Current trends in the delivery of mental healthcare bring this question to the fore. We have long known that psychotherapy is a limited resource, plainly inadequate to meet mental health needs. This limitation is true not only of individual psychotherapy but also of all forms of psychotherapy combined: individual, group, couples and family. Not only is the distribution of mental health services grossly uneven geographically, the pervasive limitations of resources have also become more glaring in the context of healthcare debates and global economic woes.
New service delivery mechanisms
Thus, not without justification, Alan Kazdin and Stacey Blase argue that we must develop and disseminate a far broader array of non-psychotherapeutic interventions, even if the magnitude of their effectiveness is more limited than psychotherapy. Small effects with wide reach are better than no effects, given the unmet needs for mental health services. Joining a venerable chorus, these authors also advocate greater emphasis on prevention as well as the benefits of early intervention.
Yet, as a committed practitioner of Plain Old Therapy, I’m jarred by their advocacy of impersonal interventions now made possible by burgeoning new technologies. Telephone therapy is not new, and enhancing it with video seems eminently sensible; this expansion of service delivery can greatly enhance the likelihood of developing therapeutic relationships. How much is lost (or gained?) in video versus face-to-face interactions is an empirical question. But, as Kazdin and Blase review, we now have an expanding array of web-based interventions and smart-phone applications, for example, to monitor mood and promote coping skills, which are derivatives of cognitive-behavioral therapies.
Key limitation of technology
I find persuasive Kazdin and Blase’s basic point that we need to expand the reach of mental health services and that any form of help we can provide—even if modest in its effectiveness—is all to the good. Moreover, as these authors state, new technologies can serve well as adjuncts to psychotherapy. Books have done so for decades.
Yet, wedded as I may be to my iPhone and iPad, I find chilling the prospect of iPad therapy. A half-century of research on attachment relationships and the value of good patient-therapist relationships should give us pause. Doubtlessly, social networking is changing the fabric of relationships and will continue to do so in ways we cannot foresee. These changes already are influencing the delivery of mental health services and will continue to do so. While we need innovation in mental healthcare, we must wonder how much we will lose in further diluting our social connections—even to the point of relying on computers as proxies for social interactions.
Although we don’t seem to be able to live without them, computers don’t mentalize—hold mind in mind. For that, we need parents, friends, romantic relationships and—especially when things have gone wrong to the point that these ordinary relationships cannot adequately provide needed help and support—psychotherapists.
Kazdin, A. E., & Blase, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21-37.