This conversation is part 3 in a series between clinical psychologist Julie Kolzet – who runs a private practice and consulting service in New York City – and Psycom Pro Executive Editor Angie Drakulich, aimed at early career psychologists. Other segments focus on mentorship and networking and starting a private practice. Listen to the full conversation in the player or read the transcript* below.

Defining Digital Mental Health

Drakulich: Today we are focusing on some of the mental health care models entering the field, namely digital apps, which largely offer counseling and teletherapy services. How would you differentiate these from traditional teletherapy, which was established well before the COVID pandemic?

Dr. Kolzet: I’ll start by saying that digital mental health, as I see it, is a broad term that encompasses teletherapy as it has traditionally been delivered through a virtual platform or computer with a therapist on one end of the screen and the client/patient on the other. These traditional care models may or may not involve evidence-based treatments, such as cognitive behavioral therapy (CBT). When we talk about digital mental health care – this can include interactive Internet-based products (whether commercially produced or free), online support groups, chat forums, self-guided apps, wearable devices (eg, heart rate monitors, sleep and activity trackers), and blended care or integrated care models, such as talk-therapy-plus.

Digital mental health may even include seeing friends on Zoom – even though it’s not clinical therapy, these gatherings over the past year have been a lifeline for many.

Drakulich: So it sounds like we need to be specific about what we’re talking about when we refer to “digital mental health treatments?”

Dr. Kolzet: Yes, I think that’s perhaps the theme for this conversation today – your first question really taps into our current reality, which is the evolving landscape of mental and behavioral health care, which includes future directions and opportunities. There are many questions we’re trying to solve and there’s more than one “we” here trying to do that solving.

Digital Mental Health: Disrupter or Game Changer?

Drakulich: Some have called these new models “disrupters,” predicting that they may lead to the end of private practice. What’s your take?

 Dr. Kolzet: The word disrupter is such a charged word, and it can have a negative connotation.  Essentially, I think there are a lot of seats to fill at the table.

We know there’s a need to impact mental and behavioral health in a positive way through interventions – both novel and more traditional – and, if anything, COVID-19 has highlighted that for us. If we are being generous, so to speak, perhaps the covert silver lining of the pandemic has been this increased focus on mental and behavioral health.

At the end of the day, we know that people lead different lives and have different needs – from the firefighter, student, doctor, farmer, nightshift worker, or stay-at-home parent to the corporate benefits executive who’s tasked with sifting through the numerous mental health services available. Therefore, we need to focus on the development of systems rather than one-off solutions, and I believe private practice or private practitioners are still a part of the solution.

More importantly, how can we as providers and private practitioners leverage our unique skills and our training so that we may best complement all the new stuff coming into the market? Let’s be optimistic and call this new stuff complementary disruptors.

Drakulich: I love that description, and to follow up, there are so many counseling services coming out of unexpected venues, such as drugstore chains, and I’m curious whether you see these as potentially helpful or even potentially harmful?

Dr. Kolzet: While these are promotion models of mental health, not treatment, we want to be open to them. These wellness programs can have a positive public health impact. Just by way of the fact that companies are making a push to include mental health and behavioral health programs in their offerings is robust. Basically, small improvements on a larger scale matter. And, let’s face it, people need support. There is also something to be said about convenience and about meeting the individual where they are, even if that is at a drugstore.

Consumer Fatigue: Are There Too Many Mental Health Service Options?

Drakulich: New York City Health Business Leaders (NYCHBL), which is a group that covers innovation and trends in physical as well as mental health, recently released a list of 18 Mental Health Start-ups with offerings provided by health plans and employers, as well as direct-to-consumer. With so many new models and options out there, do you think consumers in need of mental health care may feel fatigued about where to turn?

Dr. Kolzet: Great question and the NYCHBL report is an excellent resource. We know that investment in digital health startups has increased to record high levels, and mental health, as well as behavioral health services, are growing. With all this abrupt expansion comes the possibility of overwhelming providers and consumers, and while I certainly don’t have all the answers, I think that when it comes to digital health offerings – whether we’re talking about computerized CBT or wellness coaching via smartphone – time will tell what sticks.

It’s not just about who gets funding – it’s also about who gets better!

