Category Archives: Social Science

A Guide to Online Therapy

With our economy still in recovery, people who would benefit from counseling may not get the help they need due to cost. There are other reasons why people may not be able to access in-person therapy — geographical isolation, disabilities that prevent travel, concern for community status, feelings ashamed or guilty for seeking help, or having social phobia and panic attacks. Online therapy can be a fruitful method of getting assistance for some types of problems. This book is a primer on how to go about doing just that.

The author begins by exploring the ways in which online therapy is different, such as missing non-verbal cues, distance preventing crisis intervention, questions of effectiveness, potential for fraud, and risks to confidentiality. Stolfe then clarifies the types of problems that respond best to online counseling and those that do not. Issues not to be handled online are suicidality, disordered thinking, medical issues related to mental health (such as anorexia nervosa), and borderline personality disorder. The types of problems he suggests for online therapy are related to personal growth and fulfillment, adult children of alcoholics, agoraphobia/anxiety disorders/social phobia, body image issues/problems, and shame/guilt. The chapter includes a table that identifies major areas of trouble and the level of care which best serves them (inpatient, outpatient, online, etc.).

Characteristics of a good therapist are discussed: empathy, compassion, knowledge, credentials, trustworthiness. For online therapy, however, Stolfe suggests additional qualities to consider: experience; an appropriate website with all necessary information; good typing, spelling, and grammar; online savvy and comfort; if the therapist receives supervision; and membership in the ISMHO (International Society of Mental Health Online).

Chapter 4 covers the basic mechanics of online counseling, i.e., the venues (email, chat) and the types of security issues related to them. Guidance for finding a therapist online and the type of fee you can expect to pay are also provided. Following that, Stolfe describes the protocol for the first contact and first appointment. He also explains how to terminate therapy, whether it’s due to financial problems, ethical concerns, or is planned (goals have been met).

The last chapters provide information on computer and Internet basics, a computer-buying checklist, online therapy ethics, types of therapy, and online therapy sites and companies.

In all, this small book is densely packed with useful information. Online therapy is likely to grow. If used ethically, it provides another resource for people wanting to improve their lives. This guide will help the potential client in his or her search to find caring and competent service.

Texas Isn’t Alone

Idaho, another state of vast rural expanses, also has difficulty providing mental health services. In some cases, such as Grangeville, the nearest mental health provider is 71 miles away.

In rural areas, mental health patients simply cannot access services –community doctors do their best to patch up their physical problems and send them back home, knowing they’ll be back.

And even in Boise, a patient can’t get an outpatient follow-up visit with one of the 28 psychiatrists in town for two to three months after an emergency situation.

Throughout the state, police officers and sheriff’s deputies have become the gatekeepers for mental health services — and they arenÂ´t trained to know what to do.

“We have to deal with the fact that by default our legal system has become our health system,” Saint Alphonsus Regional Medical Center ER director Dr. Mike Mercy said.

Too many mental health issues are first diagnosed in the emergency room, he said, and by the time patients get to the ER, they need extensive therapy, but they’re now in one of the most expensive places to get it.

Some tout the internet as a resource — online counseling. Unfortunately, online therapy services are not the answer. For one, financial obstacles prevent some people from affording a computer. Also, not all rural areas have reliable access to Internet connection. Most importantly, serious mental issues need to be handled in person; isolation is an exacerbating factor. The best answer is for the community to provide support via publicly funded government programs. Having worked at a for-profit mental health company, I have observed that the focus on profit often takes precedence over services. Mental health is best served by non-profit entities. At the moment, most services are provided thusly — except the government has decided mental health is expendable and has slashed funding for services.

It’s a quagmire.

The Idaho Statesman

How to Go to Therapy

I recently discovered this gem. Many people don’t know what questions to ask when seeking a therapist; they often aren’t sure of their rights, nor how to detect unscrupulous behavior. (Unfortunately, human nature affects this profession too, and there are occasional “bad eggs” hanging out their shingles.) This guide provides concise, clear information on the types of provider qualifications and available therapies.

The book begins by defining what psychotherapy is and how to determine if one needs therapy. The author explores some of the myths about what therapy does and the societal pressures against asking for help. The next chapter provides descriptions of the various professionals — psychiatrists, psychologists, counselors — and the numerous national and local organizations which provide listings. The author then moves on to describe the rules of therapy: what to expect in terms of confidentiality, social interaction, time, planning treatment, and sex (a therapist should never have sex with client (or former client), and you should report any therapist who attempts to). The impact and findings of research are briefly explored. Then the author devotes a chapter each to several major theories by which counselors practice: psychoanalysis & psychodynamic, cognitive-behavioral, humanistic, group, couples, and family therapy; he explains the philosophical underpinnings of the orientation and some of the techniques therapists use. He then discusses biological psychiatry and the use of medication, and provides suggestions for making the decision. The last few chapters cover alternative kinds of therapy, advice on how to set goals and stay on track, paying for therapy and using insurance, and bringing therapy to a close. An appendix provides a brief guide to diagnosis (such as what symptoms describe anxiety disorder, depression, and addictions) as well as an extensive list of references and website resources.

