Kastalia Medrano | Vox

How to find a therapist during the Covid-19 pandemic

2020-04-07T20:41:05-04:00

It’s a stressful period for all of us. Luckily, taking care of your mental health has, in many ways, never been easier. | PeopleImages/Getty Images

The coronavirus pandemic has created a paradox in mental health care: Widespread social distancing means that more people are in need of support for anxiety and depression, and that more of those resources are harder to access in person. The past several weeks, though, have wrought a change in the national mental health care landscape — a big shift of services and social safety nets from face-to-face meetings to virtual ones.

Around the country, telehealth therapy platforms have exploded into sudden prominence. Support groups, too, have set up shop online. Mental health care services might be inaccessible through traditional means, but never before have they been so accessible through phones and computers.

“We realized by the second week of March it wasn’t going to be possible to offer many of our face-to-face meetings anymore,” said Bill Greer, president of recovery community SMART Recovery. “We’re scaling up very, very quickly [online] in response to the pandemic.”

If you’re one of the 59 million Americans covered by Medicare, new Covid-19 legislation has waived the long-standing restrictions on your use of telehealth services (for the duration of this public health emergency, that is). Health Insurance Portability and Accountability Act, or HIPAA, restrictions on the use of phones to conduct telehealth visits have been lifted, meaning you can have your appointments over apps like FaceTime and Skype. And crucially, you can now meet with providers like this regardless of the distance between your physical locations, which used to just be an option for patients in rural areas that were basically therapy deserts.

To those who are very understandably feeling an increased mental or emotional strain brought on by the changes and the uncertainty of this pandemic, it’s valid to want to talk to someone about it. Very few of us want to process this alone. And whether you’re looking to move your therapy sessions online or just trying to figure out how to start therapy at all, you may find a lower barrier to entry than you’d likely face in non-pandemic times.

Here’s how to find a therapist or migrate from traditional therapy sessions to virtual ones.

If you’re new to therapy, don’t be intimidated. It just got more accessible.

A lot of people who might not have previously felt a need for mental health services are now finding themselves unsure of how to deal with the increased anxiety, uncertainty, and isolation this pandemic has brought. And while the thought of the bureaucratic nightmare that so often defines the search for a new health care provider — especially a mental health care provider — can often be intimidating to take on, this present moment is actually a good one for finding low-threshold access to care. You won’t have to trek from office to office, or face steep copays, or be limited to clinicians licensed to practice in your state. Therapy is more available than ever, and at a better price, too.

First, let’s figure out how you’re going to pay for it. If you don’t have insurance (or even if you do), there are resources available to you at no cost. Consider looking into Federally Qualified Health Centers, community-based centers that offer care including mental health and substance use services. They’re authorized to provide telehealth services even if you’ve never been a patient at one before; they have to prioritize patients who live inside their service areas, so search for one in your neighborhood here. An HRSA spokesperson told Vox that they’re encouraging health centers to provide telehealth counseling and that they’ve heard from many that are working to do so.

The national crisis text line allows you to connect with a crisis counselor for free simply by texting CRISIS to 741741 (you can also go through Facebook Messenger). It’s staffed by volunteer social workers and clinicians who reply within minutes and are available 24/7. They told me that their volume of incoming texts has roughly doubled in the past three weeks, with more than three out of four texters saying they’re experiencing anxiety related to the pandemic, and stressed that their volunteers will do what they can to help you. “If it’s a crisis to you, it’s a crisis to us,” said Ashley Womble, the organization’s head of communications. “Our conversations usually last around 30 to 45 minutes — it’s longer than you’d think.”

If you have private health insurance, a number of providers like Aetna and Blue Cross Blue Shield are currently waiving copays for telehealth visits, including those not related to Covid-19 symptoms. States like California and Arizona have ordered all insurers to cover telehealth services, too, and changes in other states could be coming.

Once you’ve figured out payment, it’s time to start looking for a therapist. This can feel daunting, but you have plenty of tools at your fingertips. If you have health insurance, your insurer’s website is likely the best resource to find covered telemedicine providers. If that is not an option, the most reputable and widely used websites that connect you with mental health professionals include Teladoc, Amwell, MDLive, and Doctor on Demand. Therapy Brands offers a directory that’s searchable by both region and specialty, and Psychology Today has a therapist directory that can be handy when you’re looking at price comparisons.

You can also find a therapist through “fast therapy” apps like TalkSpace, which connects you to a licensed therapist through not just video chat, but texting, too. Out-of-pocket TalkSpace subscriptions start at $260 per month — which sounds like a lot up front, but it gets you unlimited text, video, and audio access to a therapist five days a week. For comparison, IRL therapy might cost $200 per month in insurance copays for one 45-minute session once a week.

