Sharing your deepest emotions online: Did 2020 change the future of therapy?
COVID-19 forced the U.S. into a new era of telehealth. Therapists hope it’s here to stay.
2020 was the worst year of Kali’s life.
“Going through something like the pandemic and not having family around, feeling out of control—I was on edge all year,” says the 30-year-old Colorado resident. And she wasn’t alone.
Amid the COVID-19 lockdowns of early 2020, millions of Americans found themselves trapped at home with a backlog of unaddressed mental-health issues. As with so many other things, computer screens and video calls became the only portals out of lockdown—for work, entertainment and, ultimately, real psychological help.
By spring 2020, nearly all therapy was forced online, a shift that initially worried therapists and patients alike.
“You do all these years of school to become a psychologist and all the training is in-person,” says Dr. Justin Puder, a therapist and licensed psychologist based in Boca Raton, Florida. “So when you transition to online, you have these doubts—will the connection be as genuine? Will it be as effective?”
But by summer, many therapists, including Puder, were experiencing an unprecedented surge in new-patient inquiries.
“About six months into the pandemic, I was over capacity, and that was the first time that my private practice had filled up like that,” Puder says.
Many of Puder’s clients were teens or young adults struggling with the transition to online school and the loss of important milestones like prom or graduation. Other therapists, like Dr. Jeff Rocker in Miami, Florida, saw an influx of Black men seeking therapy after a summer of highly publicized shootings of unarmed Black males at the hands of police. Others still, like K. Michelle Johnson, a sex and relationship coach and therapist based in Denver, Colorado, saw their practices flooded with struggling couples.
“I think the pandemic created a bit of a pressure cooker for people who were suddenly unable to avoid or escape the issues they’d been having,” Johnson says.
For Johnson’s clients, the shift to virtual therapy had both pros and cons. One issue was privacy. Virtual therapy nearly always takes place on specialized HIPAA-compliant platforms that ensure a secure connection, but interruptions from nosy roommates, curious children and needy pets are facts of life at home.
Still, Jennifer Dunkle, a Certified Gottman Couples Therapist who specializes in financial coaching and is based in Fort Collins, Colorado, says many of the parents she works with still prefer online therapy—it freed them to get the help they needed without having to find or pay for childcare, she says.
That new therapy-from-anywhere paradigm has also helped improve access for people in more rural settings. Angela, 31, raises pigs and vegetables with her partner on a farm in southern Colorado. They live about 60 miles from the nearest mental health center.
With that commute, “Going into therapy could be a three-hour ordeal,” Angela says. “So virtual—I’m all about it.”
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Virtual therapy also just feels more accessible for some patients.
Haley, a 26-year-old in Atlanta, Georgia, says the idea of having to meet a therapist face-to-face had always intimidated her. That was compounded by anxiety around having to locate a new office, find parking and be somewhere on time. Conversely, just opening up a laptop from the comfort of her kitchen or bedroom? “That felt so much easier,” she says.
Puder suspects that there’s another phenomenon at play in the public’s newfound openness to virtual therapy: social media.
Puder currently has 335,000 followers on his TikTok. Rocker, better known in Miami as the “Celebrity Therapist” for his work with elite athletes and entertainers, has over 62,000 followers on Instagram. Both are part of a new wave of influencer-therapists who build their followings through bite-size mental health tips, often infused with humor and a lot of personality.
The trend has been enormously effective, Rocker says.
“People are seeing that there are so many different approaches and ethnicities and cultures within the mental health space,” Rocker says. “People are seeing that they can receive mental health services from people who look like them and talk like them and who they can relate to.”
Puder also suspects that TikTok’s rise in popularity during the pandemic has helped cultivate a new light-hearted, open, stigma-free approach to mental health, which has in turn encouraged more people to give therapy a try. After all, the difference between watching weekly videos from your favorite therapist and signing up for weekly video chats is an easy leap to make.
Better yet: According to a 2018 analysis of 64 different trials, internet-delivered therapy is just as effective as face-to-face therapy. And for some patients, it could be even more effective. Johnson reports that when clients can talk to her from a serene setting like a park, they’re able to open up and be more vulnerable than they may have been in person.
“With virtual therapy, there’s that little bit of separation between me and the client,” she says. “Sometimes that helps them let their guard down a little more.”
Kali had been going to therapy for years to help her manage her anxiety and depression. Pre-pandemic, she says she never would have considered virtual therapy. But between the political and social unrest and general pandemic anxiety, she found herself making the switch from weekly in-person sessions to weekly online sessions — something she said was “absolutely” critical to her surviving 2020.
“I genuinely have no idea what I would have done without it,” she says. “I don’t know that I would have made it through this year.”
While she looks forward to going back to in-person sessions, Kali says her opinions of virtual therapy have changed.
“I do feel like that deep connection can still be felt,” she says, “Now when I’m away on a trip, I’m more inclined to keep therapy on the schedule.”
Johnson doesn’t expect virtual therapy to ever completely replace in-person therapy. After all, in-person sessions are still a better fit for some clients, like those who may be starting deep trauma work, she says. Rocker adds that kids and teens often have trouble focusing on a screen.
But one thing is certain: Virtual therapy is here to stay, and the events of 2020 have pushed the mental health conversation in America into a new era—one Puder expects to snowball as more people continue to try therapy and talk about it online.
“When you have the opportunity to be vulnerable and talk about a low you’re in, it’s freeing,” he says. “And I think when people get a taste of that, they’ll continue the conversation.”