Teletherapy, Tumblr'd

Los Angeles therapist John Kim broke many of traditional psychotherapy rules when he built his entire practice through his popular tumblr blog. This week, the American Psychological Association will decide whether he’ll have to start following some of them.

John Kim

Charlene Corpus, a 35 year-old San Diego sales analyst, likes running errands wearing a grey hoodie emblazoned with the words “The Angry Therapist” in bright orange Helvetica.

“I like your sweatshirt. What’s The Angry Therapist?” a bank teller once asked her.

“He’s my therapist.”

The back of the sweatshirt, reads, in the same bold orange lettering: “Dream big. Listen more. Talk less. Eat clean. Get strong. Forgive often. Love hard. Live well.”

That blend of common sense, positivity platitudes and new-age wellness trends hardly sounds angry, but the title of the blog isn’t meant so much to connote its content so much as it is to provoke, and attract a young, Internet-savvy generation to psychotherapy.

The Angry Therapist is John Kim a 40-year-old Korean-American Los Angeleno who bills himself as the world’s first licensed Marriage Family Therapist with a “public” practice treating patients through a “growing online community.” He believes he is the first ever licensed therapist to build his entire client base from patients he first met on the Internet.

The site effectively harnesses the zeitgeist of internet culture – with its memes and hashtags and its oversharing – and pairs it with a variety of classic psychological approaches (cognitive behavior therapy, dialectical behavior therapy, psychodynamic, etc), to bring psychotherapy to the millennial masses. There are plans in the works for iPhone apps and themed community chat groups (e.g. one for twentysomethings, thirtysomethings, a divorce group, a nutrition group, etc).

This week, The American Psychological Association's (APA) will vote on a set of guidelines governing telepsychology. Experts believe that 80 to 90 percent of all therapy will be done remotely within 10 years. And while the association can only make recommendations that licensing bodies and state boards decide whether or not to adopt, the guidelines will aim to cover unanswered questions in the mental health community around telepsychology, such as murky interstate regulations and HIPAA compliance with technology. Kim’s own practice poses other questions, too: Can a growing online brand, and the necessary self-promotion that comes along with it, be an effective therapeutic tool?

What Kim began as a simple blog in 2010 is now a bona fide online brand, complete with support staff, grant funding, t-shirts, mugs, slogans, e-books and memes.

Three years ago, Kim was working as a counselor at a residential treatment facility. When he started The Angry Therapist, on the popular platform Tumblr, he was living with Craigslist roommates and reeling from a divorce.

Kim believes he was an angry guy earlier in life, but has since matured and grown. A lifelong LA resident and the son of Korean immigrants, he says his relationship with his alcoholic father was often fraught. He rides a motorcycle, loves greasy hamburgers, but is a Crossfit devotee with the biceps to prove it. He’ll tell you, in a blog post, exactly how he feels about being 40, divorced and single: “I did the picket fence thing early. Turns out those [expletive] things have splinters,” he writes. Now, he says, “I want [expletive] amazing, dizzy love.”

After logging years in L.A. coffee shops working on a screenplay, he decided to become a licensed therapist. He began a Tumblr blog chronicling career change and post-divorce struggles. One day, a Tumblr follower wrote him an email asking for advice on how to cope with a recent breakup. Kim wrote an insightful email back. The girl followed up, sending Kim an unsolicited $20 bill. Not long after, she became Kim’s very first client, and the site acquired a donation button.

The rest is every blogger’s fever dream: He quit his day job, had to start a waiting list of clients, started hiring a team to assist with marketing and product development as well as run his online groups.

Nearly one million page views, over 100 clients and over 3,000 tumblr “followers” later, Kim hopes he is giving talk therapy a needed image tune-up. Corpus and Kim say today’s twenty- and thirty-somethings are more open to therapy and self-improvement practices than their parents’ might have been, and that, paired with their tech know-how, could change the market of psychotherapy. A one-on-one Google Hangout session with Kim runs around $90 an hour and group sessions are $25 (like many therapists in brick-and-mortar offices today, Kim does not accept health insurance), but it costs just $9 a month to become a “member” of The Angry Therapist’s “community”: a word Kim uses often when describing the goals of his practice. Clients find Kim online – through their own tumblr blogs, through friends’ referrals on Facebook, through someone posting an Instagram of a quote from his blog. Kim’s clients are all over the U.S. and abroad. They are college kids with eating disorders, young professionals going through breakups and divorces, busy business travelers, even high-class escorts.