Once you’ve scheduled your first appointment, keep in mind that if you try a few sessions and don’t feel comfortable, it doesn’t mean therapy isn’t for you — it might just mean that therapist isn’t for you. It’s normal to meet with a few different people before you find someone you gel with, which you can now do in your pajamas rather than having to slog to a bunch of different offices across town.

Use video chat or phone for your appointments, and warn the people you live with that you need privacy

Even therapists who haven’t previously used telehealth services are pivoting to them now. Rather than Skype or FaceTime, many are using platforms like Zoom, Doxy, or thera-LINK, which have the advantage of being HIPAA-compliant, meaning your personal data is secure. In the week of March 25, thera-LINK’s parent company Therapy Brands saw a more than 4,000 percent spike in telehealth use compared to the week before.

“There have obviously been lots of [recent] changes,” said therapist and thera-LINK co-founder Carol Park. “I’ve done telehealth for years, but I moved my practice 100 percent online starting March 16. It’s been really seamless.”

If you’re encouraging your therapist to take their practice online, you might suggest thera-LINK’s Clients Plus for those who have been working at small offices, those at slightly bigger practices could try TheraNest, and those working through large firms can look to ShareNote. Therapy Brands also offers instructional videos, webinars, and customer service chats to help patients and providers navigate the logistics of moving their mental health care online.

When it’s time for your digital appointment, see if you can find a private space to conduct it. If you don’t live alone, consider shoring up your therapy appointments with a few boundaries — asking people not to disturb you during that hour, and maybe that they play something in their headphones or go on a (social distancing) walk outside to give you the peace of mind of privacy. You’re treating these video sessions as respectfully as you would traditional sessions; your family or roommates should, too.

Those in recovery from addiction can still find support and community online

This can be an incredibly isolating time for people dealing with substance use, but it’s possible to keep your support network digitally. Alcoholics Anonymous resources are accessible through a ton of sites like Online Intergroup, where you can find a directory of meetings taking place over Zoom as well as regular call-in numbers. Some, like Online Group AA, offer meetings via discussion boards. Others are primarily Skype-based. There are also a variety of AA-themed apps for download, many of them free.

Virtual Narcotics Anonymous offers meetings over the phone as well as online, and you can also search for meetings through Narcotics Anonymous here. Other digital options include Unity Recovery, Sober Grid, and In The Rooms, a free online recovery tool that serves 635,000 members and offers more than 100 different meetings a week, including AA and NA. In The Rooms’ livestream meetings usually top out around 100 people, but in recent weeks have swelled to as many as 550. “Everything started closing down and people were anxious, they said, ‘where do we go?’” said co-founder Ron Tannebaum. “It’s worked flawlessly so far. We’re so excited — we can even scale to larger meetings, maybe to 1,500.”

Encouragingly, the Drug Enforcement Administration has granted telehealth exemptions for doctors prescribing medication-assisted treatment to people with opioid use disorder, an area that’s normally subject to extraordinary regulatory oversight. And, as of March 31, people can get their buprenorphine, or opioid replacement, prescriptions refilled via telehealth platforms, too.

Support groups and fellowship programs like AA and NA aren’t regulated the way doctor-patient meetings are, and apps like Skype are subject to privacy concerns in a way that HIPAA-compliant platforms like thera-LINK are not. But online meetings do offer something crucial that one-to-one therapy or counseling does not: community.

“That familiarity is so important,” said Greer of SMART Recovery, which also offers online versions of local meetings, so you can attend a virtual meeting with the same folks you’d see in real life. “We’re trying to preserve as much of that as possible.”

This is a harrowing time for all of us. A recent study in The Lancet found that the psychological effects of social distancing can range from anger to fear to post-traumatic stress. But it also noted that there are benefits to focusing on the inherent altruism of sticking with quarantine guidelines, of limiting your contact with others and staying put. You can find some clarity and purpose in knowing that you’re helping protect people by moving your health care online. When you do, you’ll find a whole ecosystem of communities waiting to welcome you. Social distancing doesn’t have to mean we have to do everything alone.

Kastalia Medrano is a journalist whose work has appeared at Newsweek, Vice, Gizmodo, Teen Vogue, the Paris Review Daily, and Pacific Standard. She lives in New York City.

Good mental health isn’t about being happy all the time

2020-01-29T12:23:45-05:00

“No one sits down [for therapy] and says, ‘Are you happy?’” says Candice Ferguson, who is running for a Colorado state representative seat. “They say, ‘Are you sad? Are you depressed? Are you whatever.’ But no one tries [to] say that you’re going to be happy during your treatments, or once they’ve sent you on your way.”

Ferguson, who was sexually abused as a child and lived on her own before she graduated from high school, had a series of miscarriages in her 20s. She started having panic attacks. She sought a psychiatrist and was prescribed medication — now, at 43, she continues with therapy to maintain her health and is speaking publicly about her mental health history for the first time.

