Teletherapy On the Rise: Tips to Make the Most of It

Even if you could attend an in-person therapy session — most were cancelled due to COVID-19 — sitting six feet apart with masks on makes it difficult to read each other's facial expressions.

Southern Cross University, with campuses across Australia, recently surveyed over 1,000 people on their experiences and perceptions of teletherapy and found 98% of respondents said COVID-19 has impacted their mental health care significantly. Over 65% participated in online therapy since the pandemic began and survey takers touted the top benefits as no commute, flexible schedules and an easy set-up.

 "We're seeing a large increase in mental health services over video, and therapists and their clients are trying to adjust to it," says Jason Fierstein, licensed professional counselor at Phoenix Men's Counseling in Phoenix. "I think that people have started to get used to the idea of doing therapy over video, even if it's not ideal for either party. I do think that video will stay consistent for some time to come, even if COVID numbers go down, for the sheer usefulness of the platform." 

As the nation hunkers down in preparation for fall and winter weather, possible COVID-19 waves, and even things like the flu, will make it more difficult to access an in-person therapy appointment.

Your Virtual Therapist Is In

While having a virtual therapy session may be new for you, some therapists have long offered the service, and many others ramped up to teletherapy quickly at the start of the pandemic. An American Psychiatric Association survey found that before the pandemic, only about 2% of providers offered tele-psych services. Now roughly 85% offer virtual treatment.

"At the beginning, it definitely took some getting used to, particularly for clients because it felt disconnected and less personal," says Leina Rodriguez, a licensed marriage and family therapist at Refresh Psychotherapy in New York City. As time goes by though, she says, clients seem more at ease.

"I would even say that there may be clients that feel even more comfortable being open because they are already in their safe space (their home)," says Rodriguez.

In fact, that's one advantage licensed clinical social worker Catherine McCallum at Coral Life Strategies in Bethesda, Md., touts when discussing teletherapy: "We get to see them in their home environments."

This can give important clues to how well a patient is really doing, whether their space is cluttered or tidy and whether they're dressed or out of bed. Even the art on their walls or what's on their nightstand can provide insight.

On the flip side, mental telehealth care may fall short in some ways, McCallum says, particularly without the ability to detect smells like alcohol or body odor, which can be warning signs of impaired functioning. Likewise, "Seeing body language not visible by video, particularly below the neck, may be indicators of anxiety, anger, problematic or repetitive behavior," says McCallum.

For example, not being able to see bouncing feet, clenched hands, scratching and self-injury through picking, could throw off a clinician's ability to assess for safety or a proper diagnosis.

Is Teletherapy as Good as it Gets?

While teletherapy has skyrocketed, whether it's right for everyone seeking therapy or as effective as in-person treatment remains unclear.

A Harmony Healthcare IT survey asked 2,042 Americans about virtual medical services and found 46% of boomers and 57% of Gen Xers were comfortable with online appointments.  More than 40% of respondents have used telehealth for mental health and 70% would be more willing to speak with a mental health professional if they could do it virtually.

"I do think we need to investigate the outcomes of this grand teletherapy experiment so that we can determine evidence-based best treatments," says McCallum. "I have no doubt telemental health will be a bigger part now, but I do not think it will be the only modality for every client situation."

Making Teletherapy Work for You

Rodriguez notices that telehealth therapy appointment no-shows are very low because clients don't have to travel and it's much easier to attend a virtual session. "Also, many clients who suffer from depression are seeing that this is a great option for when they can't even get out of bed," she says.

What's more, during the pandemic, many health insurers as well as Medicare and Medicaid programs have waived co-pays or loosened restrictions to allow coverage for telehealth sessions. Check with your plan to be sure it's covered.

To have the most successful experience with teletherapy, Firestein recommends treating teletherapy sessions as you would a regular in-person visit. "Show up on time, make sure there aren't any distractions, such as kids, pets or other environmental noises. Find a private space in your home, or office," advises Firestein.

Some therapists say clients have connected from their parked car or tucked into a bathroom when there's nowhere else for a secluded session.

Also, get comfortable with how you look on video and adjust your computer for the best lighting and background. And if you're new to therapy or your virtual therapist, give it three to five sessions. It can be more difficult developing trust and rapport over screens with internet glitches and time lags.

 McCallum says she worries about taking the human out of human connection. But for what it's worth, it has become normalized and accepted as the next best thing.

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