Is Telehealth Right For Me?
Since the COVID-19 pandemic, telehealth services have been flourishing. All throughout the world, doctors, nutritionists, primary care physicians, specialists, and therapists are meeting with patients via screen to screen. COVID has certainly allowed health care providers to seek alternative ways of evaluating and treating patients who can not physically come into the office. This has also been true for mental health providers. Pre COVID, there were several online platforms providing psychotherapy virtually throughout the nation. Post COVID, hundreds of clinicians in private practice have decided to switch to fully virtual practices. Others have been successful at being hybrid in their work. Some clinicians have begun to get licensed in different states simply to be able to see clients who live in various states, because the ability of having a remote practice allows them to do so. Although this transition to tele-therapy has been a positive experience overall, this has also created a huge controversy among us mental health providers and the individuals we work with.
If telehealth has been great overall, then what is the issue then? Well. A lot of older, more traditional therapists have been providing therapy in person for years and years. They’ve learned techniques and clinical skills that work, but they’ve only been used in person. That’s all they’ve ever known. Any other way of providing therapy just seems to be foreign and uneasy. These therapists are also not usually as tech savvy either, which also creates friction when navigating through technological difficulties that notoriously come with telehealth work. This in person approach to therapy is highly respectable, and yes, there is evidence to prove that this has worked for patients all throughout history.
In contrast, newer clinicians, or ones that are, what I like to call, “Post Pandemic Clinicians,” such as myself, have actually learned skills specifically that work for telehealth services. Since I went to graduate school during the pandemic and completed a fully online program, aspects of engaging clients in teletherapy were included in my curriculum. When I started doing therapy, my first few sessions were on ZOOM. I learned how to make it work, and am skilled at being able to assess and evaluate through an online service. Additionally, I have learned techniques that work with teletherapy clients, and how to engage clients through a screen. I also can evaluate when a client is an appropriate candidate for telehealth services, versus when they would benefit more from in person therapy. Hence, even though my private practice work is fully remote right now, I only take on a specific age group and clientele that feel telehealth is doable for them.
So, how would a candidate for telehealth therapy be defined? Certainly, there are pros and cons to be weighed when assessing whether or not teletherapy is appropriate for you. Remember, there’s no right or wrong. It’s purely preference, looking at what the client is looking for and what feels would be the most beneficial for them at this time. Let’s look at the pros and cons, both of which are relevant to both clinicians and clients in the teletherapy world.
Pro: Teletherapy is convenient. Commuting creates extra time that a lot of clients (and therapists) may not always have. You don’t have to drive to an office or rush to get there. You can even go to a private room on your lunch break and have a session at school or work if necessary.
Con: Teletherapy may not feel as private. Teenagers especially may have difficulties doing telehealth sessions when their parents are home because they may fear someone is listening to them. It may not feel as safe. Similarly, there’s also no separation from the therapy room and your living space. This can feel odd and uncomfortable from some clients who actually prefer to have a separate space to go to that’s dedicated to them for an hour every week.
Cons: It’s not that effective for children. Fortunately, there have been new, creative therapy games and activities developed online as a way to accommodate children and keep them engaged in sessions. However- and some clinicians may disagree, I do not believe that any therapy other than in office play therapy is appropriate for children under 8 years old. For a year, I worked in a counseling clinic where I primarily saw children and preteens. From there, I learned how important it is for children to communicate their feelings through play. There’s also something to be said about them having that space away from their parents to process their world. They need toys. They need coloring utensils. For this reason, as a telehealth therapist, I do not see children anymore.
Pro: It’s great for college students. Since the majority of my caseload consists of college students, I can attest to the ways they have expressed appreciation about being able to see me throughout the entire school year, and not having to take a break in the summer and vacation months. College students can conveniently pop onto a telehealth meeting in between classes, rather than having to drive to a therapist’s office and maybe not making it back in time for class. Telehealth allows them to be flexible with therapy appointments and not have to change therapists multiple times a year based on whether they’re home or away at school.
