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Online Counseling: Help at Your Fingertips

Does America need a greater focus on mental health? Recent studies suggest that the answer may be yes.

A 2016 study by Mental Health America revealed that 18.5 percent of American adults (43.7 million) were experiencing some form of mental health issue. And that’s just the adults: approximately 10 percent of young (12-17) Americans reported at least one major episode of depression in 2016, with 64 percent receiving no treatment.

The good news is that the numbers are slightly down from 2015, but the fact remains that many Americans suffer from personal, social, or psychological problems and receive little or no help. Is there a solution?

Counseling can provide a lifeline for those experiencing depression, anxiety, insomnia, or other mental health problems that often accompany a chronic pain condition. So why are so many people going untreated? The barriers to getting help seem to be threefold: cost, accessibility, and the perceived stigma often attached to those who seek counseling.

Any or all of these barriers can prove nearly insurmountable, but increasingly, the word is getting out about the availability and efficacy of affordable, discreet online counseling. Being able to message or talk to a qualified services provider anyplace at any time via computer, tablet, or phone is now a reality.

Online Mental Health Services: A Brief History

Almost from day one, the Internet and mental health services have been linked. In 1972, a mere three years after the first-ever instant message was sent via computer, a simulated psychology session between linked computers at Stanford and UCLA was demonstrated during the International Conference on Computer Communication.

At first “online counseling” consisted mainly of informational and educational resources, but at some point, the potential for providing services previously available only in face-to-face sessions started to be widely recognized. Almost as soon as computers became more readily accessible, an increasingly plugged-in population began to seek help anonymously, first on the computer bulletin board systems of the 1970s and later in online self-help support groups.

By the mid-1990s, various types of both free and fee-based online mental health services — whether of a generalized “Dear Abby” nature or in a form more closely resembling today’s one-on-one e-counseling — had become available to the public. Today, cellular phones give many of us a hand-held computer that provides services that we can access no matter where we are. For many, this means that counseling in a convenient, affordable, and private manner is now only a click away.

Getting Started With Online Counseling

There are a number of online mental health providers to choose from. Three of the most prevalent are BetterHelpPresto Experts, and Talkspace.

Once you’ve chosen a provider, getting started may involve filling out an online questionnaire or simply clicking on a box to start talking with a counselor. Provider websites should offer cost and payment options up front so there are no unpleasant surprises later on. Be advised that although insurance won’t cover your treatment, online counseling costs only a fraction of what you’d pay for face-to-face sessions, so in most cases, you should be able to find a treatment option that fits your budget.

With the “formalities” out of the way, you’ll be matched with a counselor. Your sessions can be conducted anywhere, at any time, on your computer or on mobile devices, and reputable providers are meticulous about security, using encryption, scrambling, and secure storage to maintain the privacy of your information.

What Can (and Can’t) Online Counseling Do?

Dr. Sonya Bruner, Ph.D. is the head of clinical development for BetterHelp and a licensed clinical psychologist in California. Before joining BetterHelp, she was in private practice, working with adults with a variety of presenting problems, including anxiety, depression, and trauma, in addition to relational and family issues.

Dr. Bruner recently gave us some inside information on how online counseling works:

PP: What types of counseling/therapy services does BetterHelp provide?

SB: BetterHelp provides counseling services for individuals over the age of 18 who are struggling with a variety of presenting problems. The most common reasons people seek out support are self-reported symptoms of depression and anxiety. BetterHelp does not provide diagnostic services and cannot be used to fulfill court-ordered treatment requests. All BetterHelp counselors are licensed by their respective state regulatory boards and hold at least a Master’s degree.

PP: What do you see as some of the advantages of online versus in-person counseling/therapy?

SB: One of the main advantages of online therapy is the accessibility it provides to professional counseling for individuals who might not otherwise be able to avail themselves of treatment due to a variety of reasons. Individuals with chronic pain or illness, the elderly, and people in rural areas can all benefit from being able to access a counselor online. Another advantage for clients is that they can message their counselor anytime, instead of waiting to share a distressing event in their weekly session. It is also possible for the client to review previous, written communication with their counselor, which can help reinforce the progress that has been made.

PP: Have you helped any clients manage the stress of dealing with chronic pain?

SB: We have assisted clients with chronic pain, and the typical treatment strategy for this population involves a combination of cognitive behavioral strategies as well as mindfulness strategies to help individuals cope with their day-to-day life.

PP: Are there some instances in which you would advise a client to seek face-to-face rather than online counseling/therapy?

SB: Definitely. Clients who are struggling with active suicidal or homicidal ideation are not appropriate for online counseling and are referred to more appropriate offline resources. In addition, individuals with certain diagnoses that affect reality testing (schizophrenia, psychosis) are not typically going to be appropriately served by online counseling.

