Experiences with online therapy? + triage for daily anxiety
May 5, 2017 4:08 PM   Subscribe

I'm having some increasingly difficult-to-manage issues with anxiety in my daily life and wondering 1. if online therapy might be a good choice for my situation (and any general opinions/experiences with online therapy) and 2. what I can do to get through this when I experience problems.

Here's what I'm dealing with. I'm a 37-year-old woman who has struggled with depression in the past. I've been in and out of therapy since I was a kid. I'm very, very stressed out due to a couple of things going on that I'll describe below, and I genuinely cannot see how I can make room for traditional in-office therapy in my life right now. My insurance does have something, but it's limited and you can only go to certain people and at certain times (and I think not very often) and I cannot imagine that working for me right now. So I was thinking online therapy could work maybe? Because it's more flexible and such?? And maybe affordable?

What I have going on in terms of sources for my anxiety:

* I haaaate my job. Hate. Hate every minute of every day that I am sitting in my office which is basically all the time because I'm required to do a lot of outside-of-normal-office-hours work and events and such and I get almost no time off. I have a couple of days saved (like maybe 3), but I'm holding on tight to those in the hopes I'll get some interviews for some of the many jobs I'm applying to. Also I really don't get any breaks. It's a small office and taking lunch outside the work room or even leaving for 5 minutes is very conspicuous.

The job situation is my biggest problem by far. As I mentioned, I'm applying to other jobs as frequently as I can find them, usually a handful each week. Not working or taking a break isn't an option financially (would that it were). I've been applying for a few months. No calls or interviews yet. (PS: This was also me. Job stuff is an area of challenge for me to say the least.)

* Other stuff I have going on: I moved a few months ago and am still living in utter chaos (I'm so busy that I only have a little time each week to work on this, and then it's questionable whether I'll have any spoons available to do that work); I'm currently adjusting to CPAP therapy (it's going... ok? but it's hard and affects my sleep); I have (relatively minor) surgery coming up that is making me nervous; I have work events coming up that will make work even more hellish than usual; I'm worried about money; my car is about to go so I'll have to figure out how to get a new one; I hate the way I look and my hair and my clothes and my face and body; blah blah blah.

The symptoms I'm experiencing include a kind of pressure/discomfort in my chest (pain is too strong a word - it's kind of like there is a shaken-up bottle of soda just behind my sternum?). That's going on during many of my waking hours, particularly when I'm at work. I told my doctor about this and she prescribed Xanax for me, but I only take it rarely because I don't want to fall asleep at my desk. So I only take it on weekends, and then only sometimes. She suggested taking a daily anti-depressant as well which I really do not want to do due to past experience, but I'm starting to consider that because this is just such an annoying symptom. (Dr. gave me an EKG as well and it was normal.) I also get some lightheadedness and feel like I might start crying at work.

I am trying to manage this by trying to take deep breaths and fidget with a worry stone. That's pretty much all I've come up with so far. I think exercise would really help me but I literally have no clue how to integrate that into my life with my long work hours, and getting started is super hard. I try to walk to work sometimes but I'm usually running late and just don't have time. Finding something that enables me to do basic self-care such as exercise is a primary goal of my current job search.

So! If you've tried online therapy and have some words of wisdom for me or opinions about how it might work for my situation, I would love to hear your feedback (including specific websites/services to use). Or if you're reading this and have any bright ideas for some stuff to help me get through this current situation until I find a new job, I'd love to hear those too - especially if there's anything I can do to alleviate this chest thing.
posted by atruesock to Health & Fitness (15 answers total) 4 users marked this as a favorite
I tried online therapy, specifically Talkspace. I cancelled within a week. My therapist would just reply with "how does that make you feel?" to every single thing I sent to her. It felt like a waste of money, anyone could ask me how I feel, asking how I feel doesn't help me at all?
So I personally found it useless and patronizing. I don't know if I just had a crappy therapist, but I didn't try anyone else. It took enough effort and courage to try it in the first place, I'm bad with confrontation so I quit without telling them.
posted by shesbenevolent at 4:19 PM on May 5, 2017 [1 favorite]

I completed an online CBT course that was developed by academics here in Australia and funded by the govt. There was virtually no therapist interaction, it was all reading, activities, journaling, reflection etc, and I found it *tremendously* helpful.

