For Dr. Michael Aharoni, the seed of inspiration was sewn more than 10 years ago. It was the result of a conversation he had with his sister-in-law. She owned an agency that supplied interpreting services for the hearing impaired, and was experimenting with an application that could enable her to provide these services to her clients via video, rather than having to dispatch sign language experts to remote locations. It would result in tremendous business efficiencies. Would Dr. Aharoni be interested in investing in the idea?
Dr. Aharoni passed—thinking that the technology wasn’t quite there yet—but the conversation stuck with him. He became increasingly intrigued with the notion of delivering therapy via video, and the potential to reach the many thousands of individuals who might not otherwise have access to mental health services.
Today, realizing that potential is Dr. Aharoni’s life’s work. The CalSouthern alumnus is now a pioneer in video therapy and the Founder and Clinical Director of Access to Therapy, a nationwide network of licensed therapists and specialists who provide mental health services via video to clients across the country utilizing high-definition video and audio conferencing technology.
Tom Dellner, Editor of University Publications at CalSouthern, sat down with Dr. Aharoni to discuss Access to Therapy, the evolution of video therapy, and its unique application to a variety of population, including the military.
TD: In your experience, what sorts of populations benefit most from video therapy?
Dr. Michael Aharoni: There are hundreds of thousands of people suffering from mental health disorders who don’t have access to traditional therapy. Many are confined to their homes because of physical limitations. In addition, 50 to 60 percent of the country’s population still live in remote areas or rural communities that may have a limited number of mental health providers. And military service members—who we know face a disproportionate number of mental health issues—are extremely underserved when it comes to mental health. There may be an insufficient number of therapists on or around the bases where they are stationed, or few practitioners in service members’ communities with experience dealing with their unique issues and needs. Video therapy allows us to connect these populations with licensed therapists who can provide the services they need.
TD: Does video therapy require the practitioner to make significant modifications to their therapeutic techniques? Is its efficacy comparable to traditional therapy?
Dr. Aharoni: Regarding the first question, the short answer is “no”—video therapy essentially duplicates the types of therapy that would be conducted in an office setting for the benefit of clients that don’t have access to therapists for face-to-face sessions. It does require a bit of practice on the therapists’ part, but we’ve found that the adjustment is easy to make. And it compares very well with traditional therapy; it’s in the 90th to 92nd percentile in terms of efficacy.
TD: What do you think accounts for that slight difference in efficacy?
Dr. Aharoni: I think it has to do mostly with the atmosphere, with being in the presence of a video image instead of a warm body. A certain percentage of people might have difficulty connecting with a therapist over the video medium or just aren’t comfortable with it. The other issue is that there are certain diagnoses or issues that simply aren’t well-suited for treatment via video therapy.
TD: What are some of those issues?
Dr. Aharoni: People who have suicidal ideation or who otherwise need hospitalization or assessment for psychotic disorders; these people are simply not stable enough. But the majority of issues we deal with—behavioral issues, relationship issues, depression, anxiety, post traumatic stress disorder (PTSD), that which makes up the vast majority of what most therapists see on a day-to-day basis—can be treated via video therapy.
TD: Are there any technological barriers to treatment?
Dr. Aharoni: Good question. The major components that one needs—whether it’s the therapist or the client—are a computer, Internet connection, and a webcam. Of course, Internet connection reliability and/or speeds can vary, which can affect either the audio or video aspects of the experience, creating issues of clarity. However, connection speeds have improved dramatically in recent years and in most cases, picture and audio quality, as well as audio-video synchronization, are excellent.
TD: Can you tell us a bit about the Access to Therapy model? How does it work?
Dr. Aharoni: About five years ago I developed a website-based model for a therapy network, which has grown into Access to Therapy. The website (www.accesstotherapy.com) acts as a hub, a place where people can come to get information on a variety of psychological issues and to connect with a network of therapists all over the country. The idea was to make it as easy and intuitive as possible.
Say a client in California, for example, is looking for a therapist. Because licensed therapists can only work with residents of that state, the client will click on California from a map of the country and is then presented with a directory of network therapists in the state, complete with bios and any other information the therapists would like to make available.
Once the client selects a therapist and supplies his/her contact information, the therapist will contact the client to discuss his/her condition, schedule a time, and agree on a fee.
