Podcast: Online Teen Therapy: Everything You Need to Know

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In today’s episode, we speak with Haesue Jo, Clinical Support Lead for a large online therapy website, about their new offering for teens and adolescents.  On-line therapy is a novel idea for many — and prompts a lot of questions.  How does on-line counseling work for adolescents?  Are there a lot of differences between the experiences of teens and adults?  How are parents involved?  What are the safeguards in place?  How does payment work? 

Listen in to see what online therapy for teenagers is all about. 

(BetterHelp.com is a long-term sponsor of The Psych Central Podcast.)

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Guest information for ‘Online Teen Therapy’ Podcast Episode

Haesue Jo, MA, is a Licensed Marriage and Family Therapist with experience providing individual and family therapy in community mental health, school settings, day treatment facilities and is currently the Clinical Support Lead at BetterHelp. Her current clinical focus includes working with individuals with a variety of presenting problems, including anxiety, relationship and family issues, trauma, community violence, gender identity, and depression.

 

Computer Generated Transcript for ‘Online Teen Therapy’ Episode

Editor’s NotePlease be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in every day plain language. Here’s your host, Gabe Howard.

Gabe Howard: Hello everyone and welcome to this week’s episode of the Psych Central Podcast. And today I will be talking to Haesue Jo, who is a licensed marriage and family therapist and the clinical support lead for our sponsor BetterHelp.com. She’s here today to talk a little bit about online therapy and specifically their latest offering at TeenCounseling.com. Haesue, welcome to the show.

Haesue Jo: Hi. Thank you so much for having me.

Gabe Howard: Well it’s always a pleasure when you can hang out with me. I’ve been fascinated with online therapy for a long time and one of the primary reasons is because in mental health I realize that, depending on where you live in America, your options can be very limited. I’m very fortunate to live in a big city so I sort of have my pick of therapists and counselors. But if you live in a more rural area it sort of gets a little sticky both in terms of who you can choose and maybe your privacy options. Is this something that you have found to be a big advantage of online therapy?

Haesue Jo: Yes absolutely. We have plenty of people signing up that say very similar things, whether they’re in rural communities or they’re just in tight knit communities where everybody knows each other. We also have health care professionals signing up saying that it’s hard to find someone in their local community because they know all the other professionals; that they are peers in their workplace. So there’s a lot of different situations. And hopefully we’ve been able to provide some option for those sticky situations.

Gabe Howard: It sounds like privacy is really key to this, though. A lot of people are really describing that it’s more private for them to get the therapy and support that they need versus the more traditional you know drive, park, walk in, go to an appointment.

Haesue Jo: I think for many people it can feel that way. You don’t need to be seen anywhere per se, you can get access to services from the comfort of your own home or wherever it is that you have a solid internet connection. I think a lot of people still, as much as we’d like to help destigmatize the idea of getting mental health help, I think there are still a lot of people in today’s society and our local cultures and all that you may not want other people to know that this is something that they’re involved in. When you’re having struggles with your mental health, it can feel very isolating and personal to you, and you want to figure that stuff out on your own first before the interventions of the people that care about you or people that might not have your best interests in mind. The discrete nature and private venue that we are able to provide is something that’s appealing for a lot of people.

Gabe Howard: And also, as I talked about a moment ago, you have to know the traditional model is you have to drive there, you have to walk in, you have to make the appointment. So, it’s much more time consuming. And I also know that the traditional model is generally, you know, once a week or once every other week at a specific time. With the online model, it’s more frequent, right? I t’s not 1 hour every other week. It’s a few minutes every day or it can be it looks can you sort of talk about that a little bit?

Haesue Jo: It can be, right. So now we have thousands of providers in our network at this point and they are coming from every state in the United States. They’re all licensed here in the US and many licenses per each state are represented on the platform. And we have a lot of professionals coming to join us that have most of their, if not all of their, experience off line. So, they are very much aware of and used to these more traditional models of how we’re going to connect with our clients. Like you said, typically that’s once a week 50 minutes or so but even then, it’s more than 50 minutes. With the commitment, with driving into the parking, and everything that you just mentioned. On the online model here at BetterHelp.com we give a lot of autonomy to the independent providers to coordinate their schedules with their client or what we are finding actually is that counselors are having a really diverse kind of way of communicating with their clients. So, a counselor may have 20 clients, and it could be that half of these clients do engage very regularly in weekly live sessions. That feels kind of like that traditional model and in between those live sessions they’re supplementing it with messaging back and forth and then you also have many subscribers signing up for these services that are not looking to have live web sessions on a regular basis. So, they’re communicating with a counselor pretty frequently but through messaging and that’s not in real time but it’s more kind of like an email. I sent a message to you this morning, I might get a response from my counselor in a couple of hours, and then we go back and forth that way. And then a lot of counselors are doing a combination of that messaging and live sessions. So, there’s a whole bunch of different ways that you can find yourself figuring out what’s going to work best between you and your counselor.

