Online Therapy Makes Inroads in Israel

Forget the couch. Emails, chats and video are becoming a local alternative to traditional counseling for those who are housebound, in the army or just unable to find parking.

As soft music plays in the background, the patients sit in front of monitors and answer the computer’s queries: “Rank your depression from 1 to 10” or “how many enjoyable things did you do today?”

Welcome to “Beating the Blues,” a British-developed software designed to provide users with techniques for overcoming depression and anxiety. Feeling mentally stressed? Instead of trudging down to a psychologist’s clinic, forking out hundreds of shekels per session, hoping to link up with someone who suits your needs, you’re invited to select the most neutral therapist there is − a computer. The website states that the software is not a substitute for a real psychologist and is not meant for serious cases. It should be used as an accompaniment to a therapist, who should receive a report on your progress with the software.

Anyone who has not needed a therapist before might view this notion with cynicism. Numerous skits have made fun of sessions in which a psychologist sits across from a patient, doing nothing but nodding his head, muttering “I understand” from time to time, without really listening. Why, then, couldn’t a computer do the job?

For anyone choosing the software as an alternative to a live session, the difference in prices is staggering. Using the software costs 149 pounds ‏(NIS 800‏), for which one gets eight 50-minute sessions. This works out to NIS 100 a session, a fraction of the cost of a “live” therapist. In between sessions, users get tasks to complete.

There is no Hebrew version of “Beating the Blues.” But with the growing popularity of online treatment and exercises, there is already an Israeli website called “Be’nafshi” ‏(“In my soul”‏) that offers psychological treatment via chats, video-chats or email.

Online psychological treatment is terra incognita in terms of its efficacy. According to Dr Yochi Ben-Nun, who heads the Israeli Psychologists Association, the implications of online treatment are currently being evaluated by the association. “We have a team that is examining this area, both in terms of its efficacy and in terms of ethical implications”, he says. “In some cases this method can be an option but in others it is not recommended. It depends both on the nature of the problem and on the patient’s personality.”

The price of this service is NIS 280 for a 50-minute chat or for one email exchange ‏(one message plus a reply‏). The psychologists providing the service operate a private clinic, and themselves receive ongoing support and consultations.

Cheaper than in person

“The price is not much in comparison to regular sessions,” says Boaz Shavit, one of the psychologists who developed the Be’nafshi website. “There is an expectation in Israel today that an online session will be cheaper than a face-to-face one. In other countries this gap has been closed. I consider an hour’s session to be the same, whichever way it’s delivered.”

Shavit admits that online sessions do not yet constitute a threat to traditional treatment methods. “As in other areas, Israel lags behind America in adopting new treatment methods. In the United States, online treatment already takes up a significant market portion. On our website, 10-20 sessions are going on at any given moment.

“There are many people who find this method very suitable,” says Shavit. “The main group of users seems to be Israelis who live abroad, such as diplomats and Israelis who have re-located for work purposes. The reason for this is that it’s hard to undergo psychological treatment in a foreign language. Prices overseas are exorbitant and there are many cultural differences as well. Relocation often results in a need for help both for parents and children.

“Another target population are people who can’t leave their homes to come in for sessions, such as women who’ve recently given birth or sick and elderly people. In addition, many people find it difficult to open up in person; some have a strong need to maintain their privacy.”

These sessions are not suitable for people in more dire straits. “This method is not for people with psychiatric problems, or who are in serious crisis or in distress,” says Shavit. “However, these people can also benefit from online services. Israel is a world leader in Internet response services for people in emergency crisis situations. For example, the Sahar website deals with suicide prevention, and has saved hundreds of lives to date,” he says.

No need for parking

What about all the non-verbal messages that pass between therapist and patient in a face-to-face session, such as a trembling voice as a patient discusses relations with his parents, or avoidance of eye contact due to lack of confidence? Shavit acknowledges that there is abundant information to be gleaned from live sessions, which can be missed in online ones. An online therapist is at a sensory disadvantage, receiving less information than a therapist gets in a face-to-face meeting, he admits. “However, sometimes there is no other choice,” he says. “In addition, there is the cost benefit and the easier access. It’s cheaper and you don’t have to look for parking.”

