By JT Moodee Lockman & Danielle Nadoryk-David
Baltimore Watchdog Staff Writers
Andy Krew had been seeing her therapist, Emily, since she moved to Maryland from Ohio in 2017. She felt anxious about life transitions and wanted more emotional support than her parents or friends could provide.
Krew attended in-person therapy sessions once a week while at Howard Community College. She transferred to Towson University and for awhile took a break from therapy. She felt settled into a routine and was managing on her own.
Then COVID-19 hit.
Krew once again felt like she needed support. She was going through major life changes: She’d just moved in with her boyfriend at the time, graduated from Towson in spring and felt like it was all an overwhelming amount to juggle. She returned to Emily.
But things are now different: These days, therapy is being held through a screen, like most everything else during the pandemic.
For many people, including college students, online therapy has become a new daily reality. Instead of meeting with a therapist face-to-face at an office, patients are having intimate conversations at home through their computer. It’s a convenient arrangement, but it comes with privacy risks and doesn’t allow for the same level of connection.
Why is the need for therapy increasing? How are online therapy sessions working out? How are therapists trying to get the word out and maintaining — or developing — a rapport with their clients?
Demand for therapy rises during the pandemic
Nearly one third of Americans have reported that their mental health has declined since March, according to a YouGov survey. People ages 13 to 23 report elevated levels of stress and have displayed signs of depression, according to a survey by the American Psychological Association. College-age students have the highest stress levels of all age groups, according to the APA survey. According to the Stress in America study, 87 percent of college students reported that education has become a significant stressor, especially since classes moved online.
More young people are seeking mental health counseling since the pandemic began, the YouGov poll found. And due to the increasing number of people seeking counseling, therapists saw a 75 percent increase in the number of patients utilizing telehealth within the first two months of the pandemic, the APA survey found.
With COVID-19 restrictions keeping young adults from socializing, students have also had to cope with newly emerging feelings of isolation or loss of familiar surroundings.
Scott Peck, a doctoral intern at the Towson University Counseling Center, was expecting students to come to sessions with concerns about COVID-19 health risks. Peck was surprised when students were more concerned about suddenly moving home and having increasing amounts of schoolwork than they were with getting sick. These mounting issues make it even more important for students to have access to the mental health resources their schools provide.
Getting the word out
During the pandemic, some people have faced challenges finding therapists now that in-person sessions aren’t available. Olivia Marquis, a junior at Dartmouth College, struggled to find a therapist she was comfortable with after being told by Dartmouth College Health Service that it no longer had the resources to accommodate her after her freshman year.
At Towson, Peck said there was a drastic decline in the number of students showing up for virtual sessions when classes started online in late August. After contacting past patients, the counselors quickly realized that most students thought the Counseling Center was closed due to the pandemic. In previous semesters the Counseling Center relied on flyers and pamphlets spread around campus to inform students of upcoming events and available resources, but with campuses closed it was much harder to ensure that students got the information they would normally see plastered in lounges or on announcement boards. This meant that staff members had to make a conscious effort to post on social media more often to keep students informed.
Despite the initial lack of engagement, the Counseling Center continued to make changes such as increasing the number of counselors and group sessions to better support Towson students. In order to cover a wide range of mental health topics, the Counseling Center moved all of its group sessions to a virtual setting. The center offers format group sessions on grief and loss, as well as more casual, less structured sessions in which students can show up and support one another.
Peck said he was surprised that the most popular group is a mindfulness meditation group because he didn’t think it would translate well to a virtual format.
Privacy concerns arise
College counseling centers also face another challenge: Serving students who are living at home out of state. When everyone is on campus, there are no issues. However, regulations can prevent providers from serving people across state lines.
Matthew Torres, executive director of the Johns Hopkins University Counseling Center, said the center’s biggest challenge was state licensure. Just like all mental health providers, the center must follow the requirements of the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA requirements began to present a barrier when students tried accessing mental health services from out of state.
With therapy sessions moving online, concerns among therapy attendees are increasingly varied. One of these common concerns is online privacy. Along with information constantly moving and being shared online, there are also concerns about the at-home arrangement. It’s hard to find privacy when everyone is nearby — especially if a person is talking about someone living in the house.
Some therapists have avoided Zoom and other platforms with privacy concerns, and instead used more private venues such as Doxy. That’s where Krew and Emily hold their sessions. Krew said she doesn’t have privacy concerns.
“I’m lucky that in my home, I do feel safe,” she said. “I live with my parents and I have a really good relationship with them, but… imagine the people that don’t feel as safe in their homes and they don’t have that escaped to a place where they feel that positive energy.”
Krew said Emily made a point to make sure she was in a quiet setting away from other people and felt comfortable in that environment.
Developing rapport and building relationships
Teletherapy options have become more available and are constantly changing due to the pandemic. Michelle Ward, a marriage and family therapist, has had to change the way she helps her patients — including students. Although Ward has had previous experience with online counseling, when it came to certain treatments, like Eye Movement Desensitization and Reprocessing, it became difficult to translate this type of “wake-state hypnosis” into a virtual format.
As in-person therapy has switched to teletherapy, interactions and relationships between clients and their therapists can also change. Krew said online conversations can be more distant and less intimate. This can result in clients feeling disconnected and unfulfilled by the end of their sessions.
When recalling her first session, Krew remembers the awkwardness of not knowing when her therapist was about to talk, and when it was a good time to interject.
“I think what really stood out to me that first session that was super different from in person was that we couldn’t really…I felt like we were talking over each other a lot because you know when you’re in person, you, you can see someone taking that breath before they’re about to talk, you can kind of catch on to the clues of, like, oh, they’re trying to interject but online,” she said. “It’s like on video chat. It’s more difficult to know when the other person has something to say…So that’s kind of difficult.”
Similarly, Marquis discusses the awkwardness she’s experienced with silences during online conversation and gauging the other person’s emotions.
“The silences seem more awkward when it’s not in person,” she said. “Rather than taking a pause to sit in the silence and be comfortable, it just feels more awkward and less comfortable. It feels like its forcing you to talk rather than being able to have space to process. I think it’s hard to gauge emotions over zoom. Even if you’re looking at somebody’s face, it’s very hard to engage in the session and focus. ”