Before COVID-19, there was no shortage of information and resources on how to improve your mood. With self-help books proliferating on the internet to the ease of obtaining support and guidance from professionals, there were ample resources that could be utilized in both daily and life-related struggles. The onset of COVID-19 brought many changes to the mental health field. Psychotherapy quickly evolved into teletherapy, which has quickly become a “new normal” in the field.
These new norms are once again leading researchers to analyze treatments and modalities that are most effective when using a teletherapy platform. Here are three “hot” questions that are presently being discussed and debated among researchers and professionals:
Is telehealth effective and will it make me feel better?
Are modalities such as hypnosis, Eye Movement Desensitization Reprocessing (EMDR), and psychodynamic techniques useful and effective when utilizing a virtual platform?
How do I get a young child to become accustomed to a virtual face or even a virtual voice?
The field of telehealth is not entirely new, but has taken on a whole new level of activity since the outbreak of COVID-19. Initial research findings have been very positive and have found that it can be as or more effective than traditional face-to-face mental health treatment. However, the effectiveness of services will depend on three important factors; the nature of the condition, the specific population being served, and how telehealth can be utilized in conjunction with other services such as underlying health conditions, psychiatric needs and psychosocial stressors.
Let’s explain each of the three components:
There is a crucial difference between a new patient versus a current patient. Prior patients have already engaged in a meaningful face-to-face therapeutic alliance. Telehealth services are a continuation of a relationship that has already been formed and cultivated. When “meeting” a new patient over telehealth, these initial goals still need to be cultivated, while balancing an understanding that new clients may make very quick judgments on their interactions with their therapists. Even a slightly poor internet connection has already been shown as an early factor in the decision of a new client to terminate after one or two telehealth sessions.
It therefore becomes critically important for the therapist to be open and transparent about some of these potential obstacles. The therapist should relate that the telehealth platform is different and unfamiliar and may take some time “getting used to.” The therapist also needs to stress that the ability to be an active and engaged listener, promoting empathy and validation and implementing evidence-based techniques, will not be diminished due to the virtual platform. Assisting the client to believe that this platform will be effective will go a long way to developing a strong therapeutic alliance. Extending typical session time spans and being available after hours are also very beneficial when developing comfort and ease with new clients.
The effectiveness of telehealth also relates to the different populations that are being served. It has already been shown that while children are more attached to screens, they are also harder to engage with unfamiliar professionals over a virtual platform. When a parent “brings” their child in for a consultation session, the child may often display resistance and frustration with having to sit in front of a screen and talk to a stranger.
Shorter sessions with young children or more joint sessions with parent and child have been shown to be more effective. Furthermore, art or play therapy can be more effective when a parent or guardian is participating in the activity and follow-up discussion during the session. The “name of the game” is collaboration and teamwork.
The last point relates to the ability to serve the needs of the “whole” person. When visiting a pediatrician or a general internist, a referral for mental-health treatment may be made to combat growing academic, emotional and social challenges. The therapist may be the first stop on the journey to help someone seeking guidance and support. The therapist may realize quickly that this individual needs other services that will more immediately improve daily functioning.
As an example, let’s imagine that a client initiates treatment for symptoms of depression related to a recent job loss. These symptoms may include fatigue, loss of interest in daily activities and sleep difficulties. In this case, the developing treatment plan should not only relate to the more typical behavioral and cognitive techniques. It should also include identifying resources and services that can benefit this particular client. This can include resources for job searching and job coaching techniques that will be held remotely.
The common thread among all three components is the necessity of combining typical helping techniques with a strong understanding of the world of telehealth, its strengths and drawbacks and the importance of thinking a little “outside the box” to assist people with unfamiliar and difficult life circumstances.
Checking in with new clients during the week is also a great tool to show them that you are invested in their health and success. And yes, in my practice, I, as well as many of my fellow therapists, take the extra few minutes, the extra phone call and the extra check-in. It will surely pay off in the long run.
Mark Staum, LCSW, currently works at Achieve Behavioral Health in Monsey, New York and maintains a private practice. Mark is currently accepting new patients and can be reached at [email protected].
