When Online Therapy Isn’t Enough: Supporting Clients Who Need a Higher Level of Care

When Online Therapy Isn’t Enough: Supporting Clients Who Need a Higher Level of Care

As the country gradually emerges from one of the most challenging years in modern history, the extent of the mental health repercussions remains to be seen. What we do know is that more young people than ever before are struggling—and the majority of them aren’t getting the help they need. According to Mental Health America’s 2021 rankings, 60 percent of youth with major depression don’t receive any mental healthcare at all. Even among the states with the best youth treatment statistics, more than one in three young people are still not receiving mental health services.

Boosted exponentially by the pandemic, online therapy is helping to meet this need, providing a convenient and accessible way for teens and young adults to receive depression, anxiety, and grief counseling. For many of these clients, a weekly telepsych session—with a local therapist or one from an online service such as Better Help or Talkspace—offers the optimal level of support, giving them the skills and understanding to address mental health challenges and work toward greater flourishing. 

But for some young people, online therapy isn’t enough. If a client is getting worse rather than better, has experienced recent trauma, or is recovering from or at risk of a mental health crisis, in-person care may be necessary. As important as telepsych is in providing greater access to care, it is not sufficient when clients are suffering with acute diagnoses or in crisis. Moreover, not all adolescents respond well to online therapy vs. in-person treatment. 

10 Signs That a Client Needs a Higher Level of Care

There a number of important signs therapists should watch for indicating a client needs a higher level of care. “Knowing which questions to ask and how to read in between the lines can provide much-needed information,” says Heather Hagen, MA, LMFT, Newport’s Director of Clinical Program Development. The assessment process should also include industry-approved tools measuring clients’ levels of depression, anxiety, self-harm, disordered eating, and suicidal ideation. 

The top 10 signs that additional support is needed include:

  1. A breakdown in school performance
  2. Lack of interest activities and friends they previously enjoyed
  3. Family discord 
  4. Difficulty sleeping
  5. Trouble with law enforcement
  6. Increased use of drugs or alcohol 
  7. Disordered eating patterns
  8. Anger issues 
  9. Talking about feeling hopeless or suicidal
  10. Withdrawal from everyday interactions. 

As important as telepsych is in providing greater access to care, it is not sufficient when clients are suffering with acute diagnoses or in crisis.

The Benefits of In-Person Treatment

Particularly for adolescents—who tend to build trust and connection through action and activity as much as conversation—there are significant advantages to in-person care. For one, therapy doesn’t have to happen while sitting in an office—it can be on a surfboard, in a yoga class, on a hike, or during an impromptu chat. At both Newport Academy, our teen treatment program, and Newport Institute for young adults, a variety of experiential modalities is included in each client’s tailored treatment plan.

“Some of the most powerful interactions that a client may have in residential treatment may occur outside of the therapist’s office,” says Heather. “Experiential therapies such as equine, art, and yoga can be extremely supportive and enlightening. And therapists can cover so much ground in a short amount of time, because they see clients every day—not only during individual therapy sessions but also in group sessions, at lunch, during Adventure Therapy. Two or three months’ time in residential treatment is like a year’s worth of weekly 50-minute sessions.”

Heather often establishes rapport with young people through little things like appreciating each other’s fashion sense, talking about the pet whose picture is on her desk, or discussing a book a client notices on her shelves. And she can read body language signs that in telepsych sessions would occur outside the frame of the screen, like a client’s fidgeting hands or anxious leg bouncing. 

The peer community developed within the treatment milieu—whether residential or outpatient—is also enormously impactful in enhancing well-being and resilience. “The support of peers in who are struggling with similar feelings can normalize a client’s experience,” Heather says. “It provides a sense of community that many of our clients have never experienced. It’s not uncommon for these strong connections to translate into long-standing friendships between clients.”

Residential treatment also connects clients, along with their parents and siblings, to an alumni network of support groups and gives access to a likeminded community. At Newport, clients and staff stay in touch with biannual alumni events that typically include shared meals, games, and time to reconnect.

“Teletherapy is no doubt an excellent response for emergencies such as the COVID-19 pandemic. It has also served in the efforts of increasing access to psychotherapy in places with limitations to local mental health resources. Nevertheless it should not always replace the face-to-face therapeutic encounter. Using teletherapy beyond these contexts could pose the risk of eliminating the social activity and physical, embodied closeness that often facilitates healing.”

Journal of Humanistic Psychology

How Newport Prioritizes Our Relationships with Referring Professionals 

Our clinical outreach team works hand in hand with referring professionals to ensure a seamless admissions process for teens and young adults who need a higher level of care. We often speak one-on-one with professionals about specific program details, so they can get to know Newport and our approach. Clients’ treatment teams remain in contact with referring professionals throughout treatment and at discharge to ensure appropriate continuity of care. 

Newport’s experts can also provide support for referring professionals who are meeting parent resistance when they recommend a higher level of care. “Parents often need to be reassured that there is no shame in needing more support than what they can give their child at home,” Heather says. In fact, the time apart can actually support the process of rebuilding family harmony, she notes. Because parents and children are able to take physical space from each other after a difficult family therapy session, they may be more open and honest in the conversation. Afterward, they have the opportunity to separately process their experience before coming together again.

Understanding the many benefits of in-person care can help parents embrace the decision to move their teen to a higher level of care, or to support their young adult in seeking more intensive treatment. Families, referring professionals, and treatment providers must work together to ensure that young people find sustainable healing and move forward into a fulfilling life.