Online Therapy: Has Its Time Come? Lessons From MOOCs

Online Therapy: Has Its Time Come? Lessons From MOOCs

We live in a wonderful world of change and transition.

Thanks to online giants like eBay and Amazon, ecommerce transactions account for about 13% of all retail sales. That may not sound like much, but online sales are on the brink of exponential growth.

The important development is that online commerce accounted for about 49% in the growth retail sales (Zaroban 2018, Thomas 2018). Ecommerce is reaching an inflection or “tipping” point in which growth will increase exponentially. Those boarded up shops in strip malls might be around for a while.

This is why ecommerce is a “disruptor” of traditional retail sales – it creates disorder in advertising, selling and delivery of retail goods.

Lyft, Uber and Airbnb do not offer taxis or hotel rooms. The only thing they do is connect people who want transportation or lodging with people who have them and are not using them.

Now, anyone with a parked car or unused space in their home can put those resources to work. These businesses connect people who want to share their unused property for a price.

This very simple concept is upending taxi industries all over the world and has the hotel industry re-examining its basic business model.

Not all promising new technologies lead to disruptions of entire industries. New ideas that seem like they could turn an industry upside down sometimes simply flop.

For example, Segway was hyped as a personal transportation device that was going to force entire cities to redesign their transportation infrastructure. Never happened though. People never seemed very comfortable on the devices, and voted with their feet. The technology was cool, but there was no significant need for using a machine to replace walking, particularly in an era in which people pay personal gym memberships to access treadmills simply for the health benefit.

(Who would have ever thought gyms could create an income stream by renting the ability to walk for hours without going anywhere? We do indeed live in amazing times.)

Segway was an impressive solution in search of a problem. However, we should not ignore impressive problems looking for elegant solutions.

For example, NASA has been searching for a solution to the potential problem of astronauts experiencing mental health issues on long duration space flights. Distances are so vast that messages to and from Mars can take more than half an hour. Mars is relatively close. Communication with astronauts exploring the moons of Saturn or Jupiter could take considerably longer. Mental health issues require immediate responses from trained professionals, but that simply is not possible on long duration space flights.

One possible solution is Woebot, an application developed by Clinical Psychology researchers at Stanford University. It engages in conversation based on Cognitive Behavioral Therapy (CBT) to treat low-level depression and anxiety. It seems to work well, but also has some shortcomings, namely price and limited therapeutic outcomes. It seems to work best for keeping relatively healthy people on track, but returns diminish for long-term treatment or serious mental health issues. (See Harris, 2017 and Brodwin, 2018 for more information on Woebot.)

Of course, traditional therapists have been offering services via the internet for years. It’s a niche service, but fits the needs of many people. Advantages are that interactions can be more anonymous than face-to-face therapy, people in rural areas do not have to spend hours traveling to appointments and costs can be lower for those without health insurance.

The biggest problem, and it is getting more prominent, is the legality of offering therapy online. Mental health professionals are licensed by the state in which they reside, and are required to offer services only within the state in which they are licensed. Therapists can be licensed in more than one state but rarely do so because of the expense and added oversight. This puts a limit on market size and revenue generation.

The most interesting thing about online therapy is there is not much demand for it. People with serious mental health needs usually respond much better to medication than talk therapy. In the 1990’s new generations of drugs became available that replaced talk therapy with drug therapy. Drugs are more effective and a lot cheaper than talk therapy and many therapists found their contracts drying up. In response, they rebranded themselves as “life coaches” and shifted their competitive competency to offering general self-improvement training.

We see this reflected online in the many websites focusing on self-improvement topics. Google returns 270,000,000 hits for “relationship coaching” and 310,000,000 for “career coaching”. Clearly, there is a huge demand for informal, non-professional personal services addressing the general topic of personal improvement.

“Licensed online psychotherapy,” returns only 5,350,000 results. That might be an impressive number, but it is only a fraction of more informal services delivering a similar product.

Clearly, there is a huge demand for informal, non-professional personal services addressing general topics of personal improvement.

It is easy to find examples of personal services offered on the internet. There are plenty of platforms for writers to publish free articles about personal improvement topics. Short “courses” now seem to be the rage, ranging in price from a few dollars to a few hundred dollars.

Every one of these styles has one thing in common – the idea is to educate the customer in some way. They all have the goal of moving information from the person offering the service to the person receiving it’s like taking a class.

There is an important difference between psychotherapy and self-improvement. The demand that exists for coaching and personal improvement is different from that for psychotherapy. People seeking personal services for self-improvement are on a quest for knowledge, while those who seek psychotherapy are looking for relief from discomfort.

This is a subtle, but very important distinction. People searching for enlightenment are like students looking for knowledge. People looking for psychotherapy are like patients looking for a cure to their ailments. The search for self-improvement is active and student centered; the search for psychological relief is passive and practitioner oriented.

We need to look to education, not therapeutic interventions, to guide us to designing a platform offering self-improvement tools.

MOOCs are a disruptive web-based education system that never disrupted anything. Even though Massive Open Online Classrooms (MOOCs) failed spectacularly after a promising start, they offer lessons for creating a personal improvement online service.

The basic concept of MOOCs is still compelling: Free/Cheap Education offered online, delivered by real college instructors, using the same textbooks colleges and universities use. Anyone anywhere could watch real lectures by top academics at elite universities, read the same textbooks and take the same quizzes and tests, without paying a cent. Companies like Udacity and Concordia sprang up, hoping to expose waves of learners to passive advertising.

