Content warning: This piece contains discussion about suicide and depression.
A few months back my mom asked me a question: “Now that your hobbies are your job, what do you do for fun?”
I didn’t know how to answer. In the past few years I've been fortunate to make a living creatively. By grouping together several jobs—at the moment I'm technically employed by four different companies—I've been able to provide for myself. Practically what this means is that I'm never far away from my computer. There is always some deadline. Some tweet. A meeting to schedule. On the phone, I told mom that I like my work, that I'm lucky to do what I do. When I said that Ma didn't miss a beat. Immediately she replied: “Really? It’s just that you seem so tired lately. You’re always so down.”
I laughed it off, said goodnight, and hung up. But the truth was that I had been pretty tired lately. I had been pretty down. The pace required to make rent left me feeling constantly overwhelmed. That combined with a genetic predisposition for depression meant I had been thinking about killing myself a couple of times a day, every day, for months. Suicide would mean I’d never have to apologize for another late email, and that seemed infinitely more appealing than kicking around for an additional 50 years to pay off a liberal-arts education and live with two roommates in a rented apartment.
Recognizing these thoughts were a problem, I started looking for solutions in the same place I look for everything else: the internet.
In the past few years online therapy has risen in popularity. Many therapists now offer their clients video sessions, allowing for greater flexibility on when and where they communicate. Therapy apps BetterHelp and TalkSpace offer users round-the-clock messaging with a matched therapist, in addition to limited video sessions. The apps also claim to be more affordable than traditional methods.
While they’ve got their champions, many traditional therapists have noted the limitations of the apps.
Bronwyn Singleton, a psychotherapist based in Toronto, did a free trial of BetterHelp. She wanted to see how the service stacked up against her own practice, and if there was anything to learn from the experience. From the outset there were problems.
“They matched me with a play therapist, a therapist who specializes in working with children. I would never have selected this therapist on my own,” she said. “I should have lobbied for change, but I found that prospect time-consuming.”
Singleton also noted the limitations of video when building rapport. Body language is very telling of our moods, and without the face-to-face contact she felt it was difficult to really establish a bond with her matched therapist. On a practical level she also wondered about the business model. The app wasn’t cheap—especially when converting the price tag from Canadian to American dollars—but even so, Singleton questioned what the company was paying their practitioners for 24-hour service while still maintaining a profit. It all seemed a bit cold and impersonal.
“I think apps could risk being alienating for people who lack human connection,” said Singleton. “In terms of a larger cultural critique, I don’t think therapy should be a disembodied experience, but maybe I’m just old-fashioned.”
I liked the idea of accessing something easily at my fingertips, so I decided to give BetterHelp a shot. A few clicks to a better mind. Facetiming to nirvana. I signed up for the free trial and answered BetterHelp's questionnaire as best I could. Why was I seeking therapy? Because I couldn’t make myself care about anything. Had I ever been diagnosed with depression, anxiety, or any other mental illness? I had three different diagnoses from three different child psychiatrists. What was I hoping to get out of the experience? I wanted to go a few days without thinking about killing myself. After filling out the form I was matched with a therapist in Texas who specializes in behavioral psychology. A text message popped up on the app where Texas introduced himself, his techniques, and asked me for the broad strokes of my situation.
Looking at the text I felt paralyzed. So much of my work is writing down how I feel about things, but when I tried to articulate the truth, it all seemed hopelessly banal. Noting the bare facts and their relative insignificance made me feel like an idiot. Objectively I didn’t have anything real to complain about. But I still felt like garbage. Getting it into words only made things seem worse. After rewriting my responses a half dozen times, I finally hit send.
Fifteen minutes later Texas responded with a handful of calming platitudes about first steps, and a suggestion to book a video appointment. Another text popped up with encouraging words and more questions about my life. I knew what all this was for, that in this context that it was building rapport, but looking at my phone the whole thing just reminded me of the emails and messages that had been causing me so much stress in the first place.
The video session didn't inspire more confidence. We chatted about my life generally, and while I was grateful for a chance to vent, I wasn’t connecting with Texas. The whole thing felt like a bad first date neither of us were impolite enough to end. I knew midway through the session that this wasn't going to work for me but kept at it because I also knew being a depressed person hadn't been working for me either.
Afterwards, there was a follow-up text touching on some of the things we talked about in our hour, along with a reminder to advocate for my own self worth, and a question about how I was feeling. The message sat in the app until a day before my trial was set to expire. It felt like homework. I deleted BetterHelp.
I then started to look for other options, checking out the pricing for similar apps, and wondering if maybe that could be an answer. I put out a call on social media asking if anyone had positive experiences with online therapy, and a few people said it had improved their lives. They liked how writing things out helped them organize what was really bothering them. They enjoyed the flexibility. The truth was I didn't think I had the temperament for it. I knew that something needed to change, but looking for help in a way that was as easy, quick, and efficient as clicking buttons on my phone left me feeling alienated. Maybe the act of finding a therapist you like, making the effort to physically attend the sessions, and putting in the work was part of getting better. While those steps seemed daunting—especially when some days getting out of bed was a herculean task—the idea of putting in that effort seemed to matter. It was possible that had I stuck it out with the app it could have pulled through, but I didn't think so.
After deleting the therapy app I wallowed for a bit before taking the dive and googling "affordable therapist near me." That’s how I found a person whom I now see twice a month. I'm not always sure I like it. I don't always feel like I have gotten the most from a session. But I go anyway, and in general I think, perhaps, it is helping. I noted that the bi-weekly sessions cost half of what the app would. We talk a lot about how to spend less time on my phone.
If you or someone you know is considering suicide, help is available. Call 1-800-273-8255 to speak with someone now or text START to 741741 to message with the Crisis Text Line in the U.S., or call Crisis Services Canada at 1-833-456-4566.
Graham Isador @presgang