The past year has challenged our collective mental health in ways we never expected. Three out of four therapists say they’ve seen more patients with anxiety disorders since the pandemic started. But as trying as the past year has been, it has also led us to adopt innovative ways to access health care, such as virtual visits, teletherapy, and even text message therapy.
Text messages might seem like a radical departure from a face-to-face therapeutic relationship. But, for some, the timing was right to give it a try: In-person visits were either off limits or stirred up anxiety, and many have felt burned out on video meetings. Especially for younger Americans, who already send and receive an enormous amount of texts each day, trying therapy by text might not feel so foreign.
Curious how it works, and who it may be a fit for? Keep reading for the answers to your questions.
How It Works
Text therapy might sound like a replacement for traditional face-to-face therapy, but Peter Yellowlees, MD, chief wellness officer at UC Davis Health and a past president of the American Telemedicine Association, says that we should get away from this black-and-white thinking — it’s not text therapy or seeing a therapist in person. “The important thing about therapy is the relationship between the patient and the therapist, and how any particular technology can on the whole support that relationship.”
Text therapy “is probably ultimately going to find its most useful place as part of hybrid care,” says Yellowlees. “I see its long-term main use as being part of a range of technologies that people use to connect with their therapists, rather than being primarily used exclusively by itself.”
In one study, people who engaged in text therapy alongside traditional talk therapy stayed in treatment longer, suggesting that it does have a place as an add-on to in-person therapy. Since the medium is so new, scientists are still evaluating its value as a stand-alone treatment.
Nicole (Nikki) Lacherza-Drew, PsyD, a practicing psychologist in New Jersey, New York, and Florida who practices teletherapy via video, phone, and asynchronous chat, says that the effectiveness of text-based therapy depends entirely on the patient and their situation. “It’s a great option for an add-on,” she says, or as a substitution for when the patient is busy that week and doesn’t have the time for a full therapy session.
Who's a Fit
Yellowlees says that there’s a generational appeal to text therapy. “The primary characteristic is age. The millennials and later generations have been brought up on texting, and generally prefer texting to phone calls. So, they're going to be much more likely to take to therapy or extra therapeutic intake via texting.”
“Other people want to use text therapy because they’re embarrassed or scared to see a therapist face to face,” Yellowlees adds. Lacherza-Drew says that for some people, being able to plan out their responses as opposed to feeling put on the spot eases a lot of anxiety surrounding therapy.
Text therapy also has logistical benefits. “For people that have a difficult work schedule, or don’t have the ability to schedule a standing appointment time, we’ll do asynchronous messaging,” says Lacherza-Drew. That way, the patient can simply respond whenever they get a chance. Yellowlees adds that some people may want to try text therapy because they live in isolated areas where it’s hard to find licensed professionals.
Some people might just want to try text therapy as a pilot project to see if they want to go into a more extensive form of treatment after, says Yellowlees.
Privacy concerns also come into play here. Before the pandemic, Lacherza-Drew says that most of her patients preferred speaking over video or phone. But once stay-at-home orders were put in place, many of her patients switched to text therapy to avoid accidental overhearing. “Their kids, partners or parents were home, so speaking aloud wasn’t as private as before.”
Lacherza-Drew explains that text therapy may be suitable for someone dealing with very low-level anxiety, or a difficult adjustment to a life transition. “People dealing with the shift in their schedule once COVID happened would be appropriate candidates for chat-based therapy.” But she says that solely communicating via text is a no-go if she has any concerns that the patient may hurt themselves or others.
“A lot of therapy is what’s happening in real time,” says Lacherza-Drew. “Chat therapy does put the therapist at a disadvantage because you’re not seeing the facial expressions or body language.” Because of that, she says that it’s not appropriate for high-risk patients who have safety concerns, or other people who have serious mental health disorders.
What It Costs
How much you’ll pay for text message therapy depends on both your insurance and the specific mental health provider. Some mainstream services are covered by many major insurance providers. Medicaid programs in 16 states offer reimbursement for messaging therapy. On the other hand, some insurance companies will only cover live teletherapy sessions, not asynchronous messaging, and many individual providers of text therapy don’t work with insurance at all.
If you’re paying for text therapy out of pocket, expect to pay roughly $60 to $80 per week, depending on how often you chat with your therapist.
Some texting apps will boast cheaper prices than that, but Yellowlees says that, “like everything else, you get what you pay for,” and that you probably won’t get the same degree of professionalism from heavily discounted services.
What Else to Consider
The connection between you and your therapist is a crucial part of effective mental health treatment, and it can be hard to establish a strong relationship when you’ve never interacted in real time. “I never start a chat-based therapy with a person that I haven’t met on the phone or on video,” says Lacherza-Drew. You may want to consider setting up an initial face-to-face meeting or phone call with your provider before transitioning or supplementing with text therapy.
Also, Yellowlees advises against speaking to a therapist who is anonymous, or using a service where you can’t choose your therapist. “You need to make sure the therapist is licensed. You need to know who they are and what their background is.”