Is Text Therapy Effective?

Living with a mental illness looks different for everyone, but for many there are times when the symptoms of anxiety and / or depression are worse than others. One minute I’ll be typing, feeling neutral, and then feelings will start to build up. (I picture it like that old couple together in bed on the Titanic who got stuck there just watching the room fill with water, knowing they were about to die … which probably doesn’t help with depression.)

Even in a privileged place when it comes to mental health where I get the therapy and medications I need, there are times when everything seems too overwhelming and I wish I could write to my therapist right now and there (but I don’t). Sometimes, though, I use free online text / chat therapy services, and whether it was a licensed therapist on the other end of the line or some other AI chatbot , it helped.

But what about regular visits to your therapist via text messages or chat? Is this effective or even a good idea? Could this be an option for many people who first encountered mental health issues during a pandemic and are not familiar with all of it? To find out, we spoke with several mental health experts.

What is text message and chat therapy?

First of all, the term “therapy” can mean different things to people. What we will be discussing here involves talking with a trained professional (or computer) about your mental health. Instead of seeing the therapist face-to-face (in person or via teletherapy), the client and therapist exchange messages via text or online chat. We’ll cover both text / chat based therapy with a real licensed therapist on the other end of the line, and the type where “therapist” is an AI-controlled chatbot.

What are the potential benefits?

Before we move on to the risks and limitations of this form of therapy, let’s look at some of the possible ways it can help.

Accessibility and convenience

The biggest benefit of text message and chat based therapy (for both humans and chatbots) is accessibility. “Text therapy can reach more patients because of the lower time, money and location constraints,” says Lifehacker Dr. Sabrina Romanoff , a clinical psychologist at Lenox Hill Hospital in New York.

This is especially true now, during a pandemic, because you don’t have to leave your home or look for a local therapist who accepts your insurance (or has a sliding scale) and is currently accepting new patients. Pandemic or not, it is also beneficial for those who live in an area where treatment is simply not available. And as Romanoff points out, in the case of a chatbot, the service is available around the clock whenever you need it.


Text messaging and chat therapy can be a way to access mental health support for those who might not otherwise be able to afford it. “Apps and chats are pretty inexpensive, with low monthly fees or unlimited messaging,” says Lifehacker Dr. Scott Guerin , developmental psychologist and associate professor of psychology at Keene University. “Even with an extra charge, live performances can be expensive.”

Introduction to therapy

If you’ve been interested in learning about therapy in general and want a feel for how to have these conversations, text message and chat therapy may be the way for you to do it. “This could be an opportunity for people to dive into the healing pool and encourage them to look for the real thing,” says Romanoff.

Some people prefer to write / type

We have reached a point where communication via text messages, email, or online chat has become the norm for many people. Even if you grew up and didn’t learn how to deal with your feelings through texting and typing, you may have become so used to it that you are now more comfortable using text than talking on the phone. In fact, for some people, phone calls are a source of anxiety in and of themselves . Those in this category may prefer to conduct therapy in the same way.

In a similar vein, Romanoff explains that some people can better process their emotions by recording (or, in this case, typing) them. But if this is the aspect that helps you the most, she thinks journaling might be more effective.

What are the potential risks or limitations?

When making any decision about your mental or physical health, it’s helpful to weigh the possible pros and cons of your options to see which one is best. These risks and limitations of text messaging and chat therapy are not just another way of saying “this is dangerous, don’t do it”, but some things to consider when making a decision.

Developing a specific care plan

Before starting your personal therapy sessions, you will likely have some kind of admission assessment that will help both you and the mental health professional you work with identify the areas you need to focus on and then develop a care plan that is specific. for your need.

“There are many therapies, and the only way to know which one is right for you is to talk to a mental health professional who will determine what might be most helpful,” says Dr. Georgia Gaveras, co-founder and chief psychiatrist. for tochiatry , reports Lifehacker. “It may very well be a chat-based service, but for many others it may not be enough.”

Lack of facial cues and tone

As with any form of written communication, during text-based therapy and chatting, things can get lost in translation because they make it impossible to pick up facial cues and someone’s tone.

“It’s important to understand that even in times when digital communication is the norm, an estimated 70 to 93 percent of face-to-face communication is non-verbal,” Guerin says. “That is, reading the client’s body language, looks, frown, frown, smile, hand gestures, and eye contact provides a physician with a wealth of information as he assesses the client, their problem, and develops a therapeutic plan.”

The lack of these signals can be especially problematic when someone’s words do not match their thoughts, Romanoff said. This can happen in situations where patients are hiding important information – the difference, according to Romanoff, therapists can better discern personally rather than through text. “This is especially true for high-risk groups such as people struggling with suicide, abuse or drugs.”

And as Gaveras points out, it’s not just the lack of facial cues and tones that people use when describing a situation, but there are also other physical cues that therapists use to assess a patient’s general condition. “For example, if you cut your hand but the doctor doesn’t see it, it will be incredibly difficult for the doctor to tell how bad it is,” she explains. “Similarly, in psychiatry, we learn a lot about someone through body language and facial expressions. We can see how someone was able to take care of themselves physically, whether they bite their nails, talk to themselves, or burst into tears. “

It can also make a difference to the person receiving therapy. “Either during a scheduled session or during a crisis contact, how someone says something is just as important as what they say, and it can be difficult to determine through text and of course with using only AI, ”explains Gaveras.

