While the coronavirus outbreak isn't the first time the world has suffered a global pandemic, we've never been as technologically equipped to take on the challenges of avoiding human contact as now. But as we hunker down and stay home to help prevent the spread of COVID-19, we're all becoming more isolated than before.
Not only can solitude lead to loneliness, but we're also reduced to communicating with people largely over texts and messaging. Devoid of tone and body language, our words can be read as cold. After a week of quarantines and lockdowns it's safe to say a lot of people are feeling sad and forlorn.
One obvious way to mitigate this is to video chat with your family and friends, but some people are also turning to therapy during this time. If this is something you're considering, you've probably heard of online services like BetterHelp and Talkspace. These aren't your only options, though -- there are many ways to find help whether or not you have insurance or money. Now that our schedules are no longer full of parties and bar crawls, the problems we've tried to avoid confronting are growing louder in the silence of these nights at home.
What to do if you already have a therapist
Even if you see a therapist regularly, there will be adjustments to make. By now, most visits will either have been moved online or canceled, but if not, you might want to ask about doing so. Many telehealth providers already have access to confidential video-conferencing software that's end-to-end encrypted to comply with HIPAA regulations. Anecdotally, telehealth companies have been making it easier and quicker for medical professionals to use their software for online sessions. In these cases, you'll receive instructions from your therapist on how to connect -- it'll likely be a link that you click to open the program in your browser.
Of course, for a lot of people a session can be nerve-wracking. An appointment via video is a common alternative, but it can lack the nonverbal cues like body language that can make you feel more comfortable. Though you can read facial expressions through a webcam, you might miss cues from being in the same room physically like posture, folded arms or crossed legs. If video isn't an option, a phone conversation is far better than text only. If they can't offer online substitutes, don't take it personally and try to understand their challenges -- practitioners in the US have to abide by HIPAA regulations and find encrypted, confidential means by which to conduct these sessions. It's not as easy as simply installing Skype.
If you don't have a therapist yet
If you don't already have a therapist, the process is trickier, but finding help is not impossible. The first thing you need to do is determine if your insurance covers teletherapy. If so, you'll have far more options to choose from, plus you can worry less about the expenditure. (If you don't have insurance and can't pay out of pocket, there are still options available, and we'll go over them later.) Medicare recently announced it is expanding telehealth coverage to the whole nation, so it's worth asking your provider whether it has updated its plans to include remote sessions.
Before you dive into looking for a therapist, it's good to think about your expectations -- understanding yourself will aid in establishing a helpful therapy relationship more quickly. Is your style a little more open-ended, or would you prefer a lot more guidance and structure? Do you have any preferences as to your therapist's gender, age and years of experience? What do you want to talk about or get help with? It's also okay to not have an idea at all, but at least imagine talking to someone so you get a sense for any latent preferences you might have.
Once you have an idea of your needs, you can start your search. Zocdoc and Psychology Today are two of the most comprehensive and popular therapist directories, and they let you filter with important parameters like location and compatible insurance providers. Psychology Today will even let you search specifically for those offering online or phone counseling, while Zocdoc doesn't offer that info yet. I'd recommend searching for an in-network therapist to keep your costs low. You can also add other criteria like gender. Zocdoc will also ask you what type of therapy you're looking for. In general, psychotherapy is your best bet as it's the broadest term, covers an array of methods and is colloquially considered "talk therapy" -- ie, not treating you with medication but by helping you talk through your problems. It's a good place to start before you decide with your therapist whether you need other treatment options, whether that be medication or something more targeted.
As you search, bear in mind that these are unique times. Just as some people would need to speak with a few practitioners before finding one that suits them in the real world, you might need to do so in your online hunt as well. You may also find your preferred therapists have schedules so full that getting an appointment feels impossible. Having some patience during this time and clearly communicating your needs and concerns will alleviate some of the stress throughout this process. Make sure to ask when scheduling a session whether it'll be conducted remotely or in-person, and what you'll need to facilitate your visit.
