Teletherapy Expansion During COVID-19 Quarantine

The year 2020 will go down in history as the time of change. And rapid change, at that. 

The global COVID-19 pandemic forced people to adapt to new ways of working and living. In doing so, some technological and social innovations that had only been used sporadically before, now got full attention. The forced experiment of large-scale full-time telecommuting and virtual communications showed that these practices can sustain everyday human activities. 

Another example of a practice that suddenly rose in popularity is telehealth. Medical offices adapted to the new guidelines to keep doctors and patients safe. Subsequently, the development, implementation, and use of virtual medical consultations and treatments got an instant boost. With that, behavioural health practices also received attention and teletherapy gained momentum.

Benefits of Teletherapy

Even before the pandemic, some behavioural health professionals implemented teletherapy in addition to the traditional face-to-face sessions. A 2017 study highlighted the convenience of remote therapy in various settings and the reduction of the cost of care. The study concluded teletherapy to be a promising alternative and a supplement to traditional care. 

[U]sing telemental health care for psychotherapy and other mental services improves patient satisfaction and reduces the costs of care. While being comparable to in-person services, telemental health care is particularly advantageous and inexpensive through the use of current technologies and adaptable designs, especially in isolated communities. (Telemental Health Care, […]: a Systematic Review)

Diane Franz, PhD, Pediatric Psychologist at Children’s Hospital New Orleans, cites a number of benefits of teletherapy. Some of these include the ability to see multiple family members in different locations in a same virtual session, ability to see families in their natural environment, and the ability to share written information.

Some people actually find visits via telemedicine less stigmatising and less intimidating, possibly because many people already use similar applications to talk to friends and family members. For some who might find it hard to take the steps to schedule a visit, arrange transportation and get to the physical office, this is easier and less daunting. (Franz)

In 2020,  most people are self-isolating due to COVID-19 outbreak. As people find themselves in unprecedented reality of the quarantine, mental healthcare becomes more of a necessity than ever. Teletherapy then comes to the rescue by not only satisfying the increased need, but by also being the only option. Modern technologies, such as live chat, video conferencing, and instant messaging, aid teletherapy even further than telephone communications previously did. 

Challenges of Teletherapy

As therapists and patients adjust to teletherapy, some challenges arise. Addressing them now will not only help smooth mental health sessions during the current situation, but also in the future. After all, if teletherapy works well, it might be here to stay even after the quarantine ends.  

A Wake Forest University School of Medicine study, Benefits and Challenges of Conducting Psychotherapy by Telephone, addresses benefits and challenges of teletherapy done through telephone. While since the time of the 2011 study additional technologies became available, the principles of phone communications still apply. 

The study presents the following challenges and solutions.

Lack of Control over the Environment

In contrast with face-to-face communications, teletherapy does not allow therapists to control the environment to promote a certain atmosphere to aid the sessions. Additionally, controlling the conversation can prove to be more difficult during distanced sessions.

The study sites the boundary establishment as a possible solution to the challenge. That means a therapist should set an expectation with the patient ahead of the session to promote similar practices as those during face-to-face interactions.

Privacy and Confidentiality

Patient privacy has always been of concern when it comes to medical care. The concerns become more acute in the age of technology. Exchanging private health information over digital mediums, such as live chat, make it more challenging to keep that information private. That is why federal laws, like HIPPA, provide guidelines for such interactions. Once again, establishing rules and discussing privacy ahead of the teletherapy session is a good rule. 

Just as in face-to-face sessions, psychotherapists and clients should fully discuss all planned services and complete a written contract to confirm their mutual agreement to the terms discussed. (Wake Forest University School of Medicine)

Development of Therapeutic Alliance

Next, the study cites the establishment of a rapport or therapeutic alliance as an obstacle to successful treatment.

Dr. Franz testifies to the validity of this claim from her own experience with teletherapy.

Some parts of therapy often consist of pauses and reflection, which is difficult to appreciate via telemedicine. It is sometimes difficult to see the subtle changes in facial expression that reflect mood changes, or changes in body language. For some, it is difficult to establish a connection via a computer. (Franz)

Challenging for telephone communications, this important aspect of therapy might be even more difficult to achieve through mediums like live chat or instant messaging. Using video conferencing, when possible, could be a great alternative. 

Other solutions include discussing goals, minimizing distractions, upping empathy cues, and even adding more small talk to the sessions. (TheraPlatform) 

Additional Concerns of Teletherapy Practices

The study cites ethical and legal concerns, training for therapists to adjust to visual sessions, and crisis counceling as additional challenges of teletherapy.

Common as they may be, these challenges therapist should address them on a case-to-case basis. While the study offers a couple general solutions, patient and therapist locations and nature of the crisis will determine the solutions. In any case, general research, training, and review of law and regulations can serve as guides.

Source: Wake Forest University School of Medicine

In addition to these challenges, professionals cite technical difficulties and adjustment to full-day technology use as a strain on mental health professionals. Furthermore, emotional stress and fatigue that comes from the adjustment as well as full-day of seeing clients in the same virtual setting is yet another widely-reported problem. (Bryan Vartabedian, 33 charts)

Future of Teletherapy

It’s difficult to say with 100% certainty if teletherapy will replace brick-and-mortar mental health practices beyond the pandemic. However, it’s clear that the practice of teletherapy will at least expand beyond its pre-pandemic use and supplement it. 

Dr. Wilfred Van Gorp, a mental health professional with offices in New York and Chicago, believes that  more doctors and patients will make use of apps, texting and other virtual forms of communication in the future. He also cites the willingness of insurance companies, which previously did not cover teletherapy, to adjust their policies, as a green light to teletherapy expansion.

As the COVID-19 quarantine continues more people find themselves feeling anxious and stressed. Subsequently, more people will opt for the use of teletherapy. With more demand for such services, practices will continue to expand their services.

To aid such rise in demand, Consumer Advocate has  put together a resource that presents the best online teletherapy services.