “work” for certain groups of people translate to the general population using behavioral science.
Entrepreneurial entrepreneurs and venture capitalists are looking at these gaps in care at a snail’s pace, turning behavioral health into a profitable opportunity. In a recent nationwide poll of more than 100 therapists seeking work in the technology space, nearly half said they were looking for roles that did not provide any clinical services.
This choice points to the same problem as the nationwide teaching shortage, with teachers flocking to other professions that offer a more stable, supportive, balanced career option and lower barriers to effectiveness. Rather than continuing to work within a broken system, highly skilled providers seek to use their knowledge of behavior change in new ways that move entire systems of care.
Unfortunately for these behaviorists and consumers, most of these therapists are not placed in positions of power (read: C-suite executive teams) to produce the kind of change they know they desperately need. There is even more hope for health technology companies that have behavioral health leaders or former therapists on their executive teams. And on the face of it, these companies seem like a godsend to consumers who are hopelessly trying to connect with therapy and to therapists who can offer their skills to therapists who join these companies. You know better when job satisfaction increases.
However, the dark side of these mental health care technology companies is that many (certainly not all) only offer contract positions, do not screen or train their providers in evidence-based practices, and target new providers by making them sick. Virtually work, and continue to pay substandard wages while top-tier traders profit from your friends and family members.
As bad as this sounds, the good news is that behavioral health systems are taking notice. Leaders are taking notice. Suppliers are taking notice. Mental health care is changing, and it’s here to stay. Access is increasing at lightning speed (still not fast enough), mobile healthcare technologies are being offered directly to businesses and consumers. Outdated systems of care will fail if the system does not keep up with the times because therapists know they can go elsewhere to provide their expertise and consumers will follow.
Perhaps 100 years from now we can see the pandemic as a catalyst for change in health care, and technology spaces will be increasingly represented by therapists who rely on them to make their offerings accessible and profitable.
To find a therapist near you, visit the Psychology Today Therapy Directory.
