Written by: John Piacentini Ph.D., ABPP and Jennifer Regan, Ph.D.
When the pandemic hit, we turned to our screens for everything from school to doctor appointments to birthday parties. And while teletherapy sessions were an option for some people years before COVID-19, the pandemic normalized popping onto your computer to meet with your therapist.
Now that in-person gatherings are back in full swing and we’re enjoying the benefits of seeing each other face-to-face again, many parents and clinicians are wondering whether teletherapy is really the best option for teens who want or need therapy. In this article, we will discuss what type of therapy is best online, describe key benefits of virtual care, and debunk common teletherapy myths that can keep people from finding the right care.
Is Teletherapy The Best Option?
It’s an understandable question. We all want our teens to get the most out of every therapy session they attend, and it’s natural to wonder if factors like screen fatigue or a lack of personal connectivity might hinder that. There are certainly some situations where in-person treatment may be preferable or recommended. Understanding more about how certain types of teletherapy work can help parents and providers successfully weigh the pros and cons of this treatment approach for their teen.
Let’s explore one of the most well-studied and effective treatments for anxiety disorders, a type of therapy known as exposure-based cognitive behavioral therapy (CBT). Fortunately, in addition to often working well for teens, it is also one of the therapies most well-suited for telehealth.
What is exposure-based CBT?
Exposure-based CBT is designed for individuals whose anxiety is causing them daily distress or keeping them from living a full life. While anxiety comes in many shapes and sizes, common struggles for teens include meeting new people, advocating for what they need, performing in sports or other activities, and worrying about the future.
Exposure-based CBT can be broken down into stages. During the first phase, therapists work with teens to identify their particular fears and worries, as well as the situations they avoid to prevent their fears from coming true. Common feared outcomes include social rejection, failing in school, or physical harm.
Once the therapist identifies those worries and feared outcomes, they then teach teens skills to manage their anxiety while gradually confronting (or “exposing” themselves to) the situations they would typically avoid. Through repeated practice, teens learn their fears may not be that realistic, and gain confidence in their ability to do the things they previously avoided.
For example, let’s say a teen has social anxiety and avoids socializing for fear of being rejected. A therapist might initially coach the teen to call a classmate about a homework assignment or ask them to go shopping together. Before calling the classmate, the therapist would prepare the teen using role-plays and practicing the appropriate skills to manage anxiety.
Next, the exposure would happen, with the teen engaging in an avoided activity. During the exposure, the therapist might provide real-time encouragement and guidance through headphones or a messaging app. Through repeated practice in more challenging situations, teens develop the ability to face their fears more effectively and independently.
Exposure-based CBT is also very effective for treating obsessive-compulsive disorder (OCD). During therapy, therapists use the same techniques to teach patients that their worst fears don’t come true when they resist completing their compulsive rituals.
It’s important to note that teenagers don’t necessarily unlearn their fears during exposure therapy. Instead, they learn to recognize that their anxious thoughts aren’t necessarily realistic and that it’s safe to ignore them. Thanks to guided real-life practice, teens gain the tools and confidence they need to complete tasks and try them on their own in the future.
What Are The Benefits of Teletherapy? Debunking Teletherapy Myths
In the case of exposure therapy, teletherapy can actually go above and beyond the limits of in-person therapy in many important ways.
- Equipping teens for the real world: CBT therapists know that the most effective work is often done outside of the therapy office. Teens need to manage their fears in their world. For many teens, that world includes home, school, and spending time with friends in their community. By connecting with teens in these environments through telehealth, therapists gain valuable insight into how their patients navigate anxiety-provoking situations. Therapists are no longer limited to artificially creating in-office practice situations that don’t quite live up to the real thing. Telehealth also allows teens to learn coping skills in the settings where they need them most. And while we don’t want to speak for teens, we can make an educated guess that they do not want their therapist loitering around in their world. Allowing a therapist to connect virtually can reduce concerns about mental health stigma.