Digital Mental Health Interventions: Measuring Impact & Access

Drakulich: Let’s talk about that – the impact. No matter what specialty of medicine we’re talking about, we know that clinicians like to rely on data – which interventions are working and how that can be measured or demonstrated. There seem to be some valid concerns that some of the new digital offerings may not fit the bill, so to speak. What type of scrutiny do you think these new companies need to undergo?

Dr. Kolzet: This is a difficult one to answer, but going back to an earlier point, I believe we need to be specific about what we’re talking about. What problems and challenges do these digital offerings aim to solve? What’s important? How is progress or remission defined? Who gets better, how will we get people to engage?

Effectiveness trials are necessary to determine what works and under what conditions, and we know that impact, value and data all matter.  It’s important to mention that measuring results in the digital health services space can be difficult and not everyone’s going to have access to the results or data.

See also, how big data is playing a role in the field of psychiatry and how to use mental health apps as treatment adjuncts.

Early Career Psychologists: Choosing a Practice Model

Drakulich: Access in many forms is definitely crucial –we talk about this in our May 2021 report on whether there should be an annual mental health assessment in the US and how that would work. What does all this mean, in your view, for the young professional – the early career psychologist or mental health professional who is maybe seeking their first job and looking at some of these nontraditional practice models? What questions should they ask as part of their interviews or in their research when looking for a first job?

Dr. Kolzet: We know that teletherapy, compared to in-person therapy, is not inferior.

Another important point that I’ve attempted to drive home is that nontraditional practice models can take on many different forms and that we cannot forget physical health. So for starters, I would recommend that young mental health clinicians embrace nontraditional holistic practice models and digital health in its many forms – but keep an eye out for quality.

As far as what questions to ask during an interview: What duty would you be performing and what is the role? Who are the customers? In digital health, for instance, the customer can include health plans, employers, health systems providers, universities, consumers (ie, individuals, families). So let’s say if the customer is a consumer, will you be providing therapy, psychoeducation, resources, or something else?

Early career psychologists should also consider state laws and regulations based on where you will be living/practicing. This is especially important for psychologists, whereas counselors may have more flexibility or freedom to practice between state lines at this point.

So, you can see we’re in a nuanced territory here, and anytime somebody enters a business relationship, especially when there’s not much precedent, they need to be sure to ask questions like, How will “success” be evaluated – will there be patient feedback or patient outcome measures? If so, which ones? Moreover, if you don’t know what personalized mental health care means or what data-driven clinical decision-making means, be sure to ask how the company defines these. Additionally, ask who has access to clinical records and how will they be stored. Finally, if you decide that the role is not the best fit, how is care coordination handled? What if the patient asks if they can follow you to your next destination?

See also, psychiatry resident Timothy Wong’s takeaways from the 2021 APA meeting track for residents, fellows, and medical students and our psychiatry residents’ corner on burnout and versatility.

Breakthrough Mental Health Care Models

Drakulich: All great advice for our young professionals entering the field. Before we close, I know you’ve been following these shifts in clinical psychology and psychotherapy for a while. I’m just wondering if it’s overwhelming for you as a clinician and do you see any breakthrough models that you think will be here for the long term?

Dr. Kolzet: Overwhelming? Yes, but not all the time. While it can be difficult to keep up with the trends, due to the fast-paced nature of the technological developments out there, especially during COVID, I think it’s important to monitor what’s going on, to learn, and to think critically about how it’s going to impact clinical practice. There are many more customers now, so it makes sense that there are going to be more products as well.

As for breakthrough models, I do think it’s safe to say that virtual or tele-based psychotherapy sessions are here to stay for good, especially with how effective they’ve been during COVID. Hybrid models (eg, software-based disease treatments, digital therapeutics) are likely here to stay as well. It’s difficult to say which of the breakthrough models will stick around for the long run in terms of outcomes, interest, and cost-benefit analyses. Let’s remember that these aren’t just buzzwords.

Overall, I believe COVID has put a spotlight on mental and behavioral health in a way that we haven’t experienced before. As I mentioned, there are many seats at the table – before COVID, we weren’t even invited to the dinner party, and now our place setting is close to the host! So as they say, necessity is the mother of invention.

*Edited for style and clarity

Last Updated: Jun 2, 2021