review: talkspace

A few months ago, I changed health insurance plans and my new insurance was not accepted at my therapist’s office so I was being charged about $100 per session, which honestly isn’t even that high but I just couldn’t afford to keep going on a student budget. After months of neglecting my mental health and reaching somewhat of a breaking point, I started looking online for remote therapy alternatives to traditional in-person therapy and talkspace was immediately on my radar.

Disclaimer: everything I’ve written below is from the perspective of a consumer and not, in any way, medical advice. 

What talkspace is about:

Therapy for how we live today

Introducing Unlimited Messaging Therapy, affordable, confidential and anonymous therapy at the touch of a button. Your professional licensed therapist is waiting to chat with you right now, and help you make a real difference in your life. You can message your therapist anytime and anywhere, from your smartphone or the web, 100% safe and secure. Welcome to the wonderful world of therapy, re-invented for how we live today.

When you first go onto the website you go through a free initial assessment with the therapist on that ‘shift.’ The assessment honestly isn’t their strongest point – it feels a lot like the messages are just copied & pasted and that they’re just feigning empathy regarding why you’re pursuing therapy, if you’ve ever done therapy before, etc. Eventually this person sends you a form to fill out, a lot of which you’ve already said so you end up repeating yourself. There’s also a place on the form where you can write any preferences for your therapist (male/female, younger/older etc.). I believe that part of the reason it sounds scripted is because, legally, they have a very narrow set of language they’re allowed to use in their assessments.

After that, you select a payment plan – paying monthly, quarterly (for 3 month period) or annually (for the whole year upfront). The longer the period you pay for, the cheaper it comes out to be per week. Initially, talkspace started as just messaging therapy but they have now added a live session component and each video chat is about 30 minutes. The unlimited messaging only comes with a complimentary ten minute live chat as a way to ‘meet’ your therapist before starting your journey together.

These are the current plans that are available for one-on-one private chat:

  • $32/week of Unlimited Messaging Therapy (billed as $128 monthly)
  • $43/week of Unlimited Messaging Therapy + 1 Live Session (billed as $172 monthly)
  • $69/week of Unlimited Messaging Therapy + 4 Live Sessions (billed as $276 monthly)
  • Couples therapy is available for $189 per month or $499 per quarter (12 weeks).

Finally – after about a day – you are paired with your therapist and you start therapy. The first couple days are mostly your therapist reading through your initial assessment and asking questions to get a better idea of where you’re at in life and get an idea of what your goals are with therapy. Then gradually you’ll start working on specific issues and moving forward. Unless you have an alternative arrangement with your therapist, she/he will check your chat two times a day during the weekdays and not at all on the weekends. Initially, it may feel like you’re moving really slowly, especially if you’ve done the traditional 50-minute therapy sessions but one week of chatting on talkspace should be considered equivalent to a traditional session.

When I first started working with my therapist, I felt that the focus of our conversations was shifting from where I wanted it to be so I just talked to her about it. Initially, it felt like she was offended but we completely cleared that up during our introduction video chat. She actually stayed in touch with me during our first weekend working together because I started therapy on a Friday. Additionally, if you feel like you’re not meshing well with your therapist, you can simply request someone else. So far I’m really happy with my experience on talkspace and finally feel like I have a consistent source of help. Below I’ve shared the reasons I think this platform is absolutely perfect for young professionals, especially those of us in medicine.

