My Case for Telehealth
Do you remember the end of 2019? We all ended that year in trepidation.
At the pandemic's start, a sense of dread gripped the globe, with many people believing it had an established beginning and foreseeable end. So as we all said goodbye-for-now and playfully joked, "see you in a year!" no one ever really thought that two years later, we'd still be living in this hybrid world—the new normal.
This new normal is full of interesting short- and long-term safety strategies that include returning to in-office work, partial in-office and remote work, full-time remote work, and telehealth (specifically Telepsychology for my branch of healthcare). And while we're all trying to figure out our stance on how scientifically sound these options are, I, for one, can tell you that I'm a big fan of telehealth and hope that it's here to stay.
So as large corporations push return-to-office, I'm okay with pushback from those still concerned over COVID transmission as well as those who prefer to do important things—such as work, school, or psychotherapy—from the comfort of their home. To help you explore telehealth, I have assembled a mix of my opinions and best practices for telehealth informed by my experience as a psychologist and professor who converted his therapy practice and curriculum online to address the global plague for the past two years.
My Case for Telepsychology:
Some advantages I’ve seen with the push to telepsychology:
Telehealth granted access to care for millions of people.
Thanks to the shift to telehealth, many people that previously couldn't meet with a therapist because the commute was a challenge due to limits in mobility, transportation, or the client's concerns at hand (like with Agoraphobia, Social Anxiety, Seizure disorders, Dementia, etc.). One more bonus is no more traffic or parking hassles! (This is huge for us, Angelenos).
Clients now get to show us, therapists, the environment they live in.
Whether clients are consciously aware or not, the background they show me is very telling of who they are, how they value this time, and their commitment to this process—all of which is rich clinical/diagnostic information that helps me help you.
Having the ability to see clients’ environments helps paint a picture of your day-to-day life. Now we online therapists get the privilege of being taken into people's homes and seeing the life clients always talk about.
Bye, bye weather delays.
Us Angelenos also can't blame the rain for missing appointments anymore! And in places that have snow days, I'm sure it's a bonus not to have to deal with the anxiety of driving on icy roads.
New welcomed behaviors from clients & therapists.
I've seen clients be more likely to take their own notes during sessions. And from my end, when a client brings something up I'm not fully knowledgeable on, I can Google it on the spot for them with permission! The share screen features that most video conference platforms have are also helpful for both therapist and client.
Better time management.
Fitting therapy into one's work schedule is more manageable with telepsychology. Given that all you need is WiFi and an electronic device capable of video conferencing, there are fewer obstacles in the way of you and a better version of you. You can get therapy from anywhere and more easily uphold time boundaries regarding your sessions.
In addition, couples therapy, group therapy, family therapy, and collateral sessions can be easier to coordinate online; the Internet has room for everyone to fit in a session now.
Telepsychology is more compatible with manualized therapy.
The use of workbooks, multimedia, and worksheets can flow better when the treatment is online. Some of the worksheets I use in my online therapy that you can download are here.
More accessible guided meditations.
The guided meditations I provided in-person but record now translate well to live virtual sessions. Click on the video below to try out one of my recordings from live sessions.
You can find more of my meditation videos—like the one above—that you can access for free on my YouTube channel.
Some disadvantages I’ve encountered doing therapy online:
Comfort is a challenge.
Some people can't find a comfortable space, or others may be in earshot due to small living spaces or restructured work-from-home situations where interruptions are highly likely (e.g., landlords, neighbors, kids, pets, etc.). Additionally, eyestrain is also a concern (especially for people who spend all day on a computer).
Technology access and issues.
Navigating video conference platforms can be challenging (I've used like 6 different ones since 2016!) when you have access to them. Still, sadly, not everyone has access to the internet or stable WiFi, so classism plays a significant role.
New problematic behaviors.
The in-person person-to-person connection can be hard to achieve virtually. Some clients report difficulty feeling engaged with a digital barrier between them and their therapist. And if that wasn't enough to throw a session off, there's the case of the "zoom bombers" that are a rare annoyance now.
Some tips I’ve given my students for doing therapy online:
Lighting is everything.
This may be the "L.A." in me, but lighting is everything when creating a space where the client can see you. Remember not to be backlit; otherwise, the client is talking to an ominous voice with a corona. Light rings have been ideal for good lighting. Also, periodically focus on the camera lens and adjust the microphone settings to a strong filter for background noise and session note typing.
Run tech checks.
Make sure your software & hardware is up-to-date beforehand. We don't need software updates interrupting this valuable time, and have a contingency plan for emergencies and technical difficulties!
Create an inviting setting.
Keep your therapy space sacred, and don't let anyone hear or be near your sessions. It's essential to designate an area for your sessions to help everyone feel anchored in the work.
A few more things to add to your checklist:
Clarify any note-taking, so clients know you are engaged in the virtual session.
Make sure telepsychology is addressed in the consent form or added as an addendum as soon as possible.
Discuss privacy and cyber security with clients as soon as possible.
Always use HIPPA-compliant software (willing to provide proof of BAA) along with a reputable electronic medical record and billing system.
Acknowledge the "ESPN Effect" when multiple screens are in the virtual therapy space for both parties.
Some tips for clients who receive therapy online:
Be present.
Therapy sessions are for your benefit, so don't multitask during that time. As hard as it may be (especially is the new normal), try not to eat, check emails, social media, or texts during your sessions. It not only distracts you but also takes away from session goals.
Honor your session.
I mean this with love, but alternatively, we know when you've allowed someone else to be in your space to hear our sessions. Confidentiality works both ways. Alert your therapist beforehand if you want to include others in your online session.
Use reliable tech.
Wireless headphones can be tricky, so maybe stick to cord headphones, at least for therapy, to ensure that the session runs smoothly and without avoidable interruptions. Also, remember to keep your charger handy if you're using a laptop. The last thing you want is your computer to shut down in the middle of a session. If you're doing your session in your car, be mindful that there may be a lag with Bluetooth audio connection.
Set boundaries.
People with overbearing parents/lovers may be eavesdropped on, so setting boundaries with the people you live with is essential.
Set up for success.
Therapists not only listen to clients, but they also pay attention to how it's said. No detail is too small, so it's important to set up a space that has good lighting so that your therapist can always see you. Remember to always ask your therapist for consent to record any content of your sessions.
Dispelling some myths:
Myth 1: virtual sessions aren't the same.
The digital therapeutic space can get as intimate and serious as in-person sessions. I've seen clients experience the gamut of human emotions just the same, and even some clients who started off in-person and then transitioned to virtual therapy have forgotten therapy was online at times.
Myth 2: therapists can't pick up on nonverbal cues.
Many clients think we can't pick up on other nonverbal cues (like nervous knee-jerking, for example) as we could in person before. Oh, but we can. The face tells it all. And if you feel your body is telegraphing something you think your therapist isn't picking up on, bring it up.
Closing thoughts (that are subject to change):
I have to remind myself that Sigmund Freud himself had to roll with the punches during the pandemic of his time. And while I can’t say definitively that telehealth will be the next evolutionary leap for psychotherapy to replace traditional in-person therapy, I cannot deny the convenience, utility, and nominal drawbacks telepsychology has provided my own clinical practice and teachings over the past two years.
I would love to hear what you, Dear Readers, have to say as either the providers or consumers of online therapy in the comments below. This helps me continually learn and polish my skills!