By Janet DiGiorgio-Miller, Ph.D.
Whether you have decided to take a hybrid approach or do all virtual therapy sessions you have come to find that there are challenges as well as benefits to telehealth. I moved out of my office on July 31st, 2020 after 18 years. It was a three-room, third-floor office space in a 1929 building with beautiful big windows in a bustling little town in New Jersey. It felt like a safe and secure place for my clients and for myself.
While I missed that office, I soon came to appreciate my home office with my furniture and my paintings and all the benefits that come with staying at home during the day. As my practice became totally virtual, I thought that I would begin to write down what worked and did not work. I also asked my clients. The following are the challenges and benefits of virtual therapy. Please feel free to continue this blog by posting your thoughts.
Telehealth presents challenges for both the provider and the client. Probably the most challenging issue is working with young children. It is difficult to keep their attention by just talking. Usually, when you are working with a child you have some play materials to assist in the conversation. This is a task that is exceedingly difficult to replicate virtually. In addition, teenagers may be viewing more than one screen at a time or multitasking. When this issue presents itself, it is good to address it and ask the client if they are attending the session. Another issue that I found is that you cannot see the whole person’s body and sometimes cannot tell if they gained weight/ lost weight or are fidgeting and or distracted.
The biggest challenge for some clients is to have a private conversation and worry if they are being overheard. This concern has led some to clients doing sessions in their car.
Another challenge is that parole officers will not allow a client to use the Internet to have a virtual appointment. Some clients have had their attorney lobby for this privilege and other clients must use the telephone to have appointments.
As we all know, you can have technology/internet issues. It is helpful to watch YouTube videos of the technical issues and find tips there. It is also helpful to remind ourselves that we as well as our clients are learning more and more about technology. So, I tell myself to be patient (with myself and others) which is one attitudinal foundation of mindfulness.
The biggest benefit by far is the convenience for clients. Therapy is now available for any client who has 45 minutes to take out of their day. Previously a client would have to find a therapist in their area, drive to the therapist's office, park and/or pay, find the office or suite, and then drive back to home or to work. Instead of taking 45 minutes to find a private place to talk clients have to take at least two hours out of their day to have a therapy appointment. It is easier for clients who work a regular job or work overnight to find 45 minutes. It is also easier get approval from their supervisor to leave for 45 minutes as opposed to two or more hours. They also save money on gas and parking. In addition, if a client forgets their appointment, I can text them and remind them and we can have a session instead of missing an appointment. I can also text clients to remind them of their appointments. Or if the client cancels an appointment at the last minute, I can fill the slot with someone who is waiting for an appointment. Another benefit is that client does not have to find childcare to attend their appointment. I had one client turn the camera away and breastfeed a baby while she was speaking in therapy.
Teens and millennials are extremely comfortable using the computer as a forum to talk. Many times, I see adolescents and young adults in their hoodies, on their beds with a cup of tea talking. In fact, some people eat their breakfast and lunch because they are in a hurry to get to work or to get back to work. I have noticed that you can see a person’s personality when they are talking from different parts of their home. You can ask them about their surroundings to get to know them better. It is also a perfect forum for clients who have been in your care and then go off to college in a different state. They have continuity of care since telehealth. You can also invite other family members to join a session.
Another benefit is you can see different people throughout your entire state/territory as opposed to having geographical limitations regarding clients coming to your office. That means the expertise is spread throughout the state or territory. This is extremely helpful since therapists with expertise in treating sexual abusers are few and far between. Another benefit is that you can evaluate and treat clients in a safe place.
Telehealth is ideal for anxious clients. Clients who have anxiety are worried about getting to the office, finding parking, being on time, and then having to settle down to discuss their anxiety in therapy.
You can still use certain tools such as reading cards, sharing screens to test clients, and showing books to suggest that they read. You can also meditate virtually. You can do your progress notes while talking to a client in a discreet manner. You can also refer to the last session notes to have a point of discussion if needed.
One unexpected benefit is that the US government is supporting telehealth by waiving copays for mental health for most insurance companies
Some clients find telehealth extremely convenient and useful however some clients indicated that they like in person sessions because it is a space for them to feel safe talking about their issues. One client told me that on one hand “It is a designated safe space to have a conversation however due not having it, it allowed me to work on several safe spaces (in and around) my home to talk.”
It is nice to be able to eat healthy food and have no commute. It also a pleasure that my husband is home more often. I can come down to my office at any time to do my work instead of having to drive anywhere. All my documents are in one place. I have more time to balance my work and self-care.
To summarize, I have found that telehealth primarily benefits clients. I do not see a difference in live or virtual therapy regarding rapport with clients or having them open up to discuss their issues. In fact, they seem more comfortable in their own home discussing personal issues. In addition, they do not have to worry or stress about getting to an office. Regardless of the shift of their work they can find 45 minutes a week to be available for a therapy session as opposed to over 2 hours if they would have to leave their home and go to the office.
I have chosen to continue doing telehealth as it is the best option for clients and has the added bonus of being home. Another major advantage of staying home is saving money by having no rent or additional expenses related to having an office, and less wear and tear on my car.
The lack of commute is a definite bonus.
I think telehealth is convenient, benefits clients, and is here to stay. So, embrace the change, notice the benefits, and enjoy.