There was a lot of enthusiasm about MOOCs.

The force behind MOOCs is Sebastian Thrun. He was a vice president at Google, celebrated artificial intelligence researcher, and the designer of an early autonomous vehicle – Stanley. In 2011, Thrun got the idea of putting his Stanford University graduate level Artificial Intelligence class online.

This is not a new idea – online classes have been around as long as the internet and the concept have been around since 1957 when CBS began syndicating Sunrise Semester. For 25 years, professors re-created their college and university courses for anyone interested in watching.

The thing that made Thrum’s idea different is that he would offer his class online for distance learners at the same time he was delivering it in a lecture hall. He would simultaneously deliver the class to both an online audience, and traditional graduate students.

At first Thrun was very encouraged. More than 160,000 students from around the world participated in the online version of his graduate level AI class. Astonishingly, over 400 online students had outperformed the elite Stanford graduate students taking the traditional course. 

Bill Bennett, former Secretary of Education 1985—88, interviewed Thurn on his radio show, “Bill Bennet’s Morning in America” shortly after that first class. “Usually I reach about 200 students and now I reach 160,000”, said Thurn. “In my entire life of education, I didn’t have as much an impact on people has I had in the last two months”, (Bennett and Wilezol, 2013, pp. 196—197).

The possibilities, it seemed at the time, were endless.

Disadvantaged students isolated by economics or geography could access excellent educational institutions. People in the poverty-stricken industrial rust belts of North America or the most isolated parts of India, Africa or South America could be on educational equal footing with the most advantaged people on earth.

Costs of education would plummet. One course, no matter how massive, would require only one professor. There would be no need to pay for the construction and maintenance of lecture halls, labs and dorms. In the giddy early days of MOOCs wild predictions of turning unneeded campuses into parks, refuges for quiet reflection and collaboration sites for MOOC students we bandied about.

Student loan debt was, (and still is) at an all-time high. The high cost of education, made MOOCs the dream solution to a problem so big it was affecting home sales and presidential campaigns in the wake of the collapse of the industrial economy in 2008. The elusive “free education” touted by Bernie Sanders might actually be possible.

“People really want good education. There is a huge need”, Thrun said on Bennett’s radio show. “Hundreds of thousands of people just sign up because they really care. They really want to advance themselves and their lives, and they don’t want to pay $50,000 or $100,000 to get there” (Bennett and Wilezol, 2013, pp. 197—198).

It was not to be. 

Only a couple of problems. For one, nobody was interested.

Lectures are the most boring of teaching methods, and teachers are always looking for better ways to keep students engaged. A screen filled with someone droning on at a lectern is not very engaging. Students rarely finished a course, instead popping in for a few minutes, before popping out again.

MOOCs do not lead to college credits or degrees. It might be true that MOOCs offered the opportunity to get the same education as people seeking a bachelor’s degree, but employers recognize only degrees, not the effort that goes into earning them. Consequently, people do not go to school to learn; they go to get the degrees that the education industry promises will lead to good paying jobs.

This has led to confusion about the role of educational institutions. On the one hand, education has traditionally been about building competencies – teaching people new skills, knowledge and insights that enrich their life. On the other hand, the education industry has branded itself as the source of credentials needed to get a job. Education now struggles with balancing its identity as credentials authority with the traditional role as a source of knowledge and wisdom.

The self-improvement movement does not have to struggle with that contradiction. Our mission is to supply customers with the intellectual tools they need to find more satisfaction in their routines of daily living. The information already exists; now the challenge is to present in in a way that is effective in terms of satisfying the need for self-improvement.

What MOOCs Tell Us

MOOC Students are dramatically better education and older than typical under graduate students or average individuals in the United States.

In a recent meta study by Weinhardt and Sitzmann (2018) researchers found that of 34,779 participants in 24 MOOC courses at the University of Pennsylvania 60% were over 40, and 83% had a post-secondary degree. A similar survey at University of North Carolina at Chapel Hill found that 72% had at least a bachelor’s degree – more than twice the rate of bachelor degree holders generally found in the United States.

The same authors also found that MOOC participants overwhelmingly had concrete expectations regarding the results if their MOOC experience. Of 52000 students surveyed 62% reported learning skills needed at their current job and 64% reported learning important information for their degree program.

Beat Practices for Online or MOOC Delivery Systems

MOOCs and online education are not the answer to poor educational outcomes because the challenges are the same as in traditional settings: poorly prepared students and ineffective study habits.

Poorly Prepared Students

Students with a narrow wealth of knowledge, either within the disciple they are studying, or more broadly generally have a difficult time storing new information. Researchers do not agree on a specific cause, but it seems new information is more easily sorted when similar information is already learned. This is illustrated by the well-known learning curve, in which introductory courses are more difficult for students than more advanced courses. Perversely, graduate students usually find learning easier and do better than undergraduate students. Some of this difference is due to students self-selecting for graduate students that interest them, but there is no doubt that previous knowledge makes new knowledge easier to retain.

Consider learning a new language. In the beginning rote memorization of nonsensical sounds is very difficult. However, with practice new words become easier to remember and form into sentences because they start to make sense. This is because previously learned words make new ones relevant. One theory of learning holds that categories are learning aids. It is easier to learn a word for a new color if we already have previous words for colors in our memory, for example.


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