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  • Writer's pictureAmy Holder

Teletherapy: What's up with that?

Prior to March 2020, I never thought I would be able to offer teletherapy. Mostly because it just wasn't an option before then. There was limited technology to support teletherapy and almost no coverage from insurance companies. When I worked in behavioral health care management for a local insurance provider, I was often asked by members if video or phone therapy was covered. My vague response went something like, "It's not listed as an exclusion on your plan, but it's not specifically covered either". This basically meant that a therapist could submit their bill indicating they provided therapy via phone or video to the insurance company, but it was unclear if it would be covered.

Flash forward to March 2020, and a global pandemic accelerated the adoption of teletherapy and it appears to be a favorable option for clients, therapists and insurance companies. A survey conducted in spring 2020 indicated that 76% of clinicians were only treating clients remotely. The same survey reported that prior to the pandemic, only 2.1% of clients were using teletherapy services and this figure jumped to 84.7% during the pandemic.

It has been over two years now and I'm still providing teletherapy full-time from home. Most of my clients prefer teletherapy because of the accessibility and flexibility. The pandemic opened the door wide open for more online health services, making therapy available to many for the firs time. I have noted a significant decrease in cancellations and no-shows, which is also supported by the research.

Interestingly, research has indicated that teletherapy is as effective as face-to-face therapy and greatly improves retention rates, according the David Mohr, PhD. Other experts note that teletherapy helps to increase overall access to therapy and decrease stigma, making it an appealing option for many people.

Now, don't get me wrong, there is a secret ingredient missing from teletherapy - presence. This can not be recreated online and can be a powerful experience for both clients and therapists. I'm also aware that glitches and other interruptions can impact the therapeutic rhythm. When working in the office, I enjoyed creating a comforting and welcoming therapeutic space for my clients. But that doesn't mean you can't have success with teletherapy, it just means that a slightly different approach must taken and educating clients on what to expect is essential. When establishing care with new clients, I often go over several tips for engaging in teletherapy to ensure a positive experience.

Some of these tips include:

Find a safe and quiet place for sessions

With teletherapy, I cannot control confidentiality to the same degree as

with face-to-face sessions. I ask my clients to find a private space where

they can ensure they won't be distracted or interrupted if possible. If

something changes on their end, whether they are in a new space, or

other people are nearby (family members, roommates, co-workers, etc), I

ask them to notify me during session. I will not conduct sessions when

clients are in public or driving. I also tell them a little bit about my space and

what steps I've taken to ensure confidentiality.

Transition to the therapy mindset - be aware of what you have before and after therapy sessions

Teletherapy offers more flexibility with scheduling, making it easy to do

almost anywhere at any time. It also means that clients don't have the

travel time or time in a waiting room to mentally prepare for their

sessions. Many clients are jumping in to therapy during the work day or

between tasks, making it more difficult to get in to the therapy mindset. I

encourage my clients to consider what they have going on before and

after sessions to ensure they can both prepare for sessions and

decompress afterwards if needed.

Because we are missing the ingredient of presence in teletherapy, clear

and direct communication is essential to ensure clients get the most out

of their experience. I remind clients that in some cases, it can take more

time to establish rapport with teletherapy and encourage them to ask

questions and voice concerns. I also remind clients that this is their

experience and that it will not hurt my feelings if they need to choose

another treatment provider for any reason.

Teletherapy might not be right for every client, or every therapist for that matter. As a provider, when I get to the end of my work day, I sometimes feel a type of exhaustion that is different from the exhaustion felt when providing in-person therapy. Sitting at a desk doing back-to-back 50+ minute sessions and staring at a computer screen can be taxing on the mind and body. It can also feel isolating working from home as a therapist without other colleagues to consult with or decompress with. These are all factors I take in to consideration when I think about the future of my therapy practice.

Overall, it seems clear that teletherapy is here to stay as part of the service array. There are limitations and benefits to both in-person and teletherapy, and should be weighed carefully by both therapists and clients. I'm not certain if or when I will return to providing in-person therapy, but my goal is still to continue providing a collaborative therapeutic experience to my clients and help them make meaningful changes and achieve their goals.

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