What If Our Problems Feel Too Big for Therapy?

Last month, I quit therapy. I had been seeing my therapist for a year: in

Last month, I quit therapy. I had been seeing my therapist for a year: in person for the first six months and then remotely. I found it harder to connect over Skype (I was always too aware of the clock), and the longer I kept it up, the more futile my weekly sessions seemed. In my normal life, I had enough to say to a therapist to fill an hour a week, no problem. Now, it’s just the same thing over and over: The world is falling apart, and I am depressed.

Nevertheless, the idea of therapy has rarely felt more visible to me: in ads on every podcast I listen to, on every meme Instagram account I follow. More people (especially young ones) are seeking therapy during the pandemic than before it. Still, it’s hard to feel exclusively heartened by these statistics. How can mental-health benefits tied to employment make a real difference when unemployment is higher than it has been in decades? And for those lucky enough to still be employed, how does texting with a therapist address the problems of overwork or a total lack of child care? 

Like a number of employers hoping to provide workers with cost-effective mental-health support during the pandemic (and everything else 2020 has thrown our way), Vox Media (of which the Cut is a part) began a partnership with Ginger a few months back. Not unlike its predecessors Talkspace and BetterHelp, Ginger is an online therapy provider, an app through which users can make immediate contact with a behavioral-health “coach” or, with a longer wait, a licensed psychiatrist. Earlier app-based therapy start-ups faced criticism over client privacy and sponsored reviews; these, among others, are weaknesses that Ginger hopes to improve upon. But while it seems like a nice option and I’m grateful it’s there, I have yet to use it. And none of my friends who have access to Ginger through work use it either.

“Maybe it would help?” says a friend, with two young kids, whose employer also started offering Ginger as a result of the pandemic. “It sounds possibly nice, and I appreciate the gesture. I just can’t fathom adding one more thing to my plate.”

My own reason is the same one I gave my traditional therapist when I called off our sessions last month: I know very well what my 2020 problems are, and therapy can’t fix them. I’ve therefore come to view Ginger as something of a hollow gesture, which is not a knock, necessarily, against the platform itself. After all, when the whole world is falling apart around you, how much can texting a behavioral health coach really help?

Two months into the pandemic, my wife lost her job, and two months after that, we moved cross-country to live temporarily with family to save money and try to figure out what the hell to do next. I don’t know how to articulate the way I’ve felt virtually every day since mid-March, but I assume you understand because you’ve felt it too. It’s bad. It sucks. I am acutely anxious and depressed all the time, and to me it seems there is very little I can do about it. I know what you’re thinking: I sound like I need therapy.

Bruce Wampold, an emeritus professor of counseling psychology at the University of Wisconsin—Madison, has studied the impact and efficacy of psychotherapy throughout his career and wants to emphasize that, generally speaking, psychotherapy works. “For most mental disorders, psychotherapy is as effective as antidepressants or anti-anxiety medications, and it’s longer lasting — there’s less relapse when it’s over than with medication and fewer additional episodes over the life course,” he says. On the whole, therapy is pretty incontrovertibly a good thing. Talk therapy, in which a patient meets regularly with a mental-health professional to talk through just about anything they want, is useful for people hoping to cope with relationship problems, grief, addiction, garden-variety stress, depression, and more. But of course, therapy can’t fix everything.

Consider England, says Wampold. “England has put billions of pounds into making psychological treatments accessible, but the rates of depression in England are going up,” he says. “That doesn’t mean that the treatment isn’t effective, but psychotherapy isn’t meant to address ills of society.” Unemployment, poverty, discrimination, and social isolation all cause massive distress, and therapy can’t fix any of them. Stronger social services, better-paying jobs, and rigorous anti-racist policies would address these issues more directly, but these things are much more expensive, time consuming, and community oriented than individual therapy. These are also things a second stimulus relief package might address, but our elected representatives have dragged their heels for months, rushing instead to confirm a Supreme Court justice before the election.

Most of these are not problems individual employers can fix on their own either. But I still wonder whether something like Ginger is better than providing a onetime bonus, additional child-care support, or two mandatory days off per month.

“Ginger recognized that there was a huge demand for therapy even before the pandemic,” says Russ Glass, Ginger’s CEO. “There are far more people who need care than there are providers to give access.” Glass tells me companies pay between $2 and $5 per user per month, depending on the size of the company and the model they choose. Some do a fee for service, paying a per-employee, per-month fee to provide access to the app, and then any services used are billed to the employee’s insurance with the company. With the single-fee model (which Vox uses), employers pay more outright per employee so that a certain number of therapy sessions are included without involving insurance. If one wants to make mental-health care genuinely accessible to one’s employees, the latter option is clearly superior.

But even though it’s free, my company’s participation remains relatively low: There’s a 20 percent sign-up rate, a representative for Ginger tells me, and only 50 percent of that group has messaged a coach more than once.

Still, that group — however small — should not be discounted: “Maybe there are people who would benefit from being in some form of psychotherapy who wouldn’t have considered it if it wasn’t offered or as visible,” says Rheeda Walker, a professor of psychology at the University of Houston and the author of The Unapologetic Guide to Black Mental Health, about app-based therapy services like Ginger. Ideally, she says, companies would take this opportunity to examine the expectations placed on employees and revise them to suit this unprecedentedly stressful period. But platforms like Ginger can, she adds, serve an important function in a workplace’s comprehensive COVID-support package.

Ultimately, Walker recommends using this time to reckon with a lot of life’s larger questions — like What really matters to me? What do I want to do with my life? — some of which people may want to talk through with a therapist. “I think where we are right now is a wonderful opportunity to invest culturally in how we do self-care,” she says. “And I know when you say ‘self-care,’ lots of people think about pedicures and bathtubs. But self-care for me is about a decision point: How do I create a context for myself, and for my family, that’s good for us?”

Therapy has helped me when I have felt ambiently bad without totally understanding why, or when I have known there’s something I need to do but can’t bring myself to do it. Throughout the months I kept seeing my therapist — because it was, I thought, the smart, self-protective thing to do — I heard myself as a broken record: I’m bored, I’m lonely, I’m cynical. But because I know the reasons (respectively: I’m doing the same thing every day, I’m seeing only two people, the government keeps proving it doesn’t care about us), my therapist couldn’t offer me much in the way of insight. I don’t think this is her fault, and I don’t think it’s mine. Our problems are just too big, and too external.

Of course, others may still find something of value from therapy right now, even if it is a little awkward over Zoom. For people whose employers have made services like Ginger available at a low cost or for free, it’s not a bad time to try it. I just wish companies didn’t begin and end their efforts there. Partnering with therapy-app start-ups is good PR and relatively cheap (especially compared with longer-term morale-boosting measures), but it’s not enough.

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