Con: There’s always technological issues. Truthfully, I’d say this is the area that I like the least. I work from home, and my house has horrible service. On days when there is a storm or the wifi is choppy, I lose phone service. I don’t have a way of communicating with clients. Not to mention that I have also lost power in the middle of an intake. Most sessions, there is some sort of sound issue or issue with choppy connection. When this happens, this feels embarrassing and unprofessional to me. Clients usually understand that if they’re agreeing to telehealth, these things happen, but it certainly doesn’t mean it’s not frustrating when it cuts into the time they’re paying for.
Pro: It’s easy to access. As I mentioned before, teletherapy services allow people all over the state to meet with clinicians that are a good clinical fit for them. Telehealth increases access to services and clients may not feel as limited in who they “have” to see. It allows leeway in deciding a therapist and reduces the possibility of “having to settle” because there’s no one else in their area taking clients. This is especially difficult for people who live in small towns, or very rural areas. With telehealth, rather than driving an hour to an appointment, these individuals can see a therapist from NYC or Westchester without having to drive anywhere! In fact, I have had tons of clients who want to have sessions while on vacation! Sometimes I have to actually encourage them to enjoy themselves and take a week off from therapy, but hey, I appreciate the enthusiasm and dedication!! It’s awesome, and it’s something that can only happen through telehealth.
Pro: It makes therapy a more relatable experience. I always joke and say that being a telehealth therapist feels similar to being a realtor. Seriously! I see different areas of client’s houses, and I get to meet their pets! This also provides me the opportunity to bring in another, relatable part of myself when I have sessions in front of my wall of guitars. It gives me the ability to connect with clients in a different way. Yes- this part is the part that’s less traditional. Some therapists don’t feel comfortable with showing any of their stuff in the background and put a virtual background or blur it out. This is totally up to the therapist’s discretion and is a respectable decision. However, with therapists like myself who excel at using personality to build a strong rapport, it is nice to be able to show off a bit of my space. This also helps remind clients that yup, I’m a human! I’m not a robot and I don’t live in some creepy underground tunnel!
Con: It neglects many nonverbal forms of communication. Sensibly, body language is an important part of a therapist’s assessment. And yes, unfortunately, with telehealth, you can not see as much of the client, so therefore you can not see as much of the body language. Arguably, when therapists are against telehealth services, this is the biggest reason why. Of course, it does create its challenges. However, on a positive note, therapists are able to focus intently on things we can see, like eye contact, eye rolls, facial expressions, hair twirling, fidgeting behaviors, etc. We still can gain valuable insight from this.
Con: Telehealth is not appropriate for serious psychiatric illnesses and safety concerns. Those with more serious diagnoses are always encouraged to see in person providers, or if necessary, seek day treatment centers. Similarly, those who are actively suicidal also are not the best candidates for online therapy due to safety concerns. Sure, if a client expresses a plan of harm, therapists can call the necessary authorities, but they can’t physically be with a client. This is a major turn away for practitioners, as we do have to be selective in the clients we take on via telehealth for certain safety reasons.
Pro: Clients often feel more comfortable expressing themselves in their own environments. To be honest, I’m not sure why this is, but I have noticed that 9 out of 10 clients are significantly better at expressing themselves in telehealth sessions than they are in in-person sessions. I think in part, it’s because clients are usually home, in a familiar area where they can easily use their coping skills right afterwards. Oddly enough, in my own therapy, I have yet to cry during an in person session, but in telehealth sessions with my therapist, the tears are quick to come out like a waterfall! This has been true for my clients as well. I truly think it’s interesting how this works and I wonder if there is founded research on this.
All in all, I have found more clients to feel positive about telehealth than not. This is also remembering that I work with young adults and teens, who tend to be more comfortable with technology than older adults. If you are someone who feels the cons of telehealth outweigh the pros, I understand. If you are someone who feels the positives outweigh the negatives, I also understand! It really does boil down to personal preference of both clinician and client. Either way, I hope you find the right therapy platform for you!