Obviously, online programs can vary a lot and I would hesitate to recommend them as a totality, but certainly some programs, for some people, can be fantastic.
posted by smoke at 4:21 PM on May 5, 2017 [3 favorites]

I have anxiety and tried Talkspace in March. I hated it and canceled within a month. My therapist was incredibly focused on finding some deep, dark "reasons" for my anxiety.*

I'm seeing a therapist in person these days and it's WORK. When I was using online therapy it was easy to put it down when it got hard. When I'm in a session with my therapist, she pushes me to do the hard work in a way that IMO no online counselor can do.

*Truth be told, I had a very happy childhood and have not repressed any trauma. I was raised by two incredibly loving, supportive parents who just happen to be anxiety-prone themselves. It was so disheartening and frustrating.
posted by schroedingersgirl at 5:10 PM on May 5, 2017

I'm trying Talkspace right now and having mixed feelings about it. The first therapist I got seemed to be going well at discussing things with me, although she tended to focus more on some of my problems rather than others... but then she started talking about 'affirmations' (like, if you write something down enough times, it will magically come true!) and I don't believe in that kind of 'woo' and don't trust people who do, so I switched to a different therapist. It's still early days with her, and I had to ask her to type her responses instead of leaving them as voice messages, but she agreed to do that, and she's willing to tackle my main issue instead of just the standard ones.
posted by The otter lady at 5:35 PM on May 5, 2017

I have anxiety and depression and tried Talkspace for a month (text based only) when I was feeling like I was in a particularly bad spot but had no availability or luck getting in with someone. Canceled it and don't plan to try it again. It's actually much more expensive for me than an in-person therapy but I would have been okay with that, except I didn't find it helpful at all - it could have been the therapist that I had, but it felt a lot like paying someone to listen to me and nod noncommittally/ask generic questions. I think it's hard to translate the "in person" therapy/counseling experience to the asynchronous text format.
posted by sm1tten at 5:36 PM on May 5, 2017

As someone licenced to be a therapist(but not working as a therapist) I have many reservations about online therapy with no face to face interaction ever though I can see how it meets some individuals needs.

There are just things that get lost, body language cues, some tone related stuff, some functioning related abilities (anxiety about meeting in person, managining meeting on time, hygiene, whatever). For example, If I see you in person week to week and I notice your hair texture changes because you're not taking care of it I can react while I may never pick up on that with a crappy webcam or text based app.

Get that CPAP figured out . Getting better sleep will make things a million times more manageable. Practice good sleep hygiene .

Xannax is highly addictive, and isn't for longer term anxiety management (it's more appropriate for out of the blue panic attacks, phobias , and performance related anxiety like stage fright) and a anti depressant would probably be more helpful long term. Continue to talk to your doctor and make sure to rule out medical causes.

Take gentle care of you.
posted by AlexiaSky at 6:18 PM on May 5, 2017 [1 favorite]

(The cbt online mentioned above might be MoodGym, free online).
posted by quercus23 at 6:24 PM on May 5, 2017 [2 favorites]

Online therapy providers I am aware of: Better Help, Talkspace, 7 Cups of Tea. Some individual practitioners offer online service. Check their websites to see.

Online therapy is terrible for crisis or higher acuity situations in my opinion. I have seen it work for anxiety, life stress and adjustment issues but you have to work to find someone who is a good fit and be clear on your expectations for contact.

It does have clinically puzzling or concerning aspects, but the research shows a high level of efficacy compared to face to face interventions, including amongst asynchronous methods such as text communication or learning modules. (Assuming the therapist does more than parrot "how does that make you feel" all the time.)