It may be helpful to think of a virtual exposure practice like a dress rehearsal for the big show. The point of the dress rehearsal is to practice just as the show would go on—with lights, the orchestra, the costumes, the set changes—to see what kinks need to be worked out before opening night. Without the whole setup, it’s just another practice run that may not actually help with the real event. Exposure practice in a therapist’s office can help, just like regular rehearsals can. But virtual coaching better prepares you for the live show.
- Logistics: Most families have hectic schedules, especially those with single parents, multiple family members, or busy work schedules. Some families need to rely on babysitters, family members, and even car services in order to get their teen to the appointment, further complicating the logistics. Depending on where you live, just making it to an office could mean an hour or more of transportation time, significantly cutting into the limited window of time teens have after school for their own activities. All of these hurdles are not only difficult for caregivers to arrange but can also interfere with a patient’s state of mind during the appointment. Teletherapy makes it easy for teens to engage with a therapist in the comfort of their own environments, and makes it easier for families to seamlessly integrate therapy into the family’s schedule.
- Attendance: Getting teens to show up for a therapy appointment is often half the battle. Therapists have seen firsthand that when it’s too complicated to get to an appointment—or if anxiety is so severe that it’s a struggle to get a teen out the door—it just doesn’t happen. Often, it’s easier to convince your teen to click a link than it is to get them in the car. Many providers, not just therapists, have seen treatment attendance increase where teletherapy is available. Importantly, reducing the number of missed appointments leads to a higher dose of treatment and potentially a faster and more robust treatment response.
- Access: Mental health treatment is already inaccessible for many families. But exposure-based CBT is especially difficult to come by for teens, largely because there is a huge shortage of clinicians well-trained in the practice. Teletherapy makes it possible for teens to log into a device and match with a highly skilled provider who may be too far away from home for in-person meetings. Teletherapy both increases access to well-trained therapists and reduces the pressure felt by local therapists and clinics who are at capacity.
What Should I Consider When Deciding Whether Teletherapy Is A Good Fit for My Teen?
If you’re considering teletherapy for your teen, keep these things in mind as you decide if it’s the right move for you and your family.
- Your teen’s level of online engagement is different from yours. If you didn’t grow up with 24/7 connectivity, virtual meetings, and online chats, you may prefer engaging with people face-to-face. But remember that this is the preferred method of contact for many teens and young adults. They understand and are accustomed to engaging via screens, and it is the most modern and effective way that clinicians have to connect in a way that today’s teens understand.
- Pick a provider who takes the time to understand your situation before recommending teletherapy. Teletherapy is not one-size-fits-all, and the first step of any provider should be to understand the whole story before recommending teletherapy versus in-person therapy. A teen who talks about self-harm or harming others, for instance, may be better served in a more immediate, in-person setting than teletherapy can provide. A teen with very severe ADHD might need an in-person setting where distractions or impulsive behaviors – like logging out of a therapy session, can be minimized. Be wary of any companies who push teletherapy as a universal solution without getting to know your teen or utilize resources like chatbots to provide care rather than highly-trained therapists. Additionally, make sure a provider can outline the ways they keep their teletherapy practice and your personal information secure and HIPAA (privacy)-compliant.
- Make sure you can create the right environment for teletherapy. Therapy won’t be beneficial if you or your teen cannot properly engage in the session. Along with a reliable internet connection, privacy is key. Make sure there is a dedicated private space where your teen can access therapy, and make it clear to them that your family values and respects that privacy. You’ll also want to make sure they are in the right headspace for the session—dressed comfortably but appropriately, for instance, and lacking distractions like multiple screens loaded on their computer or loud noises from another room.
It’s understandable to want to do away with some pandemic-era virtual events, like virtual birthday parties or happy hours. But teletherapy has earned a permanent place in modern mental healthcare, thanks to the access, insight, and real-world experience it can provide today’s connected teens. In the right situation, it may be the most effective and efficient way to give your teen the confidence and tools they need to navigate the world and thrive in the future.
Lumate has expert therapists who specialize in working with teens and young adults. We are currently accepting patients (12-25) in FL, NY, NJ, CT, PA, NC and CA who may be struggling with anxiety and OCD. Schedule an appointment today.