  • Access. I love that I can literally text my therapist whenever I have an experience I need help processing or figuring out the best way to approach a specific situation. With my previous therapist, I would not be able to get an appointment with her until at least a month after I called. Right now – I’m going to be in Florida, away from pretty much my entire support system, studying for what’s probably the most difficult exam of my career. Having someone who can provide insight during trying times – literally in my back pocket – has removed a lot of the anxiety associated with living in a new place, surrounded by new people, overcoming this hurdle.
    During the clinical years of med school and residency, I will likely have several days when I start working before any therapists’ office is open and leave work after all therapists’ office close. Having the freedom to text my therapists at any time, day or night, makes it so much easier to get help when you’re working that ridiculous schedule – when you often need therapy the most but can’t access it. Additionally, you’re not limited by geography – even if I move to Vermont for residency, I can continue working with the same therapist remotely.
  • Time. When working or studying all week, the last thing I want to do is drive twenty minutes to my therapists’ office and talk to her for a whole hour about things that have added up since our last session. Sometimes I feel like a 50-minute session is too long and I don’t even have enough to discuss and other times it feels like the time just flies by and I have to wait until our next session in 3-4 weeks. I can start messaging my therapist about something and I’m able to say as little or as much as I want (or have the energy to) at my own pace.
  • Referring Back. Unlike with traditional therapy, unless you’re taking notes, you can actually refer back to exactly what your therapist said in your conversations, even after you’ve ended your subscription. So if something similar happens in the future, you can refer back to your conversations and regain that insight.
  • Continuity. I started using talkspace during a difficult time in my life when I needed help to best process and prioritize my life to set myself up for success on this exam. But after I’ve passed this exam, I may not need to work with a therapist for a few months or even a year. I can stop paying for my subscription with talkspace as soon as I feel I don’t need it and if I have another difficulty arise in my life, I just open talkspace back up and continue working with the same therapist. Those of you who have worked with multiple therapists know how exhausting it can be to repeatedly tell your story to someone else, over and over again so it’s incredible that I can just continue working with the same person!
  • Long Term. A career in medicine comes with many, many emotionally challenging times. The first two years are a marathon of constantly feeling like you need to prove your worth and taking test after test. The rest of medical school is that but also facing the realities of medicine: death, dealing with insurance companies and difficult patients, etc. It’s a life time of helping people through some of the most difficult times in their lives and we’re somehow expected to handle it all without seeking help ourselves. Talkspace allows you to stay with the same therapist throughout your years in medicine, even if you travel all over the country for your training.
  • Long Distance Couples Counseling. Many ‘medical couples’ or couples in which both people are pursuing rigorous careers often find themselves in a long distance relationship at some point in time. And while long distance comes with its own challenges on top of the challenges of learning how to ‘life’ with someone, traditional counseling is not usually an option because of said distance. We haven’t used this aspect of talkspace yet but if it’s as promising as individual therapy has been, it would be worth a try – especially for long distance couples.

You can read about how talkspace protects the privacy of their clients here and about how the select the therapists available to work with on the website here. In doing my own research about reviews on talkspace, I came across several that were concerned about the text-only basis of the therapy especially since a healthy connection is a vital part of working with a therapist. However, I do think that some of these issues are addressed with the availability of live sessions and ability to send voice and video messages to your therapist. Here you can read some pros and cons of talkspace from the perspective of both consumers and therapists working on the site.

Todd Essig, psychologist and a writer at Forbes, has shared his mistrust of talkspace here and more recently here. I do agree with some of the points he makes, especially the points he makes about the limitations in your therapist’s ability to respond in the case of an emergency. For that reason, I do believe that talkspace is not the best platform for those with acute mental illness in a current state of crisis. In that case, immediate and acute intervention should be sought at the nearest psychiatric institution with extensive follow up with regular in-person sessions. However, for those of us who have been managing our mental illnesses and need additional help in doing so, this can be a great and convenient option especially when there’s no realistic alternative.

If you do decide to try out talkspace, you can get $50 your first month by using my referral link. Full disclosure: I will also receive $50 off a month if you do use that link but that’s not at all why I’ve spent hours on this post and this post is not, at all, sponsored by talkspace. I’m truly passionate about future health care professionals taking better care of themselves and I believe talkspace is a great option that removes many of our barriers to mental healthcare.