All this information is recorded on the website, which sets up an account for the client. If the person is new to the network, Access to Therapy will contact the client, set them up with the proper equipment, and conduct a demo session to ensure that the client is comfortable with the technology and that everything is working perfectly prior to the first session.
On the date and time of the session, the client goes to the website, accesses his/her account, and clicks on a provided link to connect directly to the therapist to begin therapy.
TD: How has the response been?
Dr. Aharoni: Response to the idea has been uniformly positive, and people seemed to “get it” right away—both practitioners and clients. One reason is that medical doctors have utilized telemedicine for decades to provide specialized diagnoses and treatment to patients in remote locations. So the model is established and proven, at least in the medical community.
Building out the network has been relatively easy, as well. I’ve been pleased to contract with well-qualified, licensed therapists nationwide who are looking to grow their practices. The client side has grown more slowly. It requires a very significant marketing effort. We are focusing on California—as well as the military—initially, and will expand strategically as we grow. We’ll target Florida, New York, Arizona, Colorado, and Alaska (where there is a substantial population of people in remote areas with limited access to mental health care) next.
TD: What types of services do you offer?
Dr. Aharoni: We offer psychotherapy, counseling, life coaching, mediation, crisis management, and conflict resolution, among other services. We also have a psychiatrist that will be joining our team soon. In addition, students in CalSouthern’s School of Behavioral Sciences might be interested to learn that we work with psych interns and offer supervision—this provides an excellent opportunity for the intern, and a more affordably priced service that appeals to certain clients.
CalSouthern: Please tell us a little about your work with the military. Why is video therapy so well-suited for our service men and women?
Dr. Aharoni: First, there aren’t enough therapists who understand the military culture. There’s a critical shortage of these practitioners, especially in the areas where the military population is located.
Exacerbating the problem is that there’s a much greater need for therapists. With the extended wars in Iraq and Afghanistan, we are seeing more and more service members coming back with Post Traumatic Stress Disorder, Traumatic Brain Injury, anxiety, etc. Video permits us to summon more therapists to meet the growing need of the military personnel and their families. (It’s important to remember that it’s not just the service member who is affected. For every military service members, there are another three or four people who are closely related to that person—spouses, children, parents—who are impacted by the experience and may need help.)
We are focusing intently on this population. As you might expect, there’s a significant amount of red tape that one encounters when working with the military, but it’s beginning to open up.
For example, TRICARE is the military’s health care program. It’s the first major insurance program to approve payment for psychological treatment via video therapy, and we are currently seeing military clients around the country. (We also expect all major private insurance providers to cover video therapy either this year or next. They are working toward that direction already. Telemedicine has provided them with the model. But changing policies takes time.)
CalSouthern: In what ways can video therapy provide advantages over traditional therapy in the military setting?
Dr. Aharoni: In addition to the main advantage of providing the access to the services in the first place, there are others, as well. Let’s say a marine is coming back from his second or third tour. With video, we can conduct a session with that marine, who may live on a base, and his wife, who may live in another location to conduct marriage or relationship counseling.
We can also access that service member’s support system, which might not live in the same area. This group support is so important. When service members come back from a tour, the unit often breaks up and scatters, making access to that support system (with which the service member has shared the experience of combat) impossible by traditional methods. But through video, we can conduct group therapy with as many as 16 people (although we usually limit these group sessions to seven or eight) on the screen at the same time. Perhaps they meet weekly with a licensed facilitator; the service members get that critical support: they’re able to see each other, speak to one another, and have that contact. It’s a tremendously valuable tool, and another excellent example of video therapy’s application to the military.
TD: What do you foresee for the future of video therapy?
Dr. Aharoni: The technology is continually getting better and more reliable. In most cases, we’re already doing HD-quality work. With the proliferation of laptops, smartphones, tablets like the iPad, and near-ubiquitous wifi access, we’ll be able to provide mental health services practically everywhere—borders and barriers to therapy are rapidly dissolving. And as people becoming increasingly comfortable with video communication as the technology grows, any resistance or hesitancy to embrace video therapy will fade away.
CalSouthern alumnus Dr. Michael Aharoni, a pioneer in the field of video therapy, brings mental health services to underserved populations.