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
Feeling Blue? It could be Seasonal Affective Disorder...
Seasonal affective disorder (SAD) is one of the few ailments that is on a clock: It usually begins in October, and people who suffer from it usually feel the full effects in January and February. We also know that it’s more common for people living in places that get less sunlight during the winter and it’s more common in women than men, according to psychologists and researchers.
Traditionally, SAD is treated with antidepressant medication or light therapy, but there has been recent piloting towards a new approach using cognitive behavioral therapy (CBT), looking at the effects of CBT method on reducing negative thought patterns for people with SAD, using the Socratic method to interrupt negative thought patterns and make way for more mood-neutral thoughts, while simultaneously focusing on behavior and helping people to make slight shifts in their habits.
Here are a few questions to consider.
Q
What is seasonal affective disorder?
A
Seasonal affective disorder is a type of clinical depression that commonly occurs in the fall and winter months and typically resolves in the spring and summer. While it can take any seasonal pattern, the fall/winter type is overwhelmingly the most common. The only thing that makes it different from garden-variety depression is the seasonal pattern that it follows.
Because of their similarities, SAD is often misdiagnosed as depression. It sometimes takes a few years for people who have this pattern to recognize that it’s a pattern, and that it’s tied to the seasons.
Q
What are the most common symptoms?
A
Because we’re diagnosing depression when diagnosing SAD, we look for at least five of the nine diagnostic symptoms of depression. We’re diagnosing a depression that follows a seasonal pattern, meaning we’re looking for depressive symptoms that are present much of the day, almost every day, for at least two weeks. The hallmark symptoms of depression are:
Feeling consistently down for most of the day or nearly every day.
A loss of interest in the things that would have otherwise been enjoyable, such as social activities that previously would have brought a sense of enjoyment or pleasure.
Feeling overwhelmingly tired or experiencing low energy.
Inability to hold attention and focus or experiencing difficulty in concentrating.
Feeling worthless or hopeless.
Issues with sleep. Either too little or too much. In winter depression, we tend to see hypersomnia or sleeping too much. In most cases, the individual sleeps for at least an extra hour a day compared to the spring or summer. Some patients may sleep ten to even fourteen hours a day and are still tired. It’s not restorative sleep that we’re seeing. A minority of patients, on the other hand, experience insomnia.
Changes in appetite or weight. This could be either wanting to eat a lot more or a lot less than usual. In winter depression, it’s usually wanting to eat more, and it’s usually carbohydrate-rich foods. Either sugars, starches, or both. With this, we typically see weight gain with an increased appetite or weight loss with a decreased appetite.
Agitation often accompanied by feelings of guilt and shame.
In extreme cases, thoughts of death or suicide.
Individuals can be diagnosed with SAD when they’re experiencing five of these symptoms, which need to include the first and/or second symptom.
These are not momentary symptoms; rather, they are pervasive for at least a couple of weeks. On average, it’s estimated to be five months of the year in a major depressive episode. It’s a lot of time to spend in depression, in terms of the cumulative toll that it could take on a person’s life.
Q
Whom does it affect most?
A
Similar to depression, there is a pronounced gender difference for those affected by SAD. Depression in general is two times more common in women than in men, and data suggests seasonal depression is even more common in women than in men. When we look at its prevalence, we’re looking at a single snapshot in time. And we’ve found that most cases occur in young adults, typically in their twenties to thirties. We’re not entirely sure why it occurs in this age range, though, since these studies don’t follow people over time. One theory is that SAD becomes less prevalent as people age, because they learn how to cope with it or possibly move to places that don’t have winters that are as harsh.
Q
How does SAD differ from depression? For individuals who have been previously diagnosed with depression, does that put them at an increased risk of developing SAD?
A
It’s estimated that up to 10 to 20 percent of recurrent depression cases follow a seasonal pattern. This is generally the course of depression, in which a depressive episode tends to return over time, with periods of time without depression between the episodes.
For SAD patients, there are unfortunately very few studies that have tried to look at the long-term trajectory of the disorder. So we don’t have a coherent idea of its outlook. We’ve tried contacting people we knew who had SAD in the past to learn about their experience and see where they’re at today, and we’ve found mixed long-term courses. A lot of them continue to experience SAD episodes every winter. Others become more subclinical, where they used to have full-threshold SAD, and now they may just have the winter blues. Some develop a completely nonseasonal course where they still have depressive episodes but it’s not tied to the seasons. And others fully remit, where they don’t have depression, seasonal or otherwise, moving forward.
