When Distance Is an Issue: Geographic Barriers to Therapy

About 20 percent of people who make an appointment with a therapist never show up to their first appointment; another 20 percent make it to their first session but never return. Opening up to a therapist for the first time can be overwhelming, and some people back away after a first attempt until they feel ready to try again. However, the reasons people don't come back to therapy are often much more mundane than that. Can online therapy be the solution?

A long, arduous commute can be enough to make someone quit an otherwise good job, and the same is true for therapy. Researchers at the Massachusetts Institute of Technology studied skin conductance, heart rate, and other objective measures of stress and found that driving a car was as stressful as jumping out of a plane. The most stressful activity people do on a regular basis is even more intense for people who are struggling with symptoms of depression or anxiety.

Time and energy are precious resources that can be even harder to come by for people who are coping with mental health conditions. During a depressive episode, it can be taxing just to get up and get dressed in the morning. Anxiety can turn a trip to the grocery store into a series of overwhelming decisions. Tailgating, near-misses, and sudden stops demand energy from any driver; for people whose emotional resources are already depleted, it can take days to recover from the stress of a commute.

For people who like to drive, who can use public transportation, or who live somewhere there isn't heavy traffic, a long commute to a therapist's office can still present a challenge. It's hard enough to fit a therapy session into a busy schedule of work and family obligations, and it's even harder when the drive adds another hour. When therapists are not only geographically distant, but also have limited evening or weekend hours, the logistics of seeing them can become impossible to coordinate.

Arduous rural commutes put many services out of reach for people who need to access them more than a few times a year. When people live in small towns with few resources, it can take them two or more hours to drive to the nearest specialist. When they have to take a series of winding rural roads just to get to a major highway, the trip can be even longer. Therapy that requires a five-hour round-trip drive is an unsustainable commitment for most people.

Long drives can also create a financial burden. The longer the drive, the more a person has to spend on gas. Wear and tear on a car can add up to even more costs for long-distance drivers. Not only do people have to pay for repairs or replacements, they risk losing their livelihoods if they're not immediately able to get their cars to work. When financial stressors threaten a person's sense of survival, they can become more significant than the relational and emotional issues that bring people to therapy. The expenses of commuting can render the relative savings of free or low-cost therapy meaningless.

For many people, the advent of online therapy made seeing a therapist accessible for the first time. People can now schedule a session any time they have a free hour, privacy, and access to a reliable internet connection. They can talk to a therapist from the safety and comfort of their homes and not have to cancel when road conditions change. They don't have to include driving-related costs in their budget for therapy.

Still, some people hesitate to try online therapy out of concern it isn't as effective as therapy done in person. While it's true there are unique benefits when both client and therapist can be in the same room, research suggests these benefits are subtle, not essential. From studies done in 2002, when online therapy was in its infancy, to recent research in America and Europe, the results are the same: seeing a therapist using videoconferencing technology is as effective as seeing a therapist in person.

Finding the right therapist is an important part of therapy. People do best when they can work with a therapist who offers the style of therapy they need or who specializes in treating the symptoms they want to address. When a person lives close to a local therapist's office, driving there is often the best option, especially when that therapist accepts insurance, offers a sliding scale, or has affordable rates. However, even people who live close to a therapist may choose online therapy when no local therapists are a good match.

Being able to access therapy without a commute can be the determining factor in whether people only make it to a single appointment or continue in therapy long enough to achieve their therapeutic goals. When the practical barriers are removed, many people can face and overcome their emotional challenges, make progress in therapy, and heal.

If you've checked the listings on OpenCounseling and are daunted by a long or traffic-laden drive to the closest therapist, consider trying online therapy. BetterHelp (a sponsor) has therapists from a wide variety of backgrounds who practice many different therapeutic styles, and they may just have a therapist who's the perfect match for you.

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Posted on 04/09/2019 by Stephanie Hairston, MSW

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a masters-level clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments. She has also worked as a technical writer for a medical software company and as an editor for a company that appeals denials of insurance coverage for behavioral health treatment. As a writer, she is motivated by the same desire to help others that brought her into the field of social work and believes that knowledge is one of the most essential recovery tools. She strongly believes in the mission of OpenCounseling and in making therapy accessible for everyone.