Many therapists prefer to offer distance counseling on their own because those well-known services often don't pay the individual therapist well. Many other therapists object to distance counseling for a variety of reasons. I have seen it helpful for introverts, individuals with tight schedules including high performers, parents of young children, the disabled and others for whom transportation presents some level of burden. MeMail me if you have any additional questions.
posted by crunchy potato at 6:43 PM on May 5, 2017 [4 favorites]

Ginger.io is another one. I am not sure what their quality or experience is like but it looks promising and I believe offers a psychiatric component as well.
posted by crunchy potato at 6:48 PM on May 5, 2017

I've had my therapist for two years now by Skype and it's been great. I would love to have the opportunity to see her in person, and have had amazing in person counseling too (I see a psychiatrist for medication less frequently in person who's great, and have had awful to great family, couples and child therapist experiences) but the sheer flexibility for scheduling means I'm consistent in seeing her at least once a week, and she is much more affordable as a result. I could see an in person therapist once a month comparatively.

I also found initially the distance of Skype was comforting, but then I've had lots of close friendships online so talking to someone online didn't phase me. I have physical boundary issues from abuse so it was easier in a way to not have someone who I was afraid would touch me!

I browsed a bunch of profiles of possible therapists, emailed questions, and her response was the one I liked most. I was lucky. One advantage is you can try several therapists quite quickly. Journaling/email therapy is something I'm trying to get my teenage kid to consider as well.
posted by dorothyisunderwood at 7:46 PM on May 5, 2017

You're in such a bad spot, I think anybody would feel overwhelmed and anxious. These are a couple of things that have helped me make it to the other side of rough patches.

I had a therapist years ago recommend inositol to me for anxiety/depression, and whenever I've taken it, it's helped. The powder is the cheapest which is good for the depression level doses.

I've also found Flylady really helpful in the past, for a little extra cheerleading and affirmation for doing basic house chores. Even just staying at the day one or day two levels, it made a difference.

Make sure I talk to someone who loves me every day (telephone/facetime if possible, if not, at least sending an email or a text). For people who are single or live far from family/best friends, this can be harder than it would seem and is really helpful.

Something that really helps me space out. For me it's often playing Civilization. It has downsides too, but it does create these oases of peace for me.

If your office culture allows for it, headphones with active noise cancellation. SO NICE. Another Mefite a fiendish thingy has a magical mp3 file she shares. It's ocean sounds that really block out the world.
posted by Salamandrous at 8:06 PM on May 5, 2017 [1 favorite]

Xannax is highly addictive, and isn't for longer term anxiety management (it's more appropriate for out of the blue panic attacks, phobias , and performance related anxiety like stage fright) and a anti depressant would probably be more helpful long term

Please, please don't spread this misinformation. It is absolutely possible to take Xanax (FYI, not Xannax) and other benzos responsibly over the long term. This requires careful supervision from and candid communication with your psychiatrist or primary care provider. But it is certainly possible, and there is absolutely no shame in needing a benzo. For those of us with moderate or severe anxiety, benzos are a necessary complement to therapy and an SSRI, SNRI, or other daily medication.
posted by schroedingersgirl at 8:06 AM on May 6, 2017 [2 favorites]

My experience with online therapy was that it was laughably, horrifically bad.
posted by Violet Hour at 11:40 AM on May 6, 2017

TLDNR- As someone with horrible anxiety and depression (not to mention borderline personality disorder) online therapy for me SUCKED. I did it for 30 days and only talked to my counselor 3 times. (I left without reporting why...I hate confrontation.) Years ago, I saw a therapist in person for a couple of years but when I wanted to go back, he was no longer seeing patients. I tried a few, in person, counselors that were recommended to me by my psych...one even fell asleep while I was talking... (how much worse could I feel???) So a friend recommended an online therapist. What a joke. I did do an intensive outpatient DBT course that helped me IMMENSELY. I'm now in with a new in-person therapist and so far, it's working out. Good luck to you whatever you decide.
posted by Amalie-Suzette at 6:59 PM on May 6, 2017

I can't speak to online therapy, but when I finally started seeing a weekly therapist, it was primarily because her office was located about a block and a half away from my office and I would go immediately after work. I am not sure if that is something that would work for you, but if your office is located in a sort of business district, there might be an office nearby that you could get to after work with minimal fuss if online options don't seem like they'd work for you. Of course, if you get a new job, this may end up being less convenient. Good luck! You sound like you're under an incredible amount of pressure, but you're doing great. Hopefully you can find a less stressful job soon!
posted by helloimjennsco at 6:54 AM on May 8, 2017

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