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Saturday, May 27, 2017

In my work as a clinical therapist, I treat patients who struggle with anxiety and depression, as well as a host of other life stressors such as grief from the loss of a loved one or even loss of employment. Many people find that the period between face-to-face sessions can be very challenging, and they need support to manage their day-today stress and to effectively process the insights we make during our weekly or biweekly sessions. These complements to therapy come in the form of Apps such as Headspace, Flowy, Happify and Smiling Mind, which are examples of platforms that guide in the practice of meditation and mindfulness, and which even remind people to take any medications they require on schedule. Others like Talkspace or 7 Cups of Tea link people with a licensed psycho-social therapist with whom they can chat immediately if needed. In moments of crisis, a person can message the Crisis Text Line from anywhere in the United States for immediate assistance. Of course these platforms do not replace face-to-face therapy as a primary strategy, but they can complement and enhance its value. Moreover, where the mental health system is not adequate, these solutions can be a critical lifeline, such as for people living in remote areas with limited access to mental health treatment as well as for those who are uninsured and who cannot afford to pay out of pocket for services.

The social workers in my clinic use a remarkable, simple two-way patient-access platform called Sense Health to communicate with our patients between sessions. It enables us to text our clients from our computer directly to their phones just
to briefly check in and remind them of upcoming appointments. We can also use it to reinforce treatment goals set during a recent face-to-face session. For example, if a patient decided on a goal to take a walk each day, we can send them reminders each morning or inquire each afternoon as to how their walk went. They can also text us to reschedule appointments or to ask us to call them for some extra support when we have time in our day. One great benefit I find using Sense Health is that many of my patients are able to share certain intimacies more easily in a text message, as opposed to during face-to-face meetings. This is not a replacement for the direct interaction, but it provides a different context for sharing that at times is easier, and which can ultimately facilitate our taking the issue up when we are together. It offers options to the clients.

One of my main concerns as a clinician regarding these IT approaches is the safety of the patient, for example in the case of a depressed and suicidal person.  I am reassured by the fact that many of these apps have safeguards in place to protect patients who may be at imminent risk. While these sound very engaging, it is important to realize that these  services are not appropriate for every patient, so that professional mental healthcare providers are necessary to make this
judgment for a given client.

New psycho-social support online platforms can be excellent supplements to the clinical work that we do. They can supplement regular face-to-face sessions during  the intervals between sessions and even enhance and reinforce the work done  in session. Occasionally they can even provide support services to those who cannot otherwise access them. Like all interventions they have tremendous potential utility, provided that the context and human support is appropriate. These tools are
here, and if used correctly, they represent important advantages provided by technologic advances that help provide the best possible care to our patients.

Kira Wigod is a licensed clinical social worker practicing in New York City. She works at Montefiore Medical Group where she does clinical therapy with clients from all walks of life. Kira is currently building her private practice, where she hopes to make an impact on even more lives. Contact Kira by e-mail at kwigodlcsw@gmail.com.