TAO's Founder & CSO Answers Questions about TAO
Sherry Benton, Ph.D., ABPP
Founder, Chief Science Officer, TAO Connect
First, who are the authors of this material and where are they getting their advice from?
I am the founder and chief science officer for TAO. I am responsible for organizing content experts and creating all content in TAO. I am a licensed psychologist with 30 years of experience and a strong identity as a psychotherapist. I am a fellow in the American Psychological Association, I am Board Certified by the American Board of Professional Psychology, I am the past president of the Academy of Counseling Psychology of ABPP, past president of the Association of Counseling Center Training Agencies , past vice President for Practice for the society of Counseling Psychology, and a board member of the American Board of Professional Psychology Foundation. I have a substantial list of publications in refereed journals and served as an Associate Editor for Professional Psychology: Research and Practice. I received the “Outstanding Contributions to Psychology” award from the American Academy of Counseling Psychology and the APA annual award for Advocacy.
I was the Director of the Counseling Center at the University of Florida and had one of the larges staff (89 direct reports) and largest budgets ($4.5 million annually) and still could not keep up with student demand. One year I received 4 new psychologist positions that only bought me 2 more weeks without a waitlist. It was clear to me that I was never going to hire my way out of this dilemma.
How TAO content is developed and evaluated:
All content in TAO was developed with a group of researchers and practitioners with expertise in the problem area and theoretical model under development. First, all published literature is reviewed, then an outline is reviewed, this is sent to the consultants, the outline is revised. Next, content is developed and storyboarded. These storyboards are then reviewed by the consultants. The storyboards are revised. We begin hiring actors, filming, creating animations, and interactive exercises. These are reviewed again and modifications are made. All sessions and modules are published and available for our users. Ideally, we would have followed this with randomized control trials, but we have not had the funding for this and we try to keep our costs down as much as possible. Instead all users of TAO complete a well-researched, reliable and valid progress measure weekly. We evaluate TAO using these repeated measures progress instruments and effect sizes benchmarked against randomized control trials in published studies. Results are disseminated to all users annually. In addition, all users have an administrative dashboard that displays utilization, satisfaction, and outcomes.
Each summer we review our results and plan modifications to the product. The product solicits feedback after every session and this feedback from students and users is essential in our product review and planning. Most of TAO’s content development was funded by grants from The National Science Foundation. All research in TAO is approved and reviewed by the Institutional Review Board at the College of Medicine at the University of Florida.
Why add TAO?
I completely agree that ideally, all students, and for that matter, all people, should have access to high quality individual psychotherapy. There is strong evidence for its effectiveness. I also believe that resources such as TAO should never replace individual psychotherapy and should not be used for people with severe psychopathology. However, we have a serious access problem in the US. Over 90,000,000 people in the US live in underserved areas, 56% of US counties have no psychiatrists, psychologists, or clinical social workers. The access problem became very real to me in my decades working in college student mental health. Despite having one of the largest and best funded counseling centers at UF we regularly ran with wait list. If a student came in at the beginning of a semester, they received individual psychotherapy, psychiatric consultation, and were offered resources such as group and biofeedback. In spite of these seemingly robust resources we would find ourselves overwhelmed by the early October and would screen for severity and put all but the most acute on a waitlist. This is the experience of the vast majority of university mental health resources in the US. This model was a social justice nightmare. Students who sought treatment in early August tended to be white, affluent, and came from a culture where family members regularly received psychotherapy. Students who came later tended to be first generation students, from low SES families and students of color. We were essentially bestowing additional privilege on the privileged and disenfranchising the disenfranchised. The consequences were dire. You are all well aware that with a common problem such as depression memory and concentration are impaired. If you make a student with depression wait 5-6 weeks to begin treatment it will affect academic performance. For graduate and professional students like yours this can change the entire trajectory of their careers. We have an urgent need to explore options for evidence-based resources that expand access and capacity otherwise we find ourselves primarily serving the affluent to exacerbate injustice. Incidentally, TAO is used extensively by graduate and professional students across the US and Canada. Our intention with TAO is to provide effective resources that can be used as an adjunct for psychotherapy or for lower intensity treatment. Using lower intensity treatment and self-help for those who can benefit, frees hours of psychotherapy for students who absolutely must have intensive individual psychotherapy in order to heal.
When I began my career as a psychologist the internet was non-existent, online tools had not even been considered. Now we have resources and possibilities that we have never had before. Given our historic failure to reach underserved populations and to democratize our knowledge and abilities, we have an obligation as a field to see what we can do to help people with these new resources. These efforts must be led by experienced mental health professionals and not left in the hands of software engineers with little or no mental health background.
Use of TAO across campus
This has largely consisted of the subset of materials that are primarily wellness oriented such as the Acceptance and Commitment Therapy which has very good research support as a resilience tool, the relationship and communication materials and the evaluating alcohol and drug use materials (BASICS). These are focused on early intervention and prevention, while materials such as CBT for anxiety and depression and substance use disorder recovery skills focus more on psychiatric disorders.
15 minute sessions
As stated, this model is for a subset of your clients. We have found no difference in the rating of the therapeutic relationship with the shorter sessions than with fifty-minute face-to-face sessions. This is consistent with published research on the model as implemented in Europe and Australia. For the subset of students who do not appear to be responding, TAO includes a weekly progress measure that can be reviewed by the therapist, which allows the therapist to move a student to a more intensive level of therapy when needed.
Our company name “Therapy Assistance Online” TAO, the double meaning of TAO was intentional, TAO is the way or the path to enlightenment. We believe that is our mission as a company. Deep psychotherapy is an important path to this, but it may not be the only path.
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