Gabe Howard: And BetterHelp.com been around for a while now. This isn’t something that just cropped up overnight. This is an offering that’s been around for a long time.

Haesue Jo: I’d like to think that, yes. BetterHelp.com started in 2013. But my understanding is that the concept of telehealth, which is helping professionals providing their services not face to face but over some kind of technology platform, I think that’s been around for far longer than that.

Gabe Howard: I’m really glad that you brought that up because you know a lot of people hear things like “online therapy” and there’s a sort of this knee jerk reaction to say, “No, no, no. It’s never been done that way before.” But until you do something, it’s never been done that way before. And the online therapy is not really, as you said, it’s sort of the natural progression of telehealth which has been around for a lot longer. And again, it’s had a dramatic impact on rural areas or people who just cannot get to medical therapy etc. We’ve done another show all about online therapy and we’ll link that show in the show notes of this show so you can learn a whole lot more. We just sort of wanted to establish a baseline of what online therapy is. And up until recently this has really been aimed at adults. The busy adult professional, or the adult who was looking for privacy, but now you’re sort of gearing a section towards teens and you’ve discovered that there’s some differences in how you reach out to teenagers versus how you reach out to adults. Can you talk about that for a moment?

Haesue Jo: So you know, as you mentioned, we did start with adults and the nature of therapy and getting any medical treatment at all for some kind of care for a physical ailment or in our case a mental or emotional challenge or struggles that you may be facing in your life. There are a lot of laws in place in the US to protect people, right? So, these laws will make it so that if you’re going to enter into this kind of relationship with a health care provider, you need to provide your consent as a legal adult. You’re consenting for your own treatment. When you’re a minor, you’re under the care of a parent, who is your legal guardian. And if not your parents, whoever it is has that legal guardianship over you, they are the ones that provide consent for you to enter some kind of health care treatment. Right? So, we wanted to make sure we were doing this right. And so that’s why we started with adults. We found a lot of success. And now we’re working to bring this form of counseling to the younger age group, and we find a lot of differences in the ways that teenagers will communicate versus adults.

Gabe Howard: So obviously with several years of experience working with adults you probably got that model down pretty good. But we know that there’s differences, as you said, between adults and teenagers.

Haesue Jo: Mm-hmm.

Gabe Howard: How are you handling some of those difference? For one thing, in my mind at least, teenagers are probably much more adept at technology?

Haesue Jo: Mm-hmm.

Gabe Howard: They’re probably much more willing to do things like face to face and you know they can fire off a text with one thumb while half asleep and and I’m still using full sentences with complete grammar and punctuation. So what have you found? Not from a therapy level, but from just a comfortable with technology level, when it comes to teenage clients versus adult clients?

Haesue Jo: Well you know, a lot of people that are signing up for BetterHelp, so our adult clients, they are typically more tech savvy than somebody that’s not signing up or not choosing to do a lot of the things that they do in life online. But as you mentioned, a lot of teens today, they grew up in a world where technology was there when they were born. And so, I think a lot of the features and the things that are offered on the platform feel more natural and easier for them to navigate sometimes in terms of technology. I don’t think there actually is a huge difference between what I’ve observed with the teens and the adults that are using these services, since if you’re an adult looking for online counseling, you’re probably spending a lot of your time online already.

Gabe Howard: That’s a very fair point. You know, I just I think to myself that all of these adults that are using online counseling are my dad. But you’re right. He probably wouldn’t gravitate toward an online system because he is less comfortable with technology.

Haesue Jo: Yeah, we have a lot of adults signing up that aren’t super comfortable with technology and so they’ll actually e-mail us and we have a support team that’s here to help people and walk them through how some of these technology features work. But we also find it’s not really the best option for all people.

Gabe Howard: And when you say it’s not the best option for all people, do people sign up, try it, and then realize it’s not the best option? And I know that if you go to BetterHelp.com/PsychCentral you can try it for a week absolutely free.