In terms of personal contact, email treatment might seem to be of little value. However, Shavit says that this method has certain pluses. “Working with texts can be fascinating, not comparable to conventional psychotherapy,” he says. “Many people cannot express themselves verbally, and they open up by writing. For some, chats allow them to shed inhibitions they might have. Emails consist of a whole process. When one writes an email, there is some process of self-therapy going on. I’ve done some fascinating treatments this way but unfortunately they comprise only a small portion of our work. Most patients are attracted to video-chats.”

Are patients more likely to lie to a therapist or to themselves when the contact is through email or chat? Shavit says no.

“Who would invest money and time in order to lie? Besides, a patient can lie to your face as well. This has happened to every therapist. People coming to us in this mode want to reveal themselves.”

In addition to individual therapy, group therapy seems to be coming online as well. A new startup is making its first steps in the United States. It was set up by two Israelis, Oren and Roni Frank and is called “talkatala.” The site serves as a platform for group sessions, with psychologists conversing with up to eight patients at one time.

If choosing a conventional therapist requires one to be wary of charlatans, this is much more the case when it comes to online help. Here too it is useful to rely on personal recommendations. If you come without one, ask to speak to patients who can tell you about the service. Even with online therapy it is important to see the therapist’s license from the Ministry of Health. These can be sent by scanning. Just as with face-to-face sessions, an introductory session can be requested online as well. It may also help to have one face-to-face meeting, even if the rest of the treatment continues online.

Email therapy

Shiri Liebstein uses email correspondence in her therapeutic sessions. “I’m a great fan of writing. I come from the therapy field, and I’m convinced that the real work, whether in face-to-face sessions or by correspondence, is done in between sessions,” says Liebstein, who conducts personal and business training and writes in the online magazine “Coaching Interactive.”

She entered the field of online training while traveling to London with her husband, who was had to be there for a long time. “I had patients in Israel who wanted to stay in touch and I found out that the work could be done online as well. It has now become a tool I incorporate in my work, even when the training is mostly done face-to-face,” says Liebstein. “When you say something, you often mask your words so that they don’t remain conscious. We carry many versions of what we said in our heads, and we don’t necessarily remember exactly how we formulated things. In training which is done online, things are expressed in writing and cannot be altered. This often allows people to discover the truth.”

Training through writing often helps people open up. “Online communication maintains a sort of screen between patient and trainer,” says Liebstein. “Many people open up more easily when writing as opposed to when they have to look at their therapist. People feel less embarrassed when no one is looking at them. “I can guide people through my questions. I teach people to go through deep introspection. It’s not just a matter of answering my questions. I’m very focused.”

The price of online training by correspondence is NIS 250 per session, which is lower than conventional sessions, which cost NIS 400. Liebstein notes that the best strategy is to combine the two methods.

Online dieting

Anyone who has attended any kind of weight-reduction workshop is familiar with the highlight of the evening, the moment in which participants have to mount the scales with their coaches watching, in order to see whether any progress has been made since the previous meeting.

Dietician Miri Belkin offers an alternative: online weight-loss workshops. She is filmed during her weekly sessions, and anyone who is interested can watch these online. The price is determined by the duration of viewing. A one-month subscription costs NIS 190, and an annual one costs NIS 130 a month. This is significantly less than the NIS 440 required for attending a session in person. Applicants receive a personal diet, tailored to their height and weight.

She began the online workshops in response to demand. “Following my TV program on Channel 2, people started to look me up, asking why I only lecture in the Tel Aviv area,” she recalls. “I have many Israeli clients living abroad, women after childbirth and shift workers who can’t attend [face-to-face] sessions. There are also soldiers who can’t come every week, and young people before their military service who continue online throughout their service.” She says she currently has hundreds of online clients.

“Success rates depend on people’s choices,” says Belkin. “Someone who is highly motivated has a good chance of succeeding. Everyone weighs themselves, but we keep track. This method is good for people who are serious about losing or maintaining their weight. It imposes self-discipline.” Belkin notes that she also has an online forum that includes a dietician on hand throughout the day, under her supervision. “From time to time I intervene and respond, as required. There is nothing like a face-to-face meeting for those who can afford it, but there are circumstances when this is the only options.” 

Sharona Gonen