Online therapy without insurance coverage
Health insurance is complicated -- teletherapy may be part of your plan but there may be requirements like sticking to pre-approved providers or having a recommendation from your primary care physician. If you're not covered, but you want to pay for yourself anyway, consider online services like BetterHelp and Talkspace. These are the two most established general-therapy providers that are HIPAA compliant. They'll cost you about $40 to $65 a week. That's cheaper than your average therapy session, which is often $200 or more (without insurance). Both services work with licensed practitioners and offer video, phone, chat and app-based therapy. Just as you would offline, you might have to meet with a few therapists before landing with one you like.
How to prepare for therapy from home
Whether you're a seasoned therapy-goer or a first-timer, doing a session at home requires some preparation. Therapists' offices are deliberately designed to be comfortable and free of distractions. Furniture is as generic as possible, and decorations are kept to a minimum -- the goal is to avoid potential triggers for patients.
You don't need to replicate a therapist's office, but to make the most of your visit, you should try to minimize distractions. Go to an area in your home where you're least likely to be interrupted. Those who have children or pets should find a way to keep them occupied for 45 minutes if possible. While a home office might be a tempting spot, it's better to find a place that doesn't remind you of work stresses. Get rid of as much clutter in your surroundings as you can. If you're using a phone to video chat with your therapist, use a tripod or a prop it up against some books to keep your hands free.
Make sure to use a headset (even your wired earbuds for your phone will do fine) so you and your therapist can better hear each other, and turn on Do Not Disturb on all your devices. If you have any downloads or video streams concurrently taking place that might affect your internet connectivity or speed, pause them. Have a glass of water handy and if you feel like you might get emotional, keep some tissues on standby.
Free alternative means of finding support
Not everyone can afford therapy, but you can find help online at no cost. There are plenty of support groups on the internet, although few of them are operated by licensed therapists. It's important to bear in mind that if you're looking for a free option, you won't be speaking with a professional and your main goal should be to feel heard. These options are best for when you need to vent or feel less alone, rather than for seeking advice or therapy.
One of the more reliable sources is Talkspace's free Facebook groups. There are also forums like Turn2Me as well as 7 Cups of Tea. The latter connects you to volunteers for one-on-one chat sessions when you just need someone to listen to your frustrations and be there for you. The r/therapy subreddit also has helpful resources for finding people going through similar issues.
If you don't want to talk to strangers or your friends, you can also consider mental health and meditation apps. Of the former category, I found Youper to be the most helpful. Its makers describe it as an emotional health assistant powered by AI. It's basically a chatbot that checks in on you every day (depending on your settings) and encourages you to identify any thinking traps you might have fallen into. By making you think about why you're sad and helping you understand that the situation isn't as bad as you think, Youper is a surprisingly educational way to get out of a funk.
Meditation apps like Headspace and Calm can also be useful in finding moments of peace when the stress of working from home for hours on end starts to grind on your nerves. These will guide you through sessions between one and 30 minutes to help you clear your mind so that you can reset and tackle your challenges with more focus.
Journaling can also be helpful during these times to put your frustrations into words. You can use password-protected journals like a private Tumblr or Penzu. If you're old-school or worried about putting your deepest thoughts online, you can always use good old pen and paper, too. There are also plenty of therapy-oriented self-help books you can read. I've found Lori Gottlieb's Maybe You Should Talk to Someone a source of inspiration in hard times past. Gottlieb herself is a licensed therapist, and her weekly "Dear Therapist" column on The Atlantic has also been illuminating.
Finally, be kind to yourself. If something makes you feel depressed -- whether it's your relentless Twitter timeline, jealousy-inducing Instagram feeds or excessive pings from noisy chat groups -- cut it out of your life for now. You don't need to make yourself even more frustrated by checking your Twitter every day. Mute your noisiest chat groups and talk to friends over the phone instead. Make appointments to call your family, set up video chats or gaming sessions that you can look forward to. Reach out and help someone else in need. Tell each other jokes, send selfies or video messages -- make each other laugh. We are all human and it's normal to feel a little lonely and anxious right now. Just know that help is within reach and we are all in it together.