She prefers not to view her well-being in terms as stark as being happy or not, which she feels can set up those with mental health issues for failure. “Happiness is a dangerous carrot to dangle,” she says.

Among those living with mental illness, there’s a shared experience of your health being judged by whether or not you seem “happy.” Despite the increasingly popular refrain that everyone should be in therapy, many still think of therapy as something you need when you’re not content with life.

“I’ve had people tell me, ‘Oh, but you always seem like such a happy guy already,’” says Vardaan Arora, a 27-year-old New Yorker who has obsessive-compulsive disorder. “But even if someone presents as quote-unquote happy, it doesn’t necessarily mean anything. And also, you can have a mental illness, and have bad days, and still have good days.”

It’s a popular myth that mental health and happiness exist on the same side of a binary. Depression in particular is portrayed as the opposite of happiness — but happiness is an emotional state, and its opposite is sadness. Depression, like other mood disorders — and anxiety, psychotic, personality, eating, and substance-use disorders — is a health condition; the opposite, aside from never developing anything to begin with, is symptom management. “I mean, happiness is not something you learn about in medical school,” says James Murrough, director of the depression and anxiety center at Mount Sinai’s school of medicine in New York City. “It’s not even in our vernacular. It’s nothing we consider.”

Murrough says people will often refer to antidepressants as “happy pills,” a premise that makes no sense to clinicians. The ideal outcome of antidepressants isn’t happiness, but a return to the patient’s baseline level of functioning, or at least a reasonable approximation.

It’s a small irony that the demographic assumed to be furthest from happiness seems less clinically and personally preoccupied with reaching it, since the rest of the country’s scheming to optimize happiness continues apace. Among the general public, happiness is a whole industry now, churning with self-help gurus and college lectures and annual UN reports and a fetishized understanding of yoga. Of course, the kicker is that for all that expended energy, we’re only getting less and less happy.

People who live with mental illness do have longer odds on experiencing happiness than their healthy counterparts, but this is because they have more limited access to care. Compared to doctors in all other specialties in the US, psychiatrists are the least likely to accept insurance, and the options for those without private coverage are generally the thinnest of all. Mental health in this country is a luxury, and luxury is only for the wealthy.

It is inordinately difficult for even people of relative privilege, such as Ferguson and Arora, to access the basic levels of care that allow them to experience happiness, and often functionally impossible for lower-income Americans like Val Phillips, a 51-year-old farmer in Colorado.

“I’m on Medicaid, and used a public health option for most of my treatment, so we had to rewrite goals every three to six months,” Phillips says. She began having panic attacks in her late 20s, after her mother died. At 43, she attempted suicide.

After that, she began seeing a therapist regularly, and got a formal diagnosis of major depressive disorder and generalized anxiety disorder. She’s tried Elavil, overdosed on Klonopin, and currently takes Prozac and Wellbutrin daily, plus Vistaril as needed for panic attacks. But she says cognitive behavioral therapy and EMDR (eye movement desensitization and reprocessing, which involves recalling traumatic events while simultaneously tracking hand movements your therapist makes, sort of like you do at the eye doctor) have helped her the most.

“Initially it was just moving me away from suicidal ideation. Then it became specific positive changes in my relationships, work life, and general health management. I cannot recall happiness ever being a goal.”

People who’ve been through some form of mental health treatment might be less susceptible to the mirage — that sustained happiness can and should be our default state — because they’ve been taught to approach emotions as being inherently impermanent for everyone, in a way that, say, chronic illness is not. There’s less of an expectation that you’re striving for happiness at all times.

“Part of therapy is helping people to be less phobic or afraid of their emotions,” says Andrew Kuller, a senior behavioral health clinical team manager at the Harvard-affiliated McLean Hospital. “To recognize that they’re going to pass, and it’s okay to feel whatever it is they’re feeling.”

All the major emotions play an important role in our emotional lives, in giving us complexity and depth. Happiness is a healthy emotion. So is anger. Sadness is healthy and can facilitate real connection, and bears little resemblance to depression — which is not healthy, and often not so much like feeling sad as like feeling nothing. Yes, doctors want you to feel happy; they want you to feel.

For people like Arora, that’s a better goal. Arora was diagnosed with OCD in 2012. He’s tried Prozac, Lexapro, Anafranil, talk therapy, and exposure and response prevention therapy — exposure to something that triggers you, followed by prevention from completing the compulsive ritual with which you cope.

“With OCD, so much of your time is spent ruminating on what may happen in the future, or what may have happened in the past. Life just sort of goes by you, and you’re not really living in the moment,” Arora says. “To me, happiness doesn’t even have to be all the good things. I want to experience the bad things too, y’know?”

Kastalia Medrano is the travel writer at Thrillist. She was previously on the science team at Newsweek, and has written for outlets including Vice, Teen Vogue, the Paris Review Daily, and Pacific Standard.