Virtual therapy may help, but isn’t for everyone

Linda Rider

Story by Heidi Perez-Moreno, UNC Media Hub

Video story by Sierra Sanders

Graphics by Stephanie Mayer

Maddie Ellis was crying in her bedroom. Last fall, she was juggling her responsibilities as a fulltime UNC student and as the university editor for the Daily Tar Heel. It was too much.

“I just was really stressed all the time and super burnt out,” Ellis said. “I really struggled to find joy in each day. I was really just not doing well.”

Many days, she was terrified of the idea of making a mistake and she felt as if she were a failure. The stress was dragging down her personality and her health. She was finding it harder to control her negative emotions. She grew lethargic, which is not her style.

A friend Facetimed her when she was crying. At one point, the friend said, “I’ve never been more worried about someone than I am about you.”

Ellis’ mother said something similar, leading Ellis to seek professional help. 

“Maybe if my mom is saying it, maybe it’s time,” she said. 

Ellis raised the volume on the television and climbed into her empty bathtub, a place most isolated from her two roommates. She dialed the UNC-Chapel Hill’s Counseling and Psychological Services’ 24/7 hotline and made an appointment for a Zoom therapy session.

“I’m seeking professional help for something that I’ve always covered up and buried, and never really sought help for,” Ellis said. 

Seeking help behind a screen

Since the start of the pandemic, more and more students have used virtual therapy as a way to seek mental health and wellness care. 

The university’s CAPS program — a popular resource for UNC students — shifted to exclusively provide virtual counseling services after concerns of COVID-19 transmission last year. 

Transitioning services from in-person to Zoom served as a way to continue offering services to UNC students at a time when many were exhausted and burned out from the stress of a remote semester. Around the same time, classes shifted to remote and most would stay like that for another year or so. 

“Our number one priority at CAPS is the mental health and overall wellbeing of our students,” CAPS Associate and Clinical Director Avery Cook said. “We serve as a possible first step in helping students identify the level of care they need. We then guide them through the process of getting that care, whether it’s within CAPS or through an outside provider.”

The virtual services aren’t the same as in-person counseling. Ellis didn’t feel comfortable during her sessions of virtual therapy because the in-person human connection was missing.

“I feel like you miss some of the body language cues and you miss so much of that human interaction,” she said. 

From the start of the pandemic up until early November, CAPS has served 6,571 students, and has provided more than 10,000 virtual appointments. The clinic also provided virtual group sessions and continued to refer students to local organizations if needed. 

Those virtual services became more necessary during the pandemic. 

Symptoms of moderate to severe depression among first-year students increased from 21.5 percent prior to COVID-19 to 31.7 percent four months into the pandemic, according to research from the Carolina Population Center and the UNC School of Medicine. Within the same time, the prevalence of moderate to severe anxiety went from 18.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 25.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} within the same timespan. 

Black students, in addition to those from gender and sexual minorities, were hit hardest by the pandemic, the research showed. 

Matthew Mills, a licensed clinical social worker and professor at UNC-Charlotte, isn’t a fan of virtual therapy services. 

“If I had to choose between the two, I would definitely choose an in-person setting,” Mills said. “I think the vibe from most clinicians is trying to figure out how we do our work in a virtual setting effectively when some of us don’t operate in our best fields — how do we adapt.” 

But he understands some of the benefits of virtual therapy, including being more accessible to those who can’t find transportation to see a counselor in-person or have a busy schedule. In addition, many of his colleagues are immuno-comproised, and so virtual therapy is the safest route to doing their jobs. 

“It’s here to stay — I don’t see it going anywhere,” Mills said. “I think it definitely opens a new door.”

Nadia Charguia, medical director of UNC Psychiatry Outpatient Services, said the department is slowly transitioning to in-person services, but the vast majority of patients are being treated through tele-health services. 

“It’s hard to take time off work, It’s hard to find time between classes,” she said. “We are definitely seeing a lot of folks gravitate towards virtual services because of how accessible they are.”

Talking behind a computer screen

Rachel Gora, currently a sophomore at UNC, has faced mental health struggles since the eighth grade.

By her senior year of high school in April 2020, she was increasingly depressed. Gore realized she wasn’t in touch with many of her friends and was missing out on a high school experience. She sought out virtual therapy, but there were constant technical issues during the appointments. Her counselor would often call her when Zoom wasn’t working at all or somebody’s WIFI was acting up as well. Sometimes, her audio would cut out at random moments. 

That, coupled with her ADHD diagnoses, made it harder to consistently attend sessions. She often missed several sessions in a row, and she hasn’t been to a session in months. It was hard to repeatedly spend time on a task that didn’t seem as though it was worth her time. 

“I think it was harder to connect online virtually rather than in-person because there’s just an aspect of connection that is missing,” Gore said. “It’s hard to put your finger down on why virtual is different but I definitely think it is.”

Taking steps to get help

Ellis’ struggles with mental health arose once she started at the DTH’s university desk. She immediately transitioned from a summer internship to the position. 

Once the semester officially started, she spent most of her time at the DTH. It was rare to find a moment to herself. It also became harder to deal with her own emotions. At her first session with a CAPS specialist last November, Ellis found it difficult to put her thoughts into words, so she didn’t. She just sobbed. 

Her therapist said she has a tendency to catastrophize and assume the worst will happen. 

“These are some things that I did take away from it and like to think about in my life now,” Ellis said. 

Between her second and third session, she did something that had rarely happened that semester – take a break. During Thanksgiving weekend, she visited the Outer Banks with friends for several days. She was finally able to read and hang out with friends. 

When she returned to see her CAPS counselor for the third session, she had nothing but good things to tell her. 

“It sounds like you don’t really need to talk today,” the therapist told her. 

The answer immediately made her feel bad. Like her feelings weren’t valid. As though she was merely being dramatic about her issues over the course of the other two sessions. 

So, she didn’t return. 

Ellis emphasized the importance of being able to advocate for yourself during therapy. She accepted the therapist’s response without mentioning that she wanted to continue seeing a counselor to reflect on why the fall semester had been so tough. 

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