Have you tried talkspace or any other online therapy platform? What has been your experience?

edit: here is a more current comparison of betterhelp vs. talkspace by zencare.

on mental illness in med school

As mental health awareness comes to an end, I wanted to address something very close to my heart: mental illness and reducing the stigma that often comes with it, especially in health care. I’ve suffered from depression and anxiety for, well I don’t really know how long but I was officially diagnosed with both during my first year of medical school. It was a really difficult time for many reasons and I just couldn’t deal with it on my own anymore and decided to get help. I was really hesitant to do so at first because I was worried about being perceived as weak, that I couldn’t handle medical school and the challenges that come with it. It’s so, incredibly, heartbreaking how many health care professionals we lose, both practicing and in training, to suicide each year. We’ve made progress on dealing with the lack of support for our community when it comes to mental health but we still have so much work to do. So much of why I want to go into academia is to change the way we educate and train our physicians, to do it in a way that doesn’t require us to rob them of their humanity, compassion and ability to empathize with others.

Before I get into how I’ve dealt with both of these diagnoses while in medical school, I want to address how absolutely ridiculous it is that this stigma exists at all but especially in the field of medicine where we know and understand the pathology behind mental illness. We know that there are actual problems in the balance of our hormones. We know that it’s not just laziness or something you just ‘push through’ or ‘get over.’ So the first step in dealing with depression and anxiety in medical school is accepting that there is no shame in having a mental illness.

Think about it this way: anxiety and depression are essentially like having allergies, your body is overreacting to something it perceives to be threatening when it’s not really that bad. With allergies, some people’s bodies think peanuts are the equivalent of poison when there is nothing inherently dangerous about peanuts – as long as you’re not allergic. I’m eating a peanut butter granola bar from Trader Joe’s as I type this and I’m not going into anaphylactic shock – because my body doesn’t perceive peanuts as a threat but for others, it most definitely is. It’s the same with depression and anxiety – episodes can be triggered by things that may not seem that bad to people who don’t have mental illness. Some people’s bodies do not turn on them when they have to take an exam, or have to speak publicly or for no apparent reason. But I obviously would never judge my friend with nut allergies for needing an epi pen or avoiding triggers, right? So why do we do that to ourselves and each other when it comes to mental illness? Let’s just make a commitment to not think of it any differently – when it comes to us or to our friends or our patients.

So now for tangible advice and steps you can take if you are dealing with depression or anxiety – and please keep in mind this advice is from the perspective of someone who has dealt with these issues, not as professional medical advice.

  • Find a therapist you trust and feel comfortable with. This can definitely be tough because it takes a certain level of comfort and trust to be able to discuss what you need to discuss with a therapist. I would recommend starting with counselors at your school if that’s an option since they usually understand at least some of the struggles students face. And I know that it can be exhausting to jump from therapist to therapist and repeatedly telling your story to a stranger but it’s worth it when you find someone you can really talk to. Yelp is a surprisingly great place to read reviews for various therapists. And it’s a good idea to go into each session with an idea of the topics you want to discuss and issues you want to work on. This link has really helpful advice on how to approach your first session with a therapist.
  • Don’t be afraid to try medication. Like we talked about above, there’s no shame in your Zyrtec game and there shouldn’t be with Prozac (or any other medication) either.
  • Prioritize your health and well being. We all know that we should take care of ourselves but how many of us actually prioritize doing so? Because we need to, especially if you’re dealing with mental illness. I find exercising regularly to be really helpful and I’ve recently also started doing yoga (at home with Yoga with Adriene), which has also been great. Prioritize getting enough sleep, especially in the first two years of medical school when you have much more control over your schedule. Pulling all nighters is not a good way to learn and you need sleep to be able to retain everything you spend hours studying. I also find that limiting my caffeine intake really helps keep my anxiety symptoms away so I’ve tried to stop drinking coffee on and off for the past few years. Try limiting it as much as you can! I’m not a fan of cooking so eating healthily can be difficult but I try to buy preprepared frozen meals made by companies like Evol Foods and Sweet Earth Foods because they provide healthier options. And if, even for a second, you start feeling ‘selfish’ for taking care of yourself remember:

    ‘Caring for myself is not self indulgence, it is self preservation and that is an act of political warfare.’ – Audre Lorde

