Visiting the website for a popular app which advertises confidential, anonymous, 24/7 text psychotherapy, I was struck by how similar it looked to those adult chatrooms which advertise “hot singles in your area are waiting to talk to you now.” Replace the words “hot singles” with “licensed therapists” and you can imagine, very clearly, how the website presented itself. Text therapy has become an increasingly popular alternative to traditional “brick-and-mortar” psychotherapy. In many ways it makes therapy more accessible to individuals who might not otherwise be able to afford it. Yet with the growth of this phenomenon, many are left asking questions about its place in the world of mental health.
Many therapists do conduct therapy over the phone, or an internet-based videophone, often to continue treatment with patients who have moved away, are attending college, or request emergency sessions. Other clinicians, Bruce Fink among them, have advocated for the widespread use of phone therapy — especially for types of therapy which focus on what the patient is saying in the moment (see Fink’s Fundamentals of Psychoanalytic Technique for a discussion of this “variation on the psychoanalytic situation”). Yet even therapy over the phone is a far cry from texting your therapist.
As of 2016, several companies advertise smart phone apps which provide text therapy services in the United States and Great Britain. They advertise a convenient, inexpensive alternative to traditional brick-and-mortar therapy, which tends to be both expensive and time consuming. They boast large networks of therapists and councilors, all licensed and ready to text you through even your most difficult life experiences. A segment on the Today Show even went so far as to declare that these apps “make visiting the therapist as easy as posting to Facebook.” Yet should therapy be such a minor commitment?
Both brick-and-mortar therapists and phone therapists acknowledge the substantial commitment required to be in therapy. For one thing, it requires setting aside time — an hour or so for the actual session, not counting the time spent in the car or the bus just getting to the therapist’s office, if attended in person. Beyond the time commitment, therapy also requires the patient to be emotionally engaged. Neither of these types of commitment, temporal or emotional, are involved in a therapy which is considered as easy as posting to Facebook.
The American Psychological Association (APA) released a “Practice Update” in late June 2015 exploring the potential difficulties of text therapy. The update emphasized the lack of empirical research into the effectiveness of text therapy, while warning clinicians of potential privacy and security considerations, as well as issues regarding the Health Insurance Portability and Accountability Act (HIPAA). Despite this sobering response from the APA, text therapy companies appear to be both popular and profitable, meaning they are not going anywhere anytime soon. So what can psychologists learn from this new variation on the therapeutic situation?
For one thing, we can see that there is a demand for inexpensive therapy. Many of these text therapy companies charge $25 a week for 24/7 access to a licensed clinician, far less than most brick-and-mortar therapists. In addition, we can see that there is a desire for accessibility — for therapy without the large time commitment involved in visiting a therapist’s office. Being able to connect with someone 24/7 also promotes a crisis-management model of therapy, turning services into a hotline rather than a treatment designed to address underlying issues.
In many ways, it is still too early to tell how text therapy will affect the field of mental health. For some, this represents a logical progression of a service adapting to the needs of modern society. For others, it is uncharted territory with dangers and drawbacks which have yet to be addressed. Either way, one thing is clear: people want therapy. Only time will tell whether the convenience of texting is suitable for the rigorous process of psychotherapy.