Once a week, Ilse Stacklie-Vogt, a sophomore at UO, sits on her bed, opens her laptop or phone and talks to her therapist through the screen. Sometimes the video freezes or background noise gets in the way, but Stacklie-Vogt enjoys the casual feeling of chatting from her own room. “I feel so much more like I can say whatever,” she said. “It’s more like I’m calling a friend.”
Teletherapy has surged in popularity during the pandemic and brings its own mix of benefits and challenges. The virtual nature makes it more accessible for those who can’t attend in-person sessions, and, for some clients, opening up from their own home is easier than visiting an office. But talking through a computer can also limit communication and add to screen time.
“A really solid, deep relationship can be formed, just across a video screen, but it can take a little longer,” said Jessica Barnese, a somatic counselor who switched to teletherapy because of the pandemic.
At-home therapy is now the norm: Three-fourths of mental health clinicians are offering only teletherapy 一 primarily over the phone or telehealth video platforms like Doxy.me and Therea-Link 一 and 16% are providing a combination of in-person and online services, according to the American Psychological Association.
Teletherapy has become a staple in a COVID-19 world, where many need extra support. When the pandemic started, UO senior Amanda Kelly wanted to see her family but struggled to find a flight home to Annapolis, Maryland. “It’s really hard to not feel alone when you can barely see any of your friends or close relatives,” she said. “If I didn’t have my one good friend I’ve been quarantining with, I would lose my mind.”
In July, over half of adults reported COVID-19 negatively impacting their mental health, according to the Kaiser Family Foundation. The impact is linked to isolation, with more mental distress among those sheltering in place.
But trying to socialize also creates anxiety. Stacklie-Vogt and her roommates allow a limited list of guests into the house, but she worries that other people will take offense. “You’re stressed about hanging out with people and what’s safe and what isn’t,” she said. “It adds a whole other layer to friendship if people are gonna be offended that you have COVID rules.”
Data released by the Center for Collegiate Mental Health in September found increased distress among college students in just two of nine categories: academic and family distress. After the pandemic started, more students agreed with statements such as “It’s hard to stay motivated for my classes” and “My family’s getting on my nerves.”
Stacklie-Vogt, used to the autonomy of her college life, struggled more with her mental health when she had to move home spring term. “There’s a lot of things in my family that are the reason why I go to therapy,” she said. “I’m sure that I will need it less, being away from home.”
Research indicates that virtual therapy is as valuable as in-person therapy. A review published in the Journal of Technology in Human Services analyzed 14 studies that compared internet and face-to-face interventions, finding they were equally effective. The results “provide strong support for the adoption of online psychological interventions,” the authors wrote.
The experiences of clients and clinicians vary, usually bringing a mix of pros and cons. For Stacklie-Vogt, talking with her therapist from her own room rather than a foreign space where “I would have been more professional” feels more casual and makes it easier to open up. She said she’s gotten to know her therapist better, because they see each other in their own homes. Whether it’s a different background or a family member making noise in another room, pieces of personal life are sometimes caught on camera and can lead to conversations that wouldn’t have happened in an office, Stacklie-Vogt said.
For busy college students who might not own cars — and who may travel home during breaks from school — teletherapy is more accessible. More students used the counseling center during summer 2020 than previous summers, said Suzie Stadelman, the center’s outreach coordinator, likely because students could attend sessions from outside Eugene. And for clients with mental health conditions that make it difficult to leave the house, like agoraphobia or depressive states, teletherapy “can really reduce barriers,” Stadelman said.
Despite the benefits of online counseling, Stacklie-Vogt wants to return to in-person services once it’s safe. “There are so many pros,” she said. “The only con — which would still stop me from continuing telehealth — is I just don’t like virtual meetings.” Exiting out of video calls and returning to the physical world leaves her feeling disoriented, especially on days with back-to-back virtual meetings.
Talking through a screen can also hinder communication. “It’s harder to make a guess about how someone’s feeling based on their body language,” Stacklie-Vogt said. You might miss the subtle clues, like someone starting to tear up or fidgeting with their hands. Technical issues and background noises can also interfere. Sabrina Schimscheimer, a sophomore studying economics, said that in her experience with teletherapy, poor communication made her feel misunderstood. “In traditional therapy, I was able to communicate properly,” she said.
In addition to video therapy expanding, texting apps like BetterHelp and Talkspace have grown in users, according to a New York Times article. Timothy Withrow, a second-year political science student at UO, tried text therapy after struggling with feelings of isolation and self-doubt. It’s convenient, he said, but “You just can’t connect over text like you can in person.”
At the UO Counseling Center, most sessions are now online, although in-person counseling is also available. There are no drop-in hours, but students can schedule same-day appointments, and the center encourages them to call in advance to help maintain social distance in the lobby. The center also has a room set up for students to do teletherapy from if they don’t have a private space.
When the pandemic started, the counseling center “ran into some struggles getting temporary licenses in multiple states,” Stadelman said. Individual states license mental health professionals and have responded to COVID-19 differently. Some states, like Connecticut, suspended licensure requirements for approved telehealth providers, while others only grant out-of-state providers temporary licenses during a declared state of emergency or for a limited number of days.
“That puts particular students at a disadvantage to be able to access care, but I think it’s started a really interesting national conversation,” Stadelman said. “There’s lots of reasons why it could be really helpful to be able to practice across state lines outside of a pandemic world.”
The UO Counseling Center can serve students in 18 states, but all students, regardless of location, can access in-the-moment support through a phone call. Case managers can also help students find resources in their area, according to the center’s website.
Many providers in the Eugene community have also switched to remote counseling. Jessica Barnese, who started providing teletherapy when the pandemic hit, experienced “a massive spike” in clients from the end of April to June. She’s found that she can still develop deep relationships with clients she’s never met in person, although it can take more time.
“Most of the way we get comfortable with each other is just feeling what it feels like to be in a room with someone,” she said. “Just getting to feel your nervous system relax in the presence of someone else.”
Because Barnese’s counseling incorporates body awareness, movement and touch, the way she supports clients looks different in a remote format. For example, rather than placing her hand on a client to help them explore physical sensation, she’ll guide the client to do so themselves. “I’ve found it still works,” she said.
While teletherapy has its pros and cons, many studies support its effectiveness, and Stadelman and Barnese encourage anyone struggling with their mental health to seek help — likely through online services. “Although it’s different, it’s still very effective,” Barnese said.
UO student Amanda Kelly agrees. “A lot of times, people feel so alone,” she said. “Those who feel alone have no idea there are millions of people who feel the exact same way, and thousands of licensed therapists who truly want to help.”