I recently read a post on Greatist that lists mental health resources for when you can’t afford a therapist. The list is broken down into apps, websites, hotlines, and support groups (both addiction and other).
Therapy isn’t cheap. The average therapy session (without insurance) can be $80-120 per session or even more depending on your location. Even with insurance, you may have high deductibles or co-pays that prevent weekly therapy sessions from being a realistic option.
With more and more services being offered online, why not look to apps and websites for mental health? Before we can evaluate their usefulness it is important to first understand what these various apps and websites include for mental health assistance.
Some, like eCBT Calm, use the same techniques that are used by therapists. In the case of eCBT Calm, cognitive behavioral techniques encourage the user to connect their feelings with their thoughts and practice mindfulness.
Others, like How Are You, are used for mood tracking and journaling, while a few are actually linked to support services like Talkspace which allows you to text message with a licensed professional for $25/week.
In addition to phone apps, there are many websites that are focused on providing mental health or support services. The most common are support groups and online forums where people can talk to other people going through similar experiences. Like group therapy, online support groups and forums may help users feel less isolated in their emotions and experiences.
With all these low cost and free options, why doesn’t everyone just use apps and websites to help them through their difficult times? Are apps and websites going to eventually replace therapists altogether?
While apps and websites are a great adjunct or supplement to mental health care, there are several reasons they can’t, and shouldn’t, replace seeing a mental health professional in person.
1. Therapy can be overwhelming.
This is true of both in-person and online therapy, as well as support groups. When you delve into why you are having certain emotions, what is triggering them and how you respond, it isn’t unusual to feel worse before you feel better. You may uncover things you didn’t anticipate. A licensed therapist or psychologist can help mediate this experience, gradually building to help you uncover the source of your emotions and being there to support you if you uncover something unsettling or overwhelming.
Photo Credit: Fox Valley Institute, Naperville, IL
2. There is more to overcoming depression and anxiety than a few skills.
Cognitive behavioral therapy (CBT) has been shown over and over to be effective for treating depression and anxiety. Because of this there are all sorts of self-help books that utilize the same techniques. You can even buy a CBT skills book with exercises used by therapists. The same can be said about dialectical behavior therapy (DBT). While these skills are certainly helpful and can ease the symptoms you are experiencing, they may not be enough for some people. Effective therapy takes time. Whether you are dealing with average life stress or managing a disorder, each situation is unique and may require more than generalized help.
3. Sometimes groups do more harm than good.
Have you ever been talking to a group of friends about something you’re going through and instead of feeling better afterward you just feel more angry, frustrated, or sad? Maybe one of your friends pointed out something frustrating about the situation you hadn’t realized yet or maybe someone suggested a self-destructive way of dealing with the situation. This same thing can happen in online forums and support groups, particularly those that aren’t monitored by a licensed professional. It happens in group counseling situations as well, but in those situations there is a therapist or psychologist who can redirect the conversation and focus on constructive ideas. Take for example group therapy for people dealing with eating disorders or self-injury. In these types of situations it is not uncommon for participants to get ideas for how to perpetuate their unhealthy behaviors. This is why there are rules in many therapy groups that prohibit discussion of techniques for self-destructive behavior. In an unmonitored online support group, none of these rules apply. Rather than getting the help and support you need, it is possible to be met instead by discussions that trigger more symptoms without a way to manage those symptoms.
4. Body language says a lot
Online communication is tricky to navigate. Who hasn’t had the experience of being misunderstood on a forum or in a text message? Even with the advent of emoticons and emojis, there are some things that you just can’t effectively communicate via the written word alone. Not only is tone all but lost in online communication, body language is completely forfeited. A trained therapist does more than just listen to your words, he or she takes note of your body language and energy level in addition to other factors to help figure out how you are really feeling and what may be leading to those emotions.
Photo Credit: Joi Ito https://www.flickr.com/photos/joi
5. Crisis situations happen
This one has more to do with why these apps and websites shouldn’t replace being seen by a licensed professional. While not everyone who is experiencing stress, anxiety, depression, or another mental health concern or disorder is at risk for suicidal thoughts and behavior, many are. While an app or website may list resources for getting additional help in the case of an emergency, a therapist’s decision to send a patient to inpatient care or to make a referral for medication management or additional help is immediate and in some cases, not up for debate. A therapist who genuinely thinks a patient is at risk for harming themselves or someone else can take immediate action to have the patient evaluated by a crisis team or admitted into a hospital. An app or website can do very little to help you in times of crisis.
These are just a few of the reasons apps and websites cannot replace being seen be a licensed mental health professional in the long-term. That said, they may be an excellent resource for either supplementing care or during times when symptoms are minimal and do not require care by a licensed professional. How do you know if this is the case? Think of it in terms of seeing a medical doctor versus checking your symptoms on WebMD (because we all do it). When your symptoms reach a point where what you are doing already doesn’t seem to be helping, it’s time to see a doctor and the same is true of mental health.
So if you need mental health care and are afraid you can’t afford a therapist, what can you do?
Many therapists offer sliding scales for patients who are paying out of pocket and some offer discounted rates. Be up front about your concerns related to the cost of therapy and find out what your options are. Some therapists even have some pro bono slots in their schedule to see some patients free of charge.
Even if your therapist does not offer a sliding scale, he or she may be able to set you up on a payment plan. While you’ll still be responsible for the full cost of your sessions, this can help make it a bit more manageable.
While many people see a therapist weekly, you may be able to see yours every other week or ever three weeks to cut down on cost. This is something that should be discussed with your therapist to ensure he or she agrees that the severity of your concerns does not necessitate more frequent sessions. Between these sessions is a great time to take advantage of other resources such as those listed above.
Check out community mental health centers or university clinics to see if they offer more affordable counseling, even short-term. Many times this is a great option for immediate care if you have a temporary loss of income and need to see someone until you can afford more long-term therapy.
The most important thing is to get help when you need it. There are many ways to find a therapist, but one of my favorites is Psychology Today where you can specify not only location, but type of insurance, specialties, languages, theoretical orientation, and much more. This way if your current therapist no longer accepts your insurance, you can find someone who does.
I have a master’s degree in mental health counseling and have experience as a therapist in training. I am not a licensed therapist and any advice herein is not intended to diagnose or treat any mental illness or concern. Consult with your therapist with any concerns you are experiencing. If you are experiencing thoughts of suicide or harming yourself, get help immediately. Call 911 or go to your local emergency room.