The way young people access therapy is changing. In the past, therapy might have been restricted to support groups or face-to-face counselling sessions.
But now, people can access therapy at their fingertips, through apps, online forums, text messages and video call sessions with counsellors.
In the UK, young people, particularly women between the ages of 16-24, are a high risk group for “psychological distress”. Yet according to government statistics from 2014, those under 36 were found to be around 10 per cent less likely to be referred for talking therapy than those over 36.
These Millennials and their younger counterparts, Generation Z, have grown up with computers and the internet. But they are highly-stressed, due to work pressures and social media. It’s small wonder then that a group of people characterised by stress and mental health issues, who feel at home online, would go there for support.
Millennials are busy and preoccupied by work. One study found that millennials are less likely to use their annual leave than other demographics and think about their jobs more than any other age group. Young people are also a significant part of the gig economy, and an online form of therapy, which can be accessed from anywhere at anytime, could make seeking help that bit easier to fit around projects.
This is the case for Brandon Relph, 18, who has several different jobs. He doesn’t have any clinically diagnosed mental health issues but uses regular FaceTime therapy sessions to manage stress. “When I’m on the road for work, or have a hectic week and can only grab a quick spare 30 minutes, being able to just call them up and have it there and then is especially useful. I believe it allows me to make considerable more use of a therapist than if I had to drive the hour and a half drive to see her every time, or even if it was a 10 minute drive. It makes it more of a normality and I can integrate whenever I like, encouraging me to use it more.”
And there are benefits for those delivering the support too. Through delivering sessions online, counsellors are no longer required to be in the office all day and can find a better work-life balance to suit their lifestyle. One such example is self care coach and therapist Eve Menezes Cunningham. She says, “[I have] been able to create a portable practice and move my life and work to the west coast of Ireland.”
While in-person therapy and online therapy can be seen as totally distinct, there’s no reason they should be. Skype sessions enabled Annie, 27, to continue an established relationship with a therapist who was moving to a new place.
“Initially I was quite sceptical about having sessions over Skype because I thought they wouldn’t be as effective,” she explains. “But it has actually been much better than I thought because it means I don’t have to give up my time travelling.”
Convenience and immediacy can have their drawbacks, however, as Annie says she feels less prepared for her online sessions than face-to-face ones. “When I travelled to visit my therapist it made me feel like I was going out of my way to take care of myself. It was a therapeutic journey to meet someone who wants to help me and I miss that mental preparation. Everything on the internet is so immediate, I’ll realise I have two minutes before my appointment and [have to] rush to find my laptop charger.”
Technological breakdown might seem like kryptonite for users and givers of online therapy, but Annie has found even these hiccoughs can be helpful. “Skype and video chats in general aren’t super fast and effective, so, if my therapist is talking and I try to intercept or cut in the whole thing goes silent and neither of us hear each other which has really forced me to listen to what she’s saying and then think about what she’s asked me,” she says.
But it’s important that therapists are trained specifically in delivering support online and this is perhaps something patients don’t look out for often enough. It’s worth a user checking if their previously in-person counsellor will now be delivering sessions online.
Menezes Cunningham says those delivering mental health support should strive to improve all the time, “The Association For Counselling And Therapy Online didn't exist when I was starting out but there are lots of online therapy trainings available now. If I were starting out now, I would [do specific online training]. With any kind of specialism, we need to keep developing and learning and working towards best practice.”
A process known as disinhibition, where those seeking support feel better able to open up about their issues because they aren’t communicating in-person, is a major benefit of online forms of therapy. This can be particularly useful for those mental health issues that are still subject to stigma, or which aren’t as visible in the media. This was certainly the case for Olivia Williams, 23, who used a forum website between the ages of 13 and 17 to seek support for her ‘Pure O’ (a form of OCD characterised by intrusive thoughts that are often disturbing in nature).
While a lot of positive work has been done to destigmatise certain mental health issues like anxiety and depression, others, like the form of OCD Olivia experiences are less represented and discussed. Taboo and lack of understanding from family and friends, (Olivia mentioned her experiences to her parents but didn’t feel they truly understood what she was going through) can lead people online.
“I just don't think [Pure O] is a very approachable subject, and you can just type behind the screen. You're anonymous. I think it just makes it a lot easier to say, ‘I'm having these crazy thoughts that I can't control.’ [On a forum] you can just type that in,” she says.
She found the forum provided a real sense of solidarity and a helpful sense of normalisation through numbers that she doesn’t feel would have been achieved through traditional one-to-one counselling.
“There was no judgment at all,” she explains. “Just seeing how many people also [had the same experience]. If you went face to face, you're not meeting people that are going through the same thing.”
The forum Olivia used was strongly moderated and had clear guidelines for users. She never experienced any negative behaviour. However, this isn’t always the case, and it may not be made clear whether the discussion is being moderated by people with mental health training or not, so users should always check.
Studies have suggested quality control can be a major issue when it comes to seeking help for mental health issues online. However, there are a number of forums and help sites hosted by mental health charities that are more reliable. For example, Anxiety UK has recently partnered with online health consultancy service videoDoc to help its therapists reach patients via an online platform and an app.
VideoDoc has a quality control programme involving quality assessment doctors, mystery shopper users, reviews and patient surveys that its founder Mary O’Brien describes as “rigorous”. These are the kind of hallmarks users should be looking for.
Meanwhile those seeking an online counsellor independently should always check they’re accredited and if in doubt, consult the British Association for Counselling and Psychotherapy’s list of registered therapists.
However for psychotherapist, couples counsellor and author of The Phone Addiction Workbook Hilda Burke, technology can compromise the level of insight she’s able to glean from an individual. “When I work with a client, the actual words they say are a small proportion of what they're communicating. Online therapy can never replicate the level of insight that comes from physical closeness.”
Brandon agrees: “I think you lose an element of the human touch when you talk through a screen. It can be harder for your therapist to pick up on body language cues.”
There are, of course, circumstances in which traditional face-to-face therapy would be more appropriate than an online support method. “It times of particular need (after a breakup or bereavement for example) I think it has been important for me to be able to actually see [my counsellor] face-to-face,” says Brandon. “I do think that during particularly tough times have a face in front of you and somewhere to go and relax is important, rather than a face on a screen.”
And not everyone will find other forms of online therapy useful. Annie felt Mindfulness apps like Calm weren’t as helpful as Skype sessions, “because they’re streamlined for people that suffer anxiety and stress. If you are stressed then I guess it could have a positive effect but I have CBT therapy for OCD and other things. I need someone to help me unravel it because I can’t do it by myself.”