No Quick Fix for Mental Healthcare
As part of my graduate training in mental health nursing, I am learning about the history of group psychotherapy and how best to leverage groups to treat people with mental illness. From studying the different models, I can clearly see how some group structures would be more beneficial than others depending on patients’ needs.
Particularly striking to me, is reading about the potentially damaging effects that non-professional groups can have on people who are emotionally vulnerable. Several studies have shown that group therapy run by leaders who are not clinically trained can actually cause psychological harm. This is not surprising to me. I have spent years of my life in school training to become a therapist, so naturally I believe that clinical training is important for patient wellbeing. What strikes me, though, are the parallels between these non-professional therapy groups and rise of “peer counselor” and “peer to peer” mental health apps that have been popping up in the past few years.
Before I go on, let me say that mental healthcare is expensive and insurance coverage is limited. It is a tragedy that individuals suffering from treatable psychiatric illnesses go without care due to barriers such as stigma, poverty and poor access. Overall, the advent of technology within the realm of healthcare is a great thing, and apps have proven to be invaluable tools for monitoring symptoms, tracking behaviors and reporting medical issues to appropriate providers. What I am concerned with, though, are those apps which claim to offer comprehensive psychotherapy to users.
I have always been skeptical of the “therapist in your pocket” model that the tech world seems so intent on building. Even if you are talking about connecting actual trained professionals with people who need help, therapeutic communication relies on non-verbal cues, intense interpersonal focus and a calm, non-triggering environment, none of which can be ensured when the conversation happens remotely via text.
What is more worrisome to me is the rise of apps that connect therapy seekers with essentially untrained “listeners”. These listeners, with the exception of rudimentary online modules, often have no real training in mental healthcare. And while they likely are well intentioned, may actually cause more harm than good.
There is a reason that mental health clinicians — whether psychiatrists, psychologists, nurse practitioners or social workers — all go to school for many years. Mental health problems are complicated. It is really, really important to be able to distinguish between depression and a depressive episode of bipolar disorder. It is really important to tease out loss of appetite brought on by anxiety from anorexia nervosa. We treat non-suicidal self injury differently than we treat an individual who is about to take his own life, and it is really important to be able to make that call. The ability to distinguish the fine lines that differentiate specific diagnoses is one of the keys to being a good therapist. It is also imperative for the safety and wellbeing of patients.
So why are these peer counseling apps bad? Because they draw in emotionally vulnerable individuals and provide them with “treatment” that is less than adequate. It is manipulative and unethical to tell people who are in mental distress that they are receiving therapy when they are not. Talking to a stranger about your problems is not therapy. It may feel therapeutic, but it is far from evidence based. And having a therapeutic conversation may be just what some people need when they are feeling anxious or stressed about everyday life. But it is not enough for a person who is struggling with a clinical mental illness, and untrained listeners often don’t know the difference.
I get it. We’re all busy and we want a quick fix for our problems. But there is no quick fix for mental healthcare and that shouldn’t be what we are striving for. It is natural to seek companionship during hard times, and it is admirable to want to help. But call it what it is. These relationships are not therapy, and when people think that texting with a stranger fulfills a real need for psychiatric intervention, then we are failing to meet their healthcare needs.
