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Has Covid Remade Psychotherapy for Good?

One therapist I spoke to who specializes in trauma witnessed some of her patients, now free of so many of the distractions of ordinary life, able to participate more fully in their treatment. “At the end of a session,” Sarah Person, who practices in Brooklyn, recalled, “people would always say, ‘I meant to talk about this, but I spent the first 20 minutes talking about the man who shoved me on the train.’”

Over the course of the past year, she found that some clients managed to get to the holy grail — the point of termination, the end of therapy — because they finally had the bandwidth to focus. “There was a feeling of ‘I don’t want to jump into the worst day of my life, but hey, I have nothing else to do right now,’” Ms. Person said. “Many of my clients went through a reassessment and really doubled down and wanted to get on with it.”

Tele-therapy is hardly a contemporary creation. First-generation video conferencing made telepsychology, as it was called, possible long enough ago that researchers had begun studying its effectiveness by the early 1960s. But it took the current crisis to bring it into wide use. Like nearly every other habit or institution upended by the pandemic, the hope for therapy is that it might now be remade, and remade more equitably.

In New York, the high cost of treatment is inextricably linked to the real-estate market. Traditionally, many of the best-trained and most-sought-after practitioners have been concentrated in the city’s therapy alleys — parts of the Upper West Side, Upper East Side and Greenwich Village near the psychoanalytic institutes and often where the therapists themselves have lived. In New York, whether you are buying a bouquet of peonies, a pound of ham, or 50 minutes of psychic relief, you are always paying someone’s rent, and commercial rents in these places are high.

But if therapists catered to some (or even all) of their patients online, reducing their overhead, they might be able to broaden the community they served, offering treatment to the less privileged, for fees on a sliding scale. The increasing availability of temporary office space in the city — space leased for a single day or even just a few hours a week — could allow therapists to accommodate some patients part of the time, others all of the time, in effect operating on a hybrid model.

Aspects governing both how therapy is regulated and how it is covered by insurers would also require long term flexibility. During the pandemic, insurers have largely waived restrictions on reimbursement for treatments conducted online or by phone and proposed federal legislation could make that change permanent. Typically therapists are licensed to practice in a single state, but all the migration that took place during the pandemic and all the heightened need led many governors to allow for quick, temporary licenses so that a therapist practicing in New York, for example, could legally treat a patient online who had moved away. These changes, too, would require ongoing adjustments.

Despite the depth and extent of the mental health crisis prompted by Covid, suicides, according to government statistics, actually went down in 2020, by nearly 6 percent, to the lowest rate in four years. Experts have attributed this to a kind of comforting sense of social cohesion that disasters can bring but also to some of the ease around accessing help. Some forms of therapy — group, family, couples — will always be the most productive held in person. But not all the old ways are worth preserving.

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