Texas Universities Turning to Online Counseling

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Faced with soaring demand for mental health services from students struggling with depression and anxiety, three Texas universities plan to launch an online counseling program this fall replacing face-to-face therapy with informational videos, online exercises and video consultations that cut the time spent on each individual by nearly 70 percent.

Texas A&M University, the University of North Texas and Baylor University hope adding the online service to their existing programs will help reach more students using 10- to 20-minute video conferences with counselors — a fraction of traditional 50-minute face-to-face sessions. But some psychology experts worry that the shortened sessions won't provide much help and will come with privacy risks. 

Developed in 2012 by a former University of Florida counseling center director, the Therapist Assisted Online program asks students to complete online modules from among more than a dozen topics like mindfulness and positive psychology. Counselors follow their progress through an online dashboard and regular mental health assessments before checking in via a weekly video conference.

The program is designed for patients with mild to moderate anxiety and depression, the top two concerns on college campuses, according to a 2015 survey by the American College Health Association.

Demand for mental health services is growing on average five times faster than enrollment, according to a report by the Center for Collegiate Mental Health.

The program offers "a way of providing more services without hiring more staff,” said Maggie Gartner, director of counseling services at Texas A&M. A counselor can see three students in an hour instead of just one.

The program costs schools between $4,000 and $25,000 annually depending on their size — a bargain compared to hiring a psychologist whose salary could start at about $50,000.

Gartner said she is optimistic up to 200 A&M students will enroll in the program this fall, cutting the average amount of time students have to wait for a counseling appointment.

At UNT, counseling center director Tamara Grosz hopes the program will be more convenient for students who live off campus, have a job or are raising children.

Jim Marsh, counseling center director at Baylor, echoed these sentiments.

“A main goal for the program is to increase our ability to see more students and see them quickly,” he wrote in an email. “With busy schedules, some students may prefer the shorter sessions and the ability to connect from their room.”

But some psychology experts are concerned counselors won’t be as effective in brief video sessions.

Cameras can't pick up some body language cues, said Darrel Spinks, executive director of the Texas State Board of Examiners of Psychologists.

“If you have such a short amount of time, are you able to gather sufficient information?” he said. “I’m not saying it’s not possible, but I don’t know if you can substantiate opinions based on that.”

Online counseling also raises concerns about confidentiality, said Ronald Palomares, an assistant professor in the Department of Psychology and Philosophy at Texas Woman’s University.

“We hear about hackers breaking into servers and people losing their laptops or cellphones all the time,” he said. “Even with safeguards, we can’t be 100 percent safe.”

Others are concerned that the use of standard modules will overlook individual qualities like race and sexuality.

“If you’re dealing with a client who has multiple types of diversity to their identity, it may not be as effective,” said Andrew Miller, president of Texas University and College Counseling Directors Association and counseling director at Sam Houston State University.

The universities planning to use the online program say these risks are minimal and will be addressed by screening students at initial in-person appointments.

“One size doesn’t fit all, and we’re working to meet the needs of those students who will respond better, and hopefully faster, to this type of intervention,” Gartner said. She pointed to the more than 30 universities around the country that are already using the program to show its success.

While studies on online counseling are new, most have shown it is equally effective as traditional therapy for treating anxiety or depression.

The bottom line for many counseling centers is that TAO can help them reach students who would otherwise go untreated.

“If our choices are give them full counseling treatment for 50 minutes or we give them nothing, it puts us in this position of playing God and deciding who will get better and who won’t,” said Sherry Benton, the program's creator. “Don’t we owe it to people who can’t get into our office to see what we can do for them?”

Clarification: We have added language to make crystal clear that the new online counseling program is in addition to other counseling services, including face-to-face sessions.

Disclosure: Texas A&M University, the University of North Texas and Sam Houston State University have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.