PP: What is the application process for therapists like?

SB: Therapists go through an extensive application process which includes completion of a case study reviewed by our internal clinical team. Counselors who are invited to participate with BetterHelp complete a video interview with a member of our team.

PP: Do your therapists ever meet their clients in person?

SB: BetterHelp is an online counseling service, and so counselors do not meet their clients in person as part of the service. However, there are counselors who have transitioned to seeing members in person if they thought this was more clinically appropriate.

PP: What steps does BetterHelp take to ensure confidentiality?

SB: We understand that confidentiality is very important to our members, and we make it a top priority. Client information is kept confidential and encrypted. In addition, we follow the guidelines provided by HIPAA:

  • All messages between client and counselor are secured and encrypted
  • Our servers are hosted in an “A Grade” facility, ensuring the best-in-class security and protection.
  • Our databases are encrypted and scrambled so they essentially become useless in the very unlikely event that they are being stolen or inappropriately used.

Life is stressful for most people, and pain, loneliness, fear can wear away at both mind and body. But help is no longer something reserved for only the wealthy, or the well placed: and the therapist’s couch has been supplemented by the keyboard, putting help within reach of more people than ever before.

If you’ve ever used online counseling, share your experience in the comments below.

PainPathways Magazine

PainPathways Magazine

PainPathways is the first, only and ultimate pain magazine. First published in spring 2008, PainPathways is the culmination of the vision of Richard L. Rauck, MD, to provide a shared resource for people living with and caring for others in pain. This quarterly resource not only provides in-depth information on current treatments, therapies and research studies but also connects people who live with pain, both personally and professionally.

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One Comment

  1. My name is Julia M. I have lived with chronic pain for nearly 30 years now. I can remember being plied with a lot of medication because none of the surgical procedures or implants of various treatment devices helped me at all. The one thing I want to say is that being an alcoholic myself with over 31 years of sobriety a drug addict will always be able to find their drug of choice. I think that patients can be watched and certainly delineated from a true addict to a person simply wanting a day free of pain. What CDC has done is punished those of us who live with incurable nearly untreatable chronic pain where you almost have to seek outside sources to give us the medication needed to control that pain in some form. What a real chronic pain patient do that no they do not want to chance losing the treatment that they do have . Is that the correct way? I think not. However our options are limited because physicians are in fear having to be concerned about the possibility of losing their practice even jail prison time consequently those of us who really need the help you, we don’t get it. If a person is truly in extreme chronic pain and conditions thereof they can be set apart from addicts in that they follow the directions, they’re cautious with the use of medication and would never consider selling that medication to anyone because they themselves are in desperate need of it. Do I want 360 morphines per month no 240 Somas per month no, more than 40 mg of methadone per day no. Would I choose this lifestyle for myself, really?!?
    I have had other treatment options one of which was a spinal stimulator it ended up causing me more grief more pain and more surgery to fix it not only that, it’s led to doctors who will not treat me if I am not willing to try these new procedures. I had a doctor completely detox me from all pain medications and muscle relaxants anything having to do with pain and left me in a position where I could barely walk much less function normally on a regular day. Do I push myself? I do am I afraid of addiction I am not because I have been taught how to manage and maintain a life of sobriety even when having to take medication for a chronic pain condition. There are organizations out there that have a lot of good information however if you are new to chronic pain you will not know what to believe. I teamed up many years ago with the National Chronic Pain Society I ended up starting a group meeting in my town for chronic pain patients, what I found was a lot of people (not the organization) pushing their own ideas on others telling them this will work or that will work or the other will work. That is not always necessarily true. We cannot know what will work for any patient anymore than we can know how bad chronic pain is for each individual, how much pain can a person tolerate and how can I say my pain is worse than yours when I don’t know what tolerance level your body has. I also have an implanted pain pump, this pump drips medication from catheter’s implanted into my spinal canal this is done on a trial of settings to find a good pre -determined amount of and type of drug is best suited for my chronic pain management. What’s needed to treat my chronic pain. I have discovered that the pump is very effective from the catheter placement downward, the efficacy is far greater. Do I still have a need for breakthrough pain medication yes I do only it is a far less amount of medication than I took without the pump. One of the problems I have ran into is that physicians are afraid to prescribe breakthrough medication because a patient has a pump, they think it should be doing all of the work . Unfortunately that is not the case. Do I still use 360 morphine pills per month no I do not I can take up to three in a day there are some days where I take only two, others I wish I could take five! I have a Multiphase incurable illness that causes me pain throughout my body. If you are a physician take your time with your patient, get to know them, stop taking the medication they desperately need away from them and recognize the behavior of a true opiate addict. Most doctors already know this. I do not think our government does. Nor do I believe the government should be allowed to tell a doctor who has many years of education, what they can or cannot use to treat their patients. Just saying…

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