The author, Carl Sherman, is a freelance writer who has written about mental health issues for almost twenty years. His work has been published in national publications, such as Psychology Today, Family Circle, Us, GQ, and Investor’s Business Daily. He writes a column and contributes articles to Clinical Psychiatry News. Mr. Sherman has organized his accumulated knowledge and experience in a highly readable manner, making it an accessible and friendly guide to counseling. This book is a necessary resource for clients and therapists alike.

October 5-11: Mental Health Awareness Week

In addition to being domestic violence awareness month, October is also mental health awareness month — October 5-11, to be specific. Some interesting resources pertaining to Texas mental health issues can be found at The Mental Health Association in Texas. Here is some information from a link on their website:

Untreated mental health problems put young people on a trajectory toward jail rather than college. Approximately HALF of youth in the Juvenile Justice System have at least one mental disorder.

–(Juvenile Probation Commission, 2003; and Criminal Justice Policy Council, 2003)

Access to Mental Health Care is already extremely limited. While 9 counties on Texas served more than 90 percent of children in the county who are Â‘At RiskÂ’ and eligible for MHMR services in 2002, 33 counties in Texas served fewer than 10 percent of children needing mental health services in the county.

Lack of access to services and proper medications can lead to tragic consequences including hospitalization, incarceration, and suicide.

There are 1 Â½ times more suicides than homicides with an average of 6 deaths each day by suicide in Texas.
Of the suicides carried out, 90% are related to untreated or under-treated mental illness with the most common factor associated with suicide being depression.
Nearly 20% of the people diagnosed with bipolar disorder and 15% diagnosed with schizophrenia die by suicide.
121 more people committed suicide in 2001 than in 2000 — a 6% increase in just one year.
33 children below the age of 14 committed suicide in Texas in 2000. Suicide is increasing among children 10-14 yrs.
167 people over age 75 in Texas committed suicide in 2000.
2,093 people committed suicide in Texas in 2000.
The highest rates for suicide in Texas are among the 45-54 age group (15.2 per 100,000) and the 75 and over age group (18 per 100,000 people).

How ironic and disturbing that in times of economic stress, money for mental health is slashed from budgets when, in fact, more people need services. The CDC maintains a list of mental health agencies in the U.S. Contact your local agencies to learn about services in your area.

Domestic Violence Awareness

This post is a guest entry written by Alexis Siefert; it was forwarded to me by a friend who has communicated with her occasionally. I found it compelling and articulate, and with Alexis’ permission, I am posting it.

I was driving down the road earlier this week when I saw one of those ever-changing signs in front of a business. You know the ones — you’re never sure if you’ve really seen the entire message unless you happen to be stuck at a red light within reading distance. Anyway, this one read “October is Domestic Violence Awareness Month.” I was another half-mile away before the true irony of that statement sunk in. And at that point I had to pull over (with apologies to all those cars behind me ~ I know that an unsignaled, multiple-lane change during the morning rush hour is considered an uncool driving practice). I sat at the side of the road, shaking, and hoping I could pull myself together in time to get to work, repair my makeup, and start the day with a happy and fresh demeanor (it happens to be a necessity for primary school teachers ~ if you don’t feel it, find a way to fake it).

I tried to figure out exactly what that meant. “Domestic Violence Awareness.” What does one really mean by “awareness?” At whom are these campaigns really aimed? The abusers? Heck no. Does anyone really think that a PSA done by a celebrity spokesmouth saying, “if you hit her, you’ve gone to far, get help,” is going to make the guy slap himself on the forehead in a V-8 moment of revelation? “Gee honey. I never realized I was being abusive. Honest. I’ll never hit you again.” And they lived happily ever after. The End.

Okay, so the “awareness” campaign probably isn’t really aimed at the abusers. So, the victim perhaps? (what a crappy word — ‘victim’ but that’s another issue all together). Getting closer maybe. However, I still doubt that a PSA, a couple of billboards, and a flyer pasted to the inside of the bathroom stall at the local Fred Meyer are things that will make the light suddenly flash on in her mind either. “Well, dang. I guess they’re right. I’ll go pack my bags and file for that divorce now. It’s been fun, but see’ya.”

Probably not.
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