I didn’t always save my vegetables for last as a child nor have I typically done the least preferred task at the end (which is, of course, inefficient planning). Yet here, you have the least preferred modality of psychotherapy showing up at the end.

Matt maintains his therapeutic relationship via text. He has never actually met nor conversed with his therapist Gary, a licensed clinical social worker who lives hundreds of miles away from Matt. He receives guidance, to some extent on demand, regarding his triggers and the ultimate anger that he harbors for his girlfriend.  It helps to keep him at bay—at least most of the time.

Platforms such as text-therapy market convenience, immediate accessibility (24/7/365), and appeal to those who are busy, young, and as a substitute for difficult to access and sometimes pricy conventional therapeutic measures.

Apps like talk-space and better-help market to the young who were raised in the tech and on-demand age, particularly those who are busy and unavailable. They offer immediate and budget therapy. A swipe left, and a swipe right does it for dating, shopping and what they don’t offer is what is most needed—the ability to connect with someone to hear your pain—you hurt, your long-repressed shame. To really connect with someone who can ‘be’ with you and guide you through a process requires more.

Texting Therapy is, overall, my least favorite of the various methods of psychotherapy.

Perfect for the millennials for whom patience is not on the high-valued list items and listening to a voicemail is more painful than nails on a chalkboard. Yet what can we expect of them when they group up in the age of technology when although the app texting them when their laundry was finished in the washing machine in the laundry of their building, they had information at their fingertips, a full-time GPS and knew little about the path of real-time other than to experience immediate gratification in most if not all aspects of their life.

While text therapy may be appealing to someone struggling with loneliness and isolation, it is by definition something that enhances isolation and doesn’t help bridge it. It fails to allow for that attunement, the patterned connection between two people, which, ironically, is what is often drives the need to reach out in the first place.

In summary, there is nothing, no process, no alternative that takes the place of good old-fashioned in-person psychotherapy. While these other solutions (online counseling and texting) offer other options, traditional face-to-face is still the favorite. And text-therapy eliminates what is often most needed with our patients.  .  . the ability to sit with their feelings and listen for their pain.

A note about text therapy-it’s not the same as texting or perusing texts in therapy.  In fact, the integration of the phone into therapy sessions has become increasingly utilized.

One of Jan’s (the 38-year-old in classic in-person therapy) pivotal moments came early in therapy when she sat and shared with her therapist, much to his traditional style chagrin, texts shared with her suitors. Through the examination of her language with them, she was clearly setting up her own alienation. They agreed, as a result, to avoid alienating statements (ie-you don’t understand when . . ., you are different from me . . ., )

Very recently, an initial inquiry was received via text, an anomaly or rather not, particularly the way most people reach out for the initial contact. Yet this person did. When I insisted we chat, I agreed to a consultation to provide direction but via video platform, as I can glean much more via face-to-face contact, albeit via video. Although not lacking access, when I denied telephone therapy, they asked for options, to which I replied with a website of credentialed sex therapists. Met with a ‘you are giving up on me already’ (clearly diagnostic). I encouraged in-office contact as most effective, and there were practitioners in his area. Yet when he reached out again, and I reminded him of our prior conversation, I was then met with “get lost,” again diagnostic.

Given the shame involved (I only know that he had sex with a family member, reportedly of age), perhaps this individual may have had a better start with anonymity. Yet, I wasn’t the person to do it.

Check out the last blog post in this series here.