In terms of how SAD differs from depression, there is a strong correlation of SAD with latitude in the United States. The farther you are from the equator, the more cases you’ll find. It is estimated that 9 percent of those people who live in Alaska suffer from SAD, compared with 1 percent of those who live in Florida. For most people—at least in the northern United States—SAD slowly begins in October. People often report an increase in their symptoms after the end of daylight saving time and experience their symptoms in full effect in January and February. It is in these two months that we find the largest proportion of SAD patients in a full major depressive episode.
Another strong link is photo period, or length of daylight. Photo period is the strongest predictor of when symptoms start in any given year for someone who has seasonal affective disorder, as well as how severe the symptoms are on a given day. The number of hours from dawn to dusk determines your photo period. We believe that photo period is what explains the onset of this disorder and can determine how bad symptoms may be on any particular day.
Q
What is the traditional approach to treating SAD?
A
Light therapy was the first line of treatment developed specifically for SAD patients. It was developed at the National Institute of Mental Health under Norman Rosenthal. He was a psychiatrist who moved from South Africa to Bethesda, Maryland, to work at the National Institute of Mental Health, and he experienced SAD symptoms. He was interested in learning more about it, and seeing if others experienced similar symptoms. He put an ad in The Washington Post, asking whether anyone experienced depression in the fall and the winter, and the lab phone rang constantly for weeks at a time. They had a huge response from people who thought they had the symptoms. They brought them they seemed to follow. From this, they developed light therapy as a form of treatment.
With light therapy, the goal is to give people a very bright dose of light, first thing in the morning, to simulate an early dawn. In theory, we’re trying to jump-start a sluggish biological clock, so that circadian rhythms go back to a normal phase as if they’re in the summer, when these people are feeling good. The devices tested in clinical trials are 10,000 LUX, which is the same intensity of light from the sky at sunrise. We block out the UV rays since they’re not necessary for an antidepressant response. We’ve found that prescribing patients to sit in front of 10,000 LUX for at least thirty minutes a day is what it takes for the treatment to be effective in people who have SAD. That said, similar to finding the right antidepressant, it can be a bit of a trial-and-error process. We try to find that sweet spot of exactly how many minutes a day and at what time or times of the day it’s most effective for the patient. The optimal benefit from light therapy must be determined on an individual basis so we can balance any side effects they may experience in response to the light.
The same drugs that are effective in treating nonseasonal depression—particularly SSRIs like fluoxetine/Prozac—have been tested for SAD with a good outcome in placebo-controlled studies. There is one drug that’s FDA-approved specifically to prevent SAD, which is Wellbutrin Extended Release. There was a large multisite study—with the GlaxoSmithKlein drug—completed a few years ago with over 1,000 SAD patients. The study compared putting people on the Wellbutrin Extended Release versus a placebo, and the participants started the treatment early in the fall when they weren’t yet having their symptoms, and the study followed them into the winter. The researchers found fewer relapses on the drug than with the placebo, which led to the FDA approval of the medication. Either bright-light therapy or antidepressant medication are typically used in treating SAD.
Q
How can cognitive behavioral therapy be used to treat SAD?
A
There is an extensive body of research demonstrating that CBT is an effective talk therapy for people with depression. There have also been a lot of clinical trials showing that it worked as well as antidepressant medications for improving depression. Additionally, when you follow people over time, after they’re treated to remission using CBT versus treated to remission using antidepressant medications, there are fewer relapses and recurrences among those treated with CBT than those treated with antidepressant medication.
Q
Recommendations?
A
Resist the urge to self-diagnose and self-treat. Seek evaluation from a qualified person who can figure out once and for all if it’s SAD or if it might be something else, including a depression that’s not following a seasonal course. And know that there are treatment options out there that are effective, including light therapy, antidepressant medications, and cognitive behavioral therapy. So there are reasons to be optimistic that one of these interventions will be helpful in terms of improving your experience.
This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. View the full article here: https://goop.com/wellness/how-to-treat-seasonal-affective-disorder/
If you live in the Los Angeles/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. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
Why You Need To Know Your Partner's Love Language
Knowing a partner’s love language just might save a relationship. The idea behind this psychology is that every individual has a different way that they give and receive love. Dr. Gary Chapman, #1 New York Times Bestseller, The Five Love Languages: How to Express Heartfelt Commitment to Your Mate, argues that these ways can be divided up into 5 simple categories:
Acts of Service
If your #1 Love Language is “Acts of Service,” you feel most loved and appreciated when your partner thinks about what they can do to ease the responsibilities that are weighing on you. Hearing “let me help you with that” or “I already took care of it” is most exciting to you. Laziness, failure to perform their share of chores, or being unthoughtful with how they can help you are all easy ways for you to feel unappreciated and unloved.