Haesue Jo: Exactly. We want to be able to provide an exploration process for people that aren’t really sure if this is something that’s going to work for them. So that’s why we like to partner with people and give out free trials so that someone can sign up for a week, test it out see if they like it, and if they’re not into it, then yes they can absolutely cancel during that free trial and we’ll go our separate ways. And our hope is that you now have some tools in your bag to look for services that are going to feel more appropriate for you.

Gabe Howard: Okay, everybody hold on, we are going to listen to a message from Haesue Jo’s employer, and our sponsor, BetterHelp.com

Announcer: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: I love your online counselling. But now I’m a parent and I’m thinking about my daughter, and I’m thinking do I want her on this platform? Am I more comfortable with the traditional model? What would you say to me as I’m sort of contemplating this decision of should I allow my 15-year-old old daughter to go online to receive services? You know this is new and I want to make sure that I’m being a good dad.

Haesue Jo: Understandable.

Gabe Howard: What would you say to me to sort of help me?

Haesue Jo: So interested parents, curious parents, intrigued parents they can check out TeenCounseling.com and they can get started. So, the way that these accounts work is that a parent is the one that does sign up first, and a parent can get their account set up and get connected with a counselor and even communicate with a counselor before ever inviting their teen into the platform. And so, in that way, the parent can sign up first and get a lot of their questions answered. Talk to this counselor. Ask the professional about what their experience is like, what their expertise is, or look into the credentialing of professional. Parents have opportunities to vet these people that they’re going to possibly introduce to their kid. And understandably, parents want to make sure that their kids are safe and talking to reliable people online. And so parents have the opportunity to sign up first, and if they find that they don’t think it’s going to be a good fit for their family, they don’t have to continue with the same kind of thing. And so, if parents are interested, they should just check out TeenCounseling.com. There are FAQ sections that are geared towards the parents. But there’s also another FAQ section for the teen themselves if they wanted to do some research on their own also. And then they’re always welcome to contact us if they have any further questions that they find that they can’t get answered through the web site.

Gabe Howard: I think the part that really kind of puts me at ease, and that I didn’t realize until you just said it, is this is parent driven. It’s a partnership between parents and child. It’s not sort of the Wild Wild West where you just create an account for your teenage daughter and hope for the best.

Haesue Jo: Correct. And you know every counselor is going to have their own approach and their own way of conceptualizing a case, looking at their teenage client in the context of this kid’s family. But I think any of us that have worked with adolescents will agree that a lot of things going on with the kid’s identity, or any concerns that are coming up, the behaviors in the context of social situations and relationships with people. A lot of that stuff very much starts at home. And so it doesn’t make a lot of sense all the time to engage in a therapeutic relationship with a kid and not involve the parent because a parent very much is in that kid’s life. So the way that the Teen Counseling accounts work is that a parent will sign up and then they can invite their teen at any time and then at that point the parent and the teen now have their own respective log in information. So, they can each log in with their own email addresses and they have their own private space. So they’re both connected with the counselor, and the counselor has opportunities to speak with the parents and opportunities to speak with the teen. But what the parent messages with the counselor is not visible to the teen and vice versa. What the counselor and the teen are communicating about, the written message, is not visible to the parent. Now when, and if, they would like to have joint sessions, where the teen and the parent are together, those live sessions can be scheduled and coordinated with the counselor. And it’s just an understanding that they’re both going to be at the same location at the same time and that will allow the counselor to have this joint session for both the parent and the kid.

Gabe Howard: I like what you said about the teenager. The child will have their own personal space and the parent will have their own personal space with the counselor having access to both. So when the parent has questions they can ask the counselor?

Haesue Jo: Yes.

Gabe Howard: But the counselor will sort of be the arbiter of information and make sure that everybody feels comfortable.

Haesue Jo: Yes.

Gabe Howard: They’re not printing a transcript and saying, “This is what your child said.”

Haesue Jo: Right. Absolutely. And in general, when therapists are working with adolescents, that is a huge theme that comes up most of the time, if not all of the time. A kid needs to feel comfortable that their parents are not going to know every small little detail about their life. This is I think a universal thing that we’ve all experienced as teens ourselves. There’s just some stuff that you don’t want your parents to know and there could be a million reasons for that. And so with the accounts on Teen Counseling, the teens have their private space. And therapists that are working with adolescents have this experience of knowing that they need to respect the privacy of this client even if the client is a kid. The kid is still a human. So privacy will be respected and usually there’s a conversation to be had with the parent that I will communicate with you when I feel that there is a need for you to know something. For example, if somebody might be in imminent danger, or if I feel like somebody is in harm’s way. Those are the things I’ll absolutely let you know about. But ultimately, to help with your teen’s progress through therapy, they need to feel like this is a safe and comfortable space and that I’m not going to be a messenger of what they’re talking about directly to you. And I’m speaking in the first person because I also work with teens. For me it’s like there’s gonna be times where I think we should all be talking so that we’re all on the same page, but that’s how I’m gonna be most of the time since right now we’re here for your kid.