“I used to think of a typical therapist as the kind of person who tries to think they have all the answers,” says Richard Tseng, a 26 year old copywriter in Boston who found Kim through Tumblr and says he would not have sought out therapy to help him process a breakup otherwise. “John portrays that he is a flawed person and is doing the best he can to become a better person.”

The APA will debate this week whether practitioners like Kim should be allowed to cross state and country lines with patients without a license in each state; a literal interpretation of most state’s guidelines indicates that an online therapist might need it. Initial comments on July 2012 draft guidelines from the APA’s Telepsychology Task Force indicate most are in favor of removing potential regulatory barriers.

There are about 2.5 million licensed marriage and family therapists (like Kim) and psychologists (those with PhDs) who practice “telepsychology,” using tools like Skype, Google hangouts and blogs, according to Marlene Maheu, a therapist who runs the Telemental Health Institute and serves on APA’s telepsychology task force.

The technology itself poses its own set of questions and ethical quandaries. Under the Health Insurance Portability and Accountability Act (HIPAA), encrypted software such as Skype and Google are not considered secure enough for legal use in telepsychology, according to Maheu's TeleMental Health Institute. She encourages consumers to question any site that doesn't say it is HIPAA compliant, although she would not comment specifically on The Angry Therapist.

A licensed therapist will often call themselves a “life coach” to get around those barriers – a title that denotes a different sort of practice and comes with far lower barriers to entry (nearly anyone can call themselves a life coach). Kim says he’s both. He's a life coach when he wants to break therapy’s fourth wall by agreeing to meet someone in their home or take a walk around a lake; he’s a therapist when he wants to show that he’s a bit more credentialed than the latest self-help guru looking to make a buck.

Kim believes his approach is revolutionizing the therapy and mental health industry not only for the tools he’s using, but through how he conceives the role of the therapist. Millennials in particular, he says, see therapy as a luxury, are open to it, “but they want to know who their therapist is.”

“He gives me concrete things he wants me to do and work on when we don’t have our sessions,” Corpus says. She’s kept a journal upon Kim’s recommendation and has also participated in a seven-day “mindfulness” program Kim ran through his website, where he gave participants a simple activity each day to practice observing, rather than judging. “In that way, he’s like a coach.”

In California, where Kim practices, the law requires licensed psychologists to put their licensing number on their website. But Kim, who received his master’s in Marriage and Family Therapy (known as an “LMT” degree) from Phillips Graduate Institute in Los Angeles and completed training residencies in addiction and eating disorder residential centers, doesn’t include this information anywhere on The Angry Therapist.

“I believe my blog is my resume,” he says.

Kim isn’t necessarily breaking the law: telepsychology is so new, Maheu says, that most online practitioners like Kim are not aware of the standards, laws and guidelines governing their practices, and it doesn’t help that there are multiple sets of them a therapist could follow. The APA hopes to codify this in its guidelines, although the draft report made no specific recommendations. As of 2000 survey of state attorneys general by conducted by the APA’s academic journal Professional Psychology: Research and Practice, only four states had enacted any statutes regulating the practice of therapy or counseling over the phone or internet.

Kim typically doesn’t treat serious personality disorders or disabilities – among the problems experts say are nearly impossible to treat without in-person intervention. Since opening his online practice, he's not dealt with a serious mental health “emergency,” but suspects he'd deal with one as he would if he had a traditional practice, by giving referrals, asking for the phone numbers of relatives and friends. He concedes that “at the end of the day, there’s nothing better than in-person.” He does some in-person work in Los Angeles, including holding open group sessions at a Koreatown coffee shop.

But he shrugs off the concerns of traditionalists, like the many quoted in a 2011 New York Times story about the rise of telepsychology, the sorts of therapists who talk about “bearing witness” and mirror neurons.

“I’m not concerned with scientific angles because therapy and self-help is a humanistic process,” he says. “Without using this platform, I wouldn’t have reached as many as I have in the last three years. It catches all the people that would not have sought out help because the traditional way is too expensive, and inconvenient, and for some, evasive.”