4 years ago · Leah Fogt · 0 comments
What to Expect from Teletherapy
The COVID-19 Pandemic has been a game-changer for just about every aspect of daily life for most of us. The way we eat, work, dress, communicate, shop…it often seems like everything has changed. Counseling is no different. In an attempt to maintain access to psychotherapy services, many mental health care providers are continuing to practice via Telehealth, which has posed a challenge for both patient and provider alike. Many people find Telehealth to be intimidating, unfamiliar, and even scary, but it doesn’t have to be. Here are some things you need to know about remote mental health care that will help make it easier, less intimidating, and even more fruitful.
What is Telehealth?
There are a lot of terms going around to describe the process of working with a healthcare provider over technology, as opposed to in person. Generally speaking, the terms “Telehealth” and “Telemedicine” can be used interchangeably to describe the practice of health care over some form of technology when the practitioner and patient/client are not physically present with one another. It is typically conducted over some video-conferencing platform specially equipped with privacy and confidentiality protection. While HIPAA regulations for Telehealth have been relaxed due to the Pandemic, Telehealth is typically not conducted over less secure platforms such as FaceTime, Zoom, Skype, or social media. Some examples of more secure platforms for Telehealth include SnapMD, eVisit, CarePaths, American Well, and Doxy.me.
Teletherapy is a specific type of Telehealth. It is the practice of providing psychotherapy services through online video connection. Ideally, the same treatment that would be offered in person is offered remotely.
What technology is involved?
Most Telehealth platforms allow the patient/client to easily participate using a variety of devices. Smartphones, tablets, and computers (laptop and desktop) will work, as long camera and microphone are enabled. (On most devices this is automatic, and you don’t need to do anything, other than maybe click an “allow” button.). Some platforms work better on certain web browsers. Your provider should let you know if you need to use a specific browser like Firefox, Google Chrome, etc.
In many situations, a good pair of headphones or earbuds can be helpful for Teletherapy, though they are usually not required. They help minimize distractions, and increase privacy. Some even filter out background noise. If you want to use headphones or earbuds, be sure they also have a microphone function.
General suggestions for clients:
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- Prepare for your session as you would an in-person session. Budget the same amount of time for your session, including transition time before and after your session. If needed and if possible, arrange for child care. If you were given homework and a between session task, do your best to complete it. Set the tone for yourself by getting dressed and grooming as you would an in-person session. You will be more invested in the work.
- Ask questions. This is new for most of us. If you are nervous or confused, ask questions. If you need help understanding the technology involved, it’s okay to ask for assistance. There is not shame in asking a question to better understand your treatment.
- Be patient. Because this is new to many providers, as well as their clientele, obstacles and challenges will get in the way. In general, accessing Telehealth platforms is easy and intuitive, but as with anything, there can be complications. Try to be patient if technology fails or isn’t working properly. Remember there is a learning curve for most people as they learn how to utilize Telehealth. Also remember it’s okay if things feel a little awkward at first. Teletherapy is a very different type of interaction from an in-person session, and it’s okay if there is some adjustment. Likewise, it is okay to give yourself permission to grieve the change, even the loss experienced by changed interactions with your therapist. Don’t be afraid to bring that up in session if needed!
- Choose your environment intentionally. Consider who is nearby when you are having a teletherapy session. Can you be overheard? Will you be un interrupted? Are you safe and relatively comfortable in the space you chose? Can you give your undivided attention to the session? It may be necessary to make some accommodations for the session like adjusting the light, asking family members to respect your privacy, crating the dog, or even asking someone to sit with the children. Consider any comfort items or therapeutic tools you may want to have close by like a box of tissues, cozy blanket, glass of water, fidget toys, or aromatherapy.
- Have a pen and paper available during your session. In case audio fails, it can be helpful to communicate a brief solution, such as “I’m logging out and back in” or “I will call you on the phone.” It may also be helpful to write down notes or ideas. Writing down the date, time, and log in instructions for your next appointment may also be useful.
- Cue your therapist. Remember, your therapist can’t read your body language and other cues as well by telecommunication as she/he can in person. It may be necessary to be a little more direct in verbalizing emotions, shifting thoughts/feelings, and needs. It is helpful to cue your therapist about how you are responding to the session. For example, “I’m starting to feel a little overwhelmed”, “I’m doing okay”, “I can keep working on this”, or “This is too much for me today.”