Gabe Howard: And it’s important to understand that that’s how it works in the “traditional model.” You know, if you go to the traditional therapist, you know you’re in the office, usually parent and child go in together. They sort of talk about the issues, then the parents leave. They talk to the child and the child leaves and then the parents come in and there’s this constant back and forth as needed etc. So the model just translated online exactly the same way. It’s not like the child loses some of that privacy or the parents lose some of that understanding or connection. It just literally transfers right online in the same way. So for people who aren’t familiar with therapy, they might not realize that it really is the exact same model.

Haesue Jo: Yes, very very similar. And in fact, I think it’s even more convenient for parents because when I work with teens in an office setting, with this minor, it’s really important for me that I’m not left alone with them in a building because I’m not their parent. And so, for me personally, and every counselor, like I said, is going to have their own approach. When I have teenage clients, I require for their parent to wait in the waiting room for the entirety of the session. And that’s just a safety precaution to make sure that this kid’s parent is around in the event that something happens. With TeenCounseling.com and these accounts, now a parent doesn’t necessarily need to be waiting in a waiting room an hour every week to know comfortably and safely that their kid is getting services from a provider. And the parent is just a message away if the counselor does need to reach them. But all in all, I think the model is very similar to what I’ve experienced off line in that there’s a way for both of them to be involved. And there’s also avenues that are provided to have the safe, private conversations with the parent or with the teen.

Gabe Howard: I really like what you kind of alluded to, where you were like you know, that the parent is waiting in the waiting room for safety, but it also means that the parent is waiting in the waiting room. So, that the child or the teenager, that person knows that Mom and Dad is what? A wall away? So that might make them think, “You know, hey, I can’t say whatever I want because what if it turns out poorly? What if I don’t like it? What if Mom and Dad overhear? They’re right there.” And I think it’s an interesting concept because, you know, the best time of day for a child to open up is probably not the best time of day for a parent to open up. You know, maybe a child you know wants to share more at night when parents just want to relax and go to bed or whatever. And often, when teenagers are getting help, they’re on their parents’ schedule, because they’re the ride.

Haesue Jo: Mm-hmm.

Gabe Howard: This does allow everybody to be the most comfortable and feel the most safe. You need to be comfortable in therapy to really get to the root of whatever the issue is.

Haesue Jo: A lot of times it is those deepest darkest secrets that are making it hard for you to function. And it can be very scary to reveal those deep dark things to people that really care about us, or people that we may fear may have some kind of judgment about that. So, therapy can be scary for a variety of reasons. And I think that’s just because some of the scary things in the world are internalized, they are within us. So yeah, I like this idea of creating safe space, creating access. You mentioned sometimes this barrier of scheduling is absolutely a thing. Sometimes the kid is free as a bird, but they can’t get to your office. So hopefully we’ve been able to alleviate some of those challenges.

Gabe Howard: Let’s talk about some more practical things for a moment. Because you know, one of the things that I’m thinking about, is you know might my child with metered data. How does it work in online therapy? I mean, is it pay per message? Pay per hour? What are sort of the safeguards in place to make sure that everybody gets what they need, including not a gigantic bill?

Haesue Jo: It’s a very good question. So on Teen Counselling, for those of the listeners that are not familiar with the way that Better Help works and how our adult clients are paying for their services there, the payment structure is very similar on Teen Counseling. So, we are a subscription based model, meaning the person paying for this account is going to enter the payment details. You’re going to select a subscription plan period. So, weekly, monthly, quarterly, whatever it is that they decide upon. Then this flat fee does not change and is going to renew on that monthly basis or whatever it is that you’ve decided upon. And in that flat fee, is included all the interactions that are going to happen during that month. And so, no matter how many live sessions a teen is able to have with their counselor, no matter how many messages go back and forth between them, that flat fee remains the same. And so the parent on the account is the one that enters payment details, and only the parent is able to edit things in the billing settings. So, the accounts on the parent end and on the teen end do look a little bit different, because the teen doesn’t have as much of the admin access into that account.