For example, a person with anxiety that leads to the disaster of everything may see a dot at the end of a message from their therapist and read it as aggressive (when very unlikely), which can make them feel even more anxious and worried about having offended the therapist or a chatbot (don’t judge if you haven’t been there).


For Romanov, there is also a problem of authenticity. “In personal therapy, we encourage patients to associate freely — to open the gates of the mind without filters — and to edit that extends to other types of communication,” she explains. “Text messages are lifting these walls. The mechanism of thinking about the answer, typing it, viewing it on the screen, contextualized by the previous conversation, leaves very little authentic response, [and] instead, there are more self-editing and censoring processes at work than if the same thoughts were conveyed through speech. “

The missing human connection

In AI-driven chatbot therapy, you are not only dealing with all of the above, but also with the problems that can arise from the fact that you are communicating with a computer, not a human. “It takes a lot of effort and vulnerability to start the therapy process,” says Romanoff. “It is not easy to play the part of the patient.”

For some people, therapy involves revealing the parts of their past that haunt them the most – things that they may not have even discussed with those closest to them. This is another case where people need therapy and want to get rid of it. For some people, revealing their deepest secrets and fears to a computer program rather than a therapist can make this process easier. Likewise, there may be people who find simple getting rid of something to be the most beneficial in therapy – regardless of who is on the other end of the conversation and who is not.

But for others, human communication – even just through text or chat – is an important part of the process. “Being fully visible, heard and withstanding this pain in the presence of another person is one of the most healing and soothing aspects of therapy,” explains Romanoff. “There is a big loss when considering the delivery of therapy to humans and robots. Robots cannot take our experience the way we need it. “

Time delay in communication

For some, text-based or chat-based therapy may not be as effective as face-to-face sessions due to time delays in communication, which Romanoff says can disrupt work flow. “Part of what makes therapy so effective is the emotional tension that matches the words. This is missing from the text, ”she explains.

And while most people go for this type of therapy expecting it to be like a text conversation, according to Romanoff, it actually usually looks like an email. “This long time between responses loses the emotional tone and meaning that was present at the moment,” she says. “Therefore, when there is a delay, the person perceives the response through a completely different lens, midpoint and perspective from when the message was originally sent.”

It takes trust

Given all we know about data and privacy, it’s understandable that you hesitate – maybe even suspect – in therapy where you have to believe that the person (or bot) on the other end of the line is who they are. called, including having everything you need. qualifications.

“From an ethical point of view, I think anyone who enters into any kind of therapeutic relationship needs to be confident that the space is safe and that their privacy is protected,” says Gaveras. “Any chat-based service must do everything it can to provide the highest level of security for its customers.” This means you have to do a little homework before choosing a site or vendor (we’ll come back to that in a minute).

Is text messaging and chat therapy effective?

At this point, you’ve probably guessed that it all depends on the individual’s needs and how they can best express themselves and experience the benefits of therapy.

Text messaging and chat therapy can work well for people with mild symptoms or for those who have gone through in-depth counseling sessions and can use them as supportive or supportive sessions, Guerin said. Likewise, Gaveras says she sees text-message and chat-based therapy as a useful addition for those also taking more traditional forms of therapy, especially those pursuing certain treatments for anxiety and obsessive-compulsive disorder (OCD).

But Guerin says that doesn’t mean text message and chat therapy is a good option for everyone. “I don’t think this type of therapy is suitable for people with serious or long-term problems, for people who have been hospitalized in the past for behavioral / emotional problems, or for those who need regular treatment to maintain a stable life. “, – he notes.

This is especially troubling for people with more complex diagnoses or symptoms who opt for chatbot therapy, Romanoff said. This is because it is often done in the form of cognitive behavioral therapy (CBT) interventions, which may not be the best option for everyone.

“These treatments are guided by guidelines and have been found to be most effective for people with a cookie cutter clinical picture,” she explains. “This means that patients have no pre-existing conditions, no premorbid or comorbid conditions, and relatively simple clinical cases. The reality is that no one is that simple, and that’s the beauty of the job. This is the main disadvantage of CBT, which is only exacerbated on the Internet. ”

Ultimately, Gaveras is optimistic about the possibilities of text and chat therapy, but says we need to understand it better first. “There has been some research done on these chat-based services that have limitations in size and scope, but they are promising,” she says, “and that’s absolutely something to explore next.”

How to choose a text message or chat service provider

If you are interested in text messaging or chat therapy but are not sure where or how to find a provider that suits your needs, Guerin offers the following tips:

  • Look for a provider that uses licensed therapists with a master’s or Ph.D. Make sure they are affiliated with a reputable and reputable company. Check their academic background to make sure they have earned a degree from an accredited college or university.
  • Look for a service or provider who has experience in dealing with what you want to solve – depression, anxiety, sleep disturbances, etc. – and has experience with people like you: younger, older, college students, retirees, etc. D.
  • Understand how the service works, including their scheduled times for interactions, whether the monthly plan is limited or unlimited, its cost, and the length of sessions.
  • Beware of any long term contracts or financial commitments.
  • Make sure that providers and services have a clear agreement and confidentiality statement (i.e. HIPAA compliant) and that they do not use your information for anything else or share it with anyone. This is to protect your privacy.
  • See how they support people with serious problems. Do they offer emergency telephone counseling or services? What if someone wants to harm themselves or others?

As with personal therapy, it can take trial and error to find the service or provider that works for you.


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