- Make the most of the opportunity. There are some unique benefits to Teletherapy clients may wish to take advantage of. For example, bringing a companion animal to the session, sharing expressive artwork, playing a musical instrument, and being in the comfort of your own home can sometimes enhance the therapeutic experience. It should be noted though, that these things can present as distractions as well. Additionally, home is unfortunately not a safe or secure environment for everyone. Be sure to communicate with your therapist about the pros/cons of the environment you are in for your session.
- Ask for what you need. It’s always a good idea to give your therapist feedback about how treatment is going, if adjustments are needed, or if there is a change in your needs or priorities for therapy. Don’t be afraid to speak up.
What to expect for Teletherapy with Me
Doxy.me is the platform I am currently using to conduct Teletherapy sessions. It works on a smartphone, tablet, or computer, as long as whatever device you are using has internet connection, a camera, a microphone, and functioning speakers. Prior to your session, support staff will contact you with a link that is unique to my practice. You will follow that link to log in, identify yourself, and check into a “virtual waiting room.” The prompts are clear and easy to follow. Once you are waiting, I will see your name in a queue, along with a still picture of you when you logged in. I will begin the session as soon as I can. I may be wrapping up the session before yours, taking a phone call, etc. If you are kept waiting more that 10 minutes past your session start time, call the office. Otherwise, don’t worry! I won’t forget you!
For those of my clients receiving EMDR Therapy, we can continue our work even though we are not meeting in person. Modifications to EMDR protocols can be made in simple ways that we can discuss and evaluate for your comfort and needs. All modifications I utilize are approved by the EMDR International Association, as well as taught and recommended by EMDR experts. I also sometimes use a program called EMDR Remote, which has Doxy.me embedded in it. Through EMDR Remote, I can provide eye movement and/or auditory bilateral stimulation. The log in process is slightly different but very simple and straight forward. EMDR Remote works best on a laptop or desktop computer, as a screen that is at least six inches wide is best. Some tablets will work as well. The makers of EMDR Remote recommend using Google Chrome or Fire Fox as your browser. We will discuss details prior to an EMDR session to hep assure everything goes as smoothly as possible, so don’t worry. You’ll know everything you need to know to get started.
Below are some screen shots which show what clients see on their screens while utilizing the two platforms I work through. Thank you to my good friend, Liz, and my husband, Chris for being my models!
This image shows what a client will see in a session via Doxy.Me. The client video is in the top right corner and can be moved to a different spot on the screen or removed entirely. This mock session was conducted with the “client” using an iPhone.
This image is also a client’s view during a Doxy.me session. It also shows the control buttons at the bottom of the screen. The camera icon allows you to turn the video function on/off. If it is off, I cannot see you. The microphone icon will turn the audio on/off. If it is off, I cannot hear you. The next icon over controls more advanced settings. The red telephone icon will end the session. You can adjust volume using the usual controls on your device.
This is an example of what clients see while using EMDR remote. The light bar is at the top of the screen where the blue oval is. I control the functions of the light bar and can make adjustments according to your preferences (e.g. color, shape, speed). The video underneath the light bar is the same as on a Doxy.me session. Also, isn’t my husband handsome? 😉
This is what clients will see during an EMDR reprocessing session when I turn on the light bar. My image will go away so all you see is the black screen with the light moving across from left to right. You will continue you hear me, and I will continue to hear and see you when the light bar is on. When the light bar is not on, it will return to the view pictured above.
Client’s wishing to engage in Teletherapy can be assured of my continued commitment to privacy and confidentiality. I will utilize headphones/earbuds to assure your end of the conversation is only heard by me. No one will be in the room with me during the session without your knowledge, and efforts will be made to prevent sound travel from my end of the conversation.
I will likely ask questions to confirm your location, privacy, and safety at the beginning of session. Crisis resources and safety plans will be reviewed as appropriate, as my ability to address safety concerns is more limited when I am working remotely. It is my commitment to offer the same quality of care remotely as I would offer at an in-person session. We may need to work together to “find a groove” with Teletherapy, even if we already had a comfort level and routine already established in our in-person sessions. We will be patient with one another and find our way through it together!
I plan to keep Teletherapy available to my clients as we continue to make our way through (and out of!) the Pandemic. When office policies permit in-person sessions, I will continue to provide the option of Teletherapy for those clients who are in at-risk groups, such as senior citizens, those with compromised immune systems, pregnant women, those with respiratory conditions, etc. In-person sessions are still preferred, though not at the cost of one’s health, safety, or peace of mind.