Word of Affirmation
If your #1 Love Language is “Words of Affirmation,” actions do not speak louder than words. Unsolicited compliments make you feel secure and happy in your relationship. Hearing “I love you” on a regular basis is important to you, and helps you to believe you are loved. Hearing the reasons behind why they love you is icing on the happy-relationship cake. Insults are not easily forgotten and not hearing enough words of affirmation will make you feel unloved.
Quality Time
Having your partner’s undivided attention is the time when you feel most appreciated. Distractions during quality time or postponing dates can make you feel like you aren’t important to your partner. Scheduling the time to be together is crucial to the success of your relationship.
Receiving Gifts
If this is your #1 language, don’t question your character. It actually has more to do with the thought behind the gift than the gift itself. You appreciate the thoughtfulness behind gift giving (whether it’s a grand birthday present or bringing home your favorite magazine from a trip to the drugstore). All gifts, whether small and daily or big and grand, remind you how much you matter to your partner and how much thoughtfulness and effort they think you’re worth. Missed birthdays or thoughtless gifts are your relationship nightmare because it makes you feel like your partner doesn’t care about you.
Physical Touch
This isn’t just about intimacy — holding hands, hugging, or pats on the back make you feel loved and cared for. Physical closeness is directly related to emotional closeness for you, and neglect can be destructive to the relationship. A hug can lift your mood or take away your insecurities.
So why is knowing your partner’s love language so crucial to the success of your relationship?
It will help you and your partner feel more appreciated.
If you’re an “Acts of Service” person dating a “Words of Affirmation” person, your partner might shower you with compliments and “I love you”s every day, but you would spend the relationship not feeling truly appreciated because they never offer to run errands or do the dishes. Understanding your partner’s love language will help you discern how they show their love, so that you do feel loved and appreciated, knowing the way in which they give their love is different than yours.
It will allow you to communicate your needs more.
Understanding that they do other things out of love, and that they just have a different love language, will help you to communicate, “it makes me feel appreciated when you clean the kitchen,” or “I feel loved when you hold my hand.”
It will show you and your partner what you both should do without being asked.
Knowing your partner is a “Physical Touch” person will make you more thoughtful about holding their hand in public or hugging them when they’re down, and you will be able to understand the meaning and importance behind these little acts that, for you, would otherwise be insignificant. Your partner will be more conscious about what they can do to show you how much they appreciate and love you. When you and your partner both know how the other gives appreciation and wants to receive appreciation, it makes for more thoughtful decisions and efforts that make you and your partner both feel loved and valued.
If you live in the Los Angeles/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. Contact me now to see if we might be a good fit to work together! Or book your appointment now!
Unpacking Emotional Baggage
When dealing with emotional baggage, you are constantly struggling under the weight of baggage, bad filters, and triggers. In any situation, nothing that is said is evaluated objectively. Everything is going through a filter that distorts the original message. It stops being about the content of the message, and instead becomes about our perceptions of the sender, and more importantly, about us. We have let ourselves get to the point where we're not really hearing anymore, we're just judging. If you've reached this point with someone, it's time to unpack your baggage.
Here are a few things that contribute to the problem and understanding them is important tp changing the situation:
Your brain processes most information using primitive filters looking only for the most basic information about threats that should be attended to.
Attention errors make it likely that you'll pay more attention and give weight to information that confirms your original point of view.
You don’t get to hear the intent of people’s messages; you only to get hear how their words come out and to feel how the message impacts you. The disconnect between intent and impact is at the heart of many strained relationships.
Start with a Positive Assumption
The next time you react to something someone else says, turn the situation on its head. Start with a positive assumption, rather than a negative one. Instead of assuming that a person is attacking you, start by assuming they are adding value.
Instead of having your normal reaction to what is said, really think about it. Repeat what they said in your head before responding. Think about the words, without reading between the lines or thinking about the back story. Hear the words coming out of someone else’s mouth—how do you interpret them now?
Pay attention to the positive, rather than the negative components of the message. Did the person start with a compliment and then share some constructive feedback? Focus on the compliment for a moment. Let it soak in.
Think about the possible positive intentions they might have had. How might the person have been trying to help? What were they trying to get at? What value are their comments adding?
If you start with a negative assumption, you waste all the value that others could be providing. A positive assumption is the only thing that gives you a chance.
If you live in the Los Angeles/Westlake Village area and are interested in understanding your emotional baggage and unpacking them, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment now!