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  • Get a furchild. This obviously isn’t for everyone but have Kohl in my life has made the struggles of 2016 so much easier to deal with it. There’s something about a tiny kitten purring on your lap that makes you feel like it’s all going to be okay. So if it’s something you can do, consider adopting a kitten or puppy. It’s amazing how they just know when you’re not doing well or need extra cuddles. He’s been the source of my sanity through studying for remediation and boards.
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  • Spend time in places that inspire you. This can be as simple as going to your local coffee shop to study or planning a weekend getaway with your significant other/a group of friends. Changing where you are makes coming home feel so sweet and reenergizes you to continue doing what needs to get done. And making time for fun things is so important – you need it to recharge.
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  • Work hard when you feel good. The thing with both depression and anxiety is that they can sneak up on you. You can have an objectively good day and still feel completely miserable. So in a way, it’s important to ‘prepare’ for these episodes by being extra productive when you are feeling well. That way if you have an off day, you won’t fall behind because you prepared for it. I always have a game plan for studying for each block but because I know that some days are going to be better than others, I plan goals for each week (rather than each day). So when I have a day when I’m feeling down, I’m not really falling behind as long as I spend the day caring for myself and getting recharged so I can tackle tasks the next day and still stay on schedule. Having this flexibility has been really great for me and also reduces the guilt of ‘doing nothing’ on the days when I really can’t.
  • Spend time in service of others. There’s something so incredibly fulfilling in giving your time or skills to help others. If you’re in healthcare, a big part of why you’re here is because you have that innate need to be in service of others. So stay in touch with that by volunteering with your local free clinic or mentoring youth from underserved communities. Doing these things also really helps bring your purpose back into perspective. It helps you remember why you’re spending so much of your time studying and making so many sacrifices.
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  • Don’t be afraid to reach out to your classmates or friends. I can’t tell you the number of messages and comments I read every week from others in this field who share that they too are dealing with depression, anxiety or both. Don’t feel obligated to share this part of your journey if you don’t feel comfortable doing so but please know that you’re not alone. And if you do decide to share, realize that your recovery is going to look different from others’ so try your best not to compare. In this age of social media, it’s easy for us to think that everyone’s life is so much easier and better than ours but realize that most people just show the pretty parts. We’re all going through difficult times.
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  • Be kind and patient with yourself. This is something that I still struggle with. It’s so easy to fall into the trap of comparing yourself to others who seem to be much more productive or being angry with yourself for ‘being lazy.’ But realize that type of thinking is not productive in any way. You’re only prolonging this episode of deeper depression or anxiety by doing so. Your body is clearly telling you it needs a break or a change so spend an hour or so taking care of yourself and come back to your work. Treat yourself with the same compassion you’d show your patient who is struggling with similar issues.
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So much of why I started this blog and started speaking about my journey on Instagram is because I did not want anyone else to feel alone in the struggles that come with this journey. You are not alone. You deserve the best out of life and while we make many sacrifices on this journey, you should not sacrifice your health and well being in order to care for others. It takes some courage to seek help and take the steps towards recovery but it’s well worth the effort. You deserve a life where happiness is the norm, not the exception. You deserve a life that does not feel like a burden. If you won’t do it for yourself, do it for your future patients because they deserve a healer who has spent time healing themselves.

edit: here is an additional resource by zencare on mental health while in college.

our three winners

‘They three,
Taken early by he.
They three,
Are part of We.’

– In memory of Deah Barakat, Yusor Abu-Salha, and Razan Abu-Salha, by Amjad Hajyassin 

our three winners

 

A year ago today, we lost three very special people at the hands of a murderer. I wrote the piece below after learning of their deaths as an attempt to process their deaths. It’s been a year and I still don’t understand. In the past year, it feels like things have gotten even worse in the U.S. for Muslims. There are hate crimes reported every week. My sisters in faith are afraid to wear hijab. A frontrunner in the Republican party openly declared that he believes that Muslims should be banned from entering the U.S – and is celebrated for it.

