Supply and Demand Psychotherapy By Sherry Benton, PhD on 10/2/18 - 1:01 PM

I am a believer in psychotherapy. For close to three decades I had the privilege of working with clients as they transformed their lives in amazing ways. Nothing is more satisfying in life than hearing from a former client years later and learning about the wonderful ways their lives unfolded after our therapy was completed. As a psychotherapist, my entire focus was on the person sitting in the chair across from me. I rarely thought about the people who didn’t make it into my office. I didn’t focus on the waiting list or the people who were referred out. I was content and satisfied in providing effective therapy and a great therapeutic relationship to my clients.

When I became an administrator, whose primary clinical responsibilities were to oversee all of service delivery, my awareness of those who don’t make it into a therapist’s office was heightened. I worked in college and university mental health clinics, and the consequences for students who were made to wait were dire. If a student waited four weeks to get treatment for their depression, they were likely to lose their entire semester. If they failed classes in a particular semester, the entire trajectory of their lives could be altered. Their graduation prospects were in jeopardy, graduate and professional school could be out of reach, and job recruiters might very well may pass on them.

As an administrator, I found myself in the intolerable position of determining who would flourish and who would flounder based entirely on the date on which that student sought services. If a student arrived in late August, we rolled out the smorgasbord; group therapy, individual therapy, biofeedback, psychiatric consultation. Whatever they wanted we could provide. In contrast, if a student arrived in early October, they would get a quick triage and then be placed on a waitlist, sometimes for a month to 6 weeks.

Compounding the problem were the obvious differences between the people who came in August and those who waited a few weeks. Students who sought services in August were more likely to have been in therapy before. They were also more likely to come from higher socioeconomic groups-they were more often white. On the other hand, students who waited tended to be from lower SES families, first generation college students and “of color.” We were operating a system that provided advantages to the already privileged, and disadvantages to the already oppressed.

I could not continue to have our agency work this way. I had to find new ways to provide effective help to these young people on their way to adulthood. We needed to increase our capacity without sacrificing effectiveness, knowing we would never be able to hire our way out of our supply and demand problem. Our efforts to solve this problem lead to the creation of my company, Therapy Assistance Online (TAO). Problems of supply and demand are not unique to college counseling centers. Over 106 million people in the US live in federally designated underserved areas for mental health. About 56% of US counties have no licensed psychologists or licensed clinical social workers. We are unlikely to ever meet the mental health needs of the population through face-to-face individual psychotherapy. In digital and online tools and services we have the best hope for putting a dent in the problem.

Our software (TAO Connect, Inc.) is used in 120 college and university counseling centers and we’ve expanded into community mental health centers, employee assistance programs in the US and Australia, a Canadian Province, and two large provider groups. I am very proud to know that our software is helpful to ten times more people than I was able to treat with individual therapy. Recently, one of our university clinicians told me the story of a student whose anxiety disorder was so overwhelming that she had to leave school. She did not have insurance to cover any private therapist, so she worked with TAO’s online CBT for anxiety course. She was able to recover fully and returned to school, and had a great semester. She credited the TAO course with teaching mindfulness skills and learning to challenge her unhelpful thoughts.

As a field we need to explore, develop, research, and test digital and online tools, especially to populations at great risk. Too often mental health apps are developed by software engineers with little or no input from mental health practitioners. Our input is vital if effective tools are going to be developed consistent with what we know works. Practitioners in mental health need to be at the forefront of addressing these dire supply and demand problems and we need to lead in the development of effective tools. We can’t afford to concede our field to software engineers.

File under: The Art of Psychotherapy, Therapy & Technology