Gabe Howard: That makes perfect sense to me. Thank you so much for answering all of my questions. It’s exciting to see where the world is going and what we’re able to achieve with technology. And I’m glad to know that it’s making things better. Is there anything else that you would like to let us know about TeenCounseling.com?

Haesue Jo: Sure, this isn’t too much of an operational thing, this is just coming from a personal space, because working with teens adolescents is near and dear to me. I’ve worked with teens off line, in office settings, in school settings, in clinic settings, for many years before I found myself in this online therapy world. And what I found is, with my teenage clients a lot of times, they take a little bit longer to open up and to warm up to you and a lot of the times, it’s because they’re not there completely out of their own volition, right? An adult client has made this choice for themselves that they’re going to walk in and get help. Typically, for a kid, a parent or a teacher or some kind of administrator at school has recognized that they’re having an issue. It’s usually an adult that’s driving this process, saying, “I think you need help. You’re going to be put in this place, whether you want to go or not.” So in the office setting, in these clinic settings face to face, teens are going to be a little bit more guarded and reserved a lot of the time. And another thing is that, you know, when you’re an adolescent and you’re growing up, you’re still learning how to regulate your emotions. I think most adults are still doing that too, actually.  But as a teen, even developmental and physiologically, your brain isn’t fully developed. And I think with all these challenges in terms of regulating emotion and being able to articulate any kind of internal process, it gets really hard to try to get comfortable with someone that you don’t know. Someone that you might feel is just going to relay all this stuff back to your mom and dad. On the online format, what I have found, and I’m pleasantly surprised by it and I appreciate every day, is this is the way that a lot of teens are communicating with each other. They send text messages and they have more time to think about what they want to say; they’re not as put on the spot and it’s not as much about emotion regulation while trying to verbally articulate some kind of challenging experience for them. They get to text. They get to send a message, take their time with it, and communicate the way that they have grown up doing all along with all their friends and their peers. So with Teen Counseling, I think there is a lot to be explored still, and a lot to be had for kids that are struggling with something in a venue that’s familiar to them and that feels safe to them. It is not going to feel like they’re being stuck in a room by force.

Gabe Howard: Right. Yeah.

Haesue Jo: They can have an app on their phone that they can open whenever they want.

Gabe Howard: And it can kind of feel like that. As a child who went to therapy with my parents, I imagine it’s much easier to make the child comfortable when they can sort of ease into it over a few weeks. Because I know with parents busy schedules

Haesue Jo: Mm-hmm.

Gabe Howard: They’re like, “Look, we’re here from 3 to 4. You must get everything out from 3 to 4, and then we’ll be back in 2 weeks from 3 to 4 and you will get the rest out then.” And you know, if you’re not in the mood, you’re not in the mood. And especially if your parents are very busy, which all of us are, if they’re very worried, which in general when you’re seeking medical treatment of any kind there’s usually some concern or worry, and you know these things cost money. Parents are worried about wasting money, as they should be in general. I think a lot of those concerns are alleviated with this other option. And that’s what it is, right? It’s just another option. Nobody is saying that you you have to use this option over that option. You have to make the right decision for you and your family and the right decision for the person seeking treatment. And this is one of those options

Haesue Jo: Yes.

Gabe Howard: And it’s really nothing more and nothing less, right?

Haesue Jo: Yes, and I think for the busy parent, the busy family, the busy kid, just having options is a good thing. Because sometimes it feels like even though there are options out there, they might not feel like those options are available to them for a variety of reasons. So yeah, I guess I like that there is this other option for people to explore.

Gabe Howard: That’s wonderful. Haesue, thank you so much. And thank you to BetterHelp.com for sponsoring the podcast. It really has allowed us to get a lot of great information into the hands of people who really appreciate it and really need it. So, we’re of course, very thankful for your support. And we also like to be transparent about that. You know BetterHelp.com is a sponsor of the Psych Central Podcast and we appreciate that as well.

Haesue Jo: Thank you so much for having me.

Gabe Howard: You’re very welcome and thank you everyone for tuning in. Obviously, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere just by visiting BetterHelp.com/PsychCentral. And wherever you download this podcast, if you would give us as many stars as humanly possible. Use your words and write us a review, show us on social media, email us, send us around, burn it onto a C.D. and play it for your grandma, whatever it takes to get mental health information into the hands of people that need it. We would appreciate it, and we will see everybody next week.

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About The Psych Central  Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.