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reflection: prison education project

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During my first year in medical school, I picked up The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander in an effort to get a better understanding about the prison system in the United States. While I had heard about the astronomically high rates of incarceration, I wanted to understand why things were the way they were. In the first chapter ‘The Rebirth of Caste,’ Alexander introduces the idea that the prison system is used as a legal and ‘politically correct’ means of slavery after emancipation of slaves. Under this system, law enforcement agencies are almost universally protected, regardless of their actions, and seemingly arbitrary (and often racist) mandatory minimum sentences exist for petty crimes. Throughout the text, Alexander also discussed the high recidivism rates within the prison system. She details many barriers that prevent inmates from reintegrating into society after returning to the free world including restricted access to employment and housing and severe parole policies.

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rights are rights

“The idea that some lives matter more than others is the root of all that is wrong with this world.”
– Dr. Paul Farmer

This past Sunday, I attended a training for the Prison Education Program at Cal Poly Pomona. The program is led by the amazing Dr. Renford Reese. After reading Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness and learning about the realities of the prison system in this country, I knew I needed to find a way to help. PEP aims to reduce recidivism rates in prisons by providing inmates with guidance and resources to pursue their goals after leaving prison.

At the training we, of course, discussed the logistics of the program, safety precautions, etc. But my favorite part of the training was when Dr. Reese brought up this idea of umbuntu. Umbuntu is the South African philosophy of ‘humanness’ and is ‘the belief in a universal bond of sharing that connects all humanity.’ Many of the struggles people face daily are structural and money needs to be used to create infrastructure to combat these injustices, but as Dr. Reese said during our training ‘Words are free. And if we believe that words have the power to hurt people, we must also believe that words can heal.’ And that’s what PEP is all about – creating a sense of umbuntu and recognizing that if anyone in our community is hurting, we are all hurting and we must actually do something to help.

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planned parenthood: the perspective of a woman and future health care professional

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Sabra Khatoon, my great grandmother, (pictured in the center of this photo) was truly the matriarch of our family. She championed women’s rights and ensured that all of her granddaughters pursued education at a time when not many women in Pakistan were encouraged to do so. And now her descendants are studying and practicing law, medicine, engineering, business, the arts and more all over the world. She truly embodies the sentiment that empowering women betters society overall. Thank you, Amma, for giving me so much of what I have today. Thank you for my mother who somehow, in a single lifetime, managed to get her MBBS, a masters’ in public health and a doctorate in epidemiology while being a partner to her husband, raising two children and now providing a loving home for many other nieces and nephews. Thank you for my father who always pushed me to be better and work harder because I am a brown woman and society already expects so little of me. And finally, thank you for my feminist identity.

On Friday, the House voted to freeze federal funding to Planned Parenthood. There’s been a lot of controversy as of late regarding Planned Parenthood after some videos that showed Planned Parenthood employees allegedly ‘harvesting’ fetal organs. Those proposing and supporting the bill claim that Planned Parenthood should not receive federal funding while an investigation can be done to decide whether these accusations hold any ground. It’s expected that the bill will be vetoed in the Senate by Democrats and is considered ‘symbolic’ of their beliefs by congressmen voting in support of it. And I fully hope that the bill is vetoed but, regardless, I am inherently uncomfortable with what this vote is supposed to be symbolic of. Here are some of the many, many reasons why:

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refugee crisis

Alan Kurdi, one of thousands of innocent lives lost in this crisis. His family has requested that this photo be used instead of the drowning one. This little boy sparked a fire under us when we became complacent about the atrocities in Syria and the current refugee crisis. Let’s not let the fire go out without doing anything to help the victims.

“You have to understand, that no one puts their children in a boat unless the water is safer than the land.” 
 Home, Warsan Shire

Enough is enough. Seriously, how is any of this real? I don’t understand how such atrocities can exist in this world for years on end and somehow the world keeps on spinning. I wish it didn’t. I wish it would just stop for a second so we could all be jerked awake to the many, many injustices that exist in this world. So that babies wouldn’t have to wash up on the shore for us to realize what’s going on. So fathers wouldn’t have to sell ballpoint pens on streets to make money to feed his family.

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