Forget the conventional images that come to mind when you think of psychologists, like chaise longues and notepads. Swap in smartphones and tablets — that could be the future of modern psychotherapy, based on the changing ways young people are communicating.
Youth-oriented services in Canada, like Kids Help Phone, are adapting to social-media-focused millennials by creating new ways for young people to connect with counsellors. The 25-year-old organization now offers an instant messaging service which can be accessed through the Kids Help Phone app or by computer.
“Young people are very used to speaking through their phones and processing without speaking out loud,” says Alisa Simon, vice-president of counselling services at Kids Help Phone.
“Young people who are using live chat are bringing [up] really serious concerns. Maybe it’s their first disclosure of abuse or neglect, or the first time they’ve faced a serious mental health challenge.”
Four nights a week, between the hours of 6 p.m. and midnight, young people now have the option of having a one-on-one synchronized conversation with one of the Kids Help Phone counsellors instead of calling the hotline.
Simon says there is an increasing demand for the live chat services. When the queue for the live chat opens, it fills up within 15 minutes and remains full until the session ends at midnight.
Kids Help Phone also offers email counselling, where young people can write in with a question. The address of the person submitting a question isn't tracked - instead, a counsellor reviews the email and posts a response on the Kids Help Phone site.
Instant messaging therapy
For millenials in particular, this tech-based therapy seems to be appealing because of how they tend to socialize.
“It’s certainly affecting how that generation approaches seeking help for mental illness. They have less of an ability to delay gratification; it seems they want answers to their questions right away,” says Dr. Marshall Korenblum, a psychiatrist at the Hincks-Dellcrest Centre for Children and Families.
“There’s some suggestion that maybe things older people take for granted - like eye contact, facial expression, a warm tone of voice, a welcoming posture - all these things are irrelevant when you’re texting. There’s some evidence non-verbal skills are declining among that generation.”
Though non-verbal therapy is helping a generation socialized by the internet to come forward and seek help, it is presenting a few challenges for mental health care workers.
For example, Kids Help Phone workers now have to receive additional training for live chat counselling due to the sensitive nature of text therapy.
“You have to look for different cues to see how the young person is doing. You have to ask particular types of questions because you don’t have the vocal cues, like ‘On a scale of one to 10 how are you doing right now?,’ and it means our live chats are about three times longer than phone calls,” says Simon.
While an average phone call to Kids Help Phone lasts around 16 minutes, live chats typically last around 44 minutes, meaning the service costs more for Kids Help Phone to maintain.
With Kids Help Phone, live chat anonymity remains a priority - counsellors don’t hear the voices of their clients and the company doesn’t track phone numbers or IP addresses in its app. For counsellors outside the organization, though, confidentiality and privacy issues are rising due to changes in communications technology.
“All the regulatory colleges for psychologists and psychiatrists are cautioning therapists not to contact patients by email, but also by texting, because these are not secure confidential ways of communicating,” says Dr. Korenblum. “The problem is, though, the horse has left the barn - patients want to communicate this way and I think the field has not responded quickly enough to figure out how to communicate with them and protect confidentiality.”
It can be difficult as well for mental health specialists to maintain boundaries with patients. Dr. Korenblum says he knows some therapists who are being contacted by their clients via text or email almost 24/7.
Benefits for therapists
Even with the challenges arising from the use of text and email therapy, these new forms of therapy can also be beneficial for therapists. Some studies have shown patients are more willing to divulge very private things anonymously through a computer or smartphone.
“For young people [for whom] saying the words out loud about what’s going on in their life is too scary, maybe typing it is the first way of addressing an issue you’re really struggling with,” says Simon.
Non-verbal therapy can also prevent people from being affected by the stigma surrounding seeking help for mental health issues. To an outside observer, it could look like they are texting a friend, when in actuality they’re in a counselling session with a therapist.
Apps provide info to therapists
Other apps that allow patients to partake in their own healing or recovery are also becoming popular. One such app gets people to track their moods to find patterns and share the findings with their therapist.
“A person can key in how they’re feeling, and that can be at midnight or four in the morning, and that will go to either an agency or to the therapist who can house the data. Now the therapist isn’t going to be checking that at four in the morning, but at least the therapist gets more of an accurate of how the person is feeling around the clock,” says Dr. Korenblum.
Emoticons are another way mental health workers are working around the non-verbal aspect of text therapy.
“Google and Microsoft are enlisting the help of psychiatrists to begin to incorporate more sophisticated emoticons, because it [text communication] is missing that element. We need to develop a whole text language for sad, angry, betrayed, hurt, because it’s impossible to convey that fully [in a straightforward email or text],” says Dr. Korenblum.
The struggle to express emotions over text message is probably why professionals say many people prefer phone or in-person therapy.
“For young people who want an immediate answer, who want to hear that someone is empathetic and understands, they want to call,” says Simon.
Dr. Korenblum agrees traditional methods are still just as effective as new methods.
“The old standard is still there, and traditional ‘one-hour-a-week going-to-the-therapist’ will still be there. I don’t see that disappearing right now.”