therapy

Like many therapists, prior to the Coronavirus pandemic I worked with clients face-to-face in a traditional office setting. During the coronavirus shutdown, the overwhelming majority of therapists switched from in-person therapy to online therapy, myself included. 

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At first, it was definitely a transition, and part of me missed the face-to-care interaction with clients. However, as time went on, I began to see the huge benefits associated with online therapy. It also became apparent that online therapy was here to stay. With that in mind, I attended additional trainings and became certified as a telemental health therapist. I wanted to ensure I was providing the most optimal (and secure) online therapy experience for my clients possible.

 

What are the benefits of online therapy?

Two words: comfort and convenience. If you have anxiety about starting therapy, an online session may feel less daunting. You can meet with me from the comfort of your sofa, or even your bed, or curl up with a favorite blanket or cup of tea. Being in your own home environment also typically brings a sense of security, which means you may be more comfortable discussing sensitive topics or bringing up difficult things, where you otherwise may have kept quiet in an office setting.

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With online therapy, you don’t have to drive to an office. You also don’t have to sit in a waiting room when you’re sick, or when you’re concerned that others around you may be sick. Online visits can be easier to fit into your busy schedule. With telemental health, depending on your schedule, you may not even have to take time off work or arrange for child care.

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It also removes the headache of figuring out transportation to and from an office, which alone can add additional costs to attending therapy sessions. Research has shown that 70% of people do not have access to therapy because of where they live or because traditional therapy is too expensive. (4) Additionally, online therapy can often offer earlier intervention due to flexibility in scheduling. Overall, online therapy makes mental health treatment more accessible to more people who really need it, which is something I strongly support.

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Are there situations that might not be a good fit for online therapy?

While there are a lot of benefits to online mental health therapy, it also is not suitable for everyone. Here are a few situations where online therapy may not be suitable:

 

• Family counseling, couples counseling

(Family and couples counseling requires me to carefully observe expressions and body language to help understand your relationship – basically all the unsaid parts of a relationship. These nuances are very difficult to observe over video. Additionally, trying to see more than one person at a time in the video feed is nearly impossible. For those reasons, I offer individual sessions only. However, in your individual session we can certainly discuss and work on relationship issues.)

• Serious medical cases

• Complicated psychiatric cases, including individuals struggling with hallucinations, or those with severe impulse control or violent tendencies

• Those who prefer on-site or face-to-face therapy

• Those with limited computer access and minimal computer knowledge/skills

 

Additional consideration may also be needed for some situations:

• Unstable internet connection may influence our ability to have a smooth discussion. Most of the time, we are able to work through these issues without much hassle. But there have been occasions where I was in the middle of a sensitive discussion with a Client, and we lost internet connection. It can be frustrating at times, but mostly internet interruptions are typically minimal.

• Role-playing may be difficult or awkward via online therapy. I don’t use a lot of role-playing in therapy, so this also tends to be mostly a non-issue.

• Emergency situations may be handled a bit differently. There may be times I ask you to share the address of your physical location with me. In the event of an emergency, I would use this address to direct help to your location.

• If you do not have home internet and will be using your phone data plan, you may want to consider whether your data plan is large enough to cover 2-4 video sessions a month.

 

Some people feel anxious in anticipating video sessions. If talking over video brings you anxiety, please let me know and we can explore ways to make you feel more comfortable. You may also want to try placing a sticky note over your own video feed (so you can’t see yourself), or we can explore phone sessions as well. Please contact me for a free 15-minute consultation to explore how we can tailor sessions to suit your needs.

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Is online therapy legit?

Even before the coronavirus pandemic, online therapy had become pretty commonplace. During the pandemic, the majority of therapists transitioned to online therapy, and now it seems online therapy is here to stay.

In the past 30 years, researchers have conducted clinical trials involving tens of thousands of patients, with excellent results. Online therapy is backed by peer-reviewed research and closely mimics an in-person therapy session. (3) Research indicates online therapy is as effective as in-person therapy for most mental health issues. (2)

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Is online therapy secure?

The site or platform I use for therapy follows a set of federal regulations known as HIPAA. When we have a video session on software that follows the HIPAA regulations, there is no point in the middle where that company has access to our conversation, and the session isn’t recorded. Other video-call sites or apps (like FaceTime or Skype) don’t have to follow these same security regulations.

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That means the information saved is comparable to what would be saved for traditional in-office visits. I keep record of our visits, and with records always comes risk, but any security concerns remain equivalent to seeing any therapist in a traditional office setting.

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Sometimes we may communicate by email or text regarding appointments, and this communication isn’t guaranteed to be secure. I take additional precautions where I can to ensure security. However, it is important to consider what you can do to keep your information secure also. I encourage you to find the most private place possible for sessions, even if that’s the bathroom or your car. You may want to add additional security measures to your phone, computer, or email, to make sure your information is kept private.

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Does my insurance cover online therapy?

Prior to the Coronavirus pandemic, online therapy was always an extra feature – sometimes it was covered by health insurance, but sometimes it wasn’t. However, the pandemic greatly shifted the way we deliver mental health services. Medicare quickly changed its policies to cover most telehealth, and many private insurance companies followed suit. Now, the majority of health insurance companies cover online therapy at the same rate as in-office therapy sessions. But, if you have any questions about your coverage for telemental health visits, you can always call the number on the back of your insurance card to ask about coverage for outpatient telemental health visits.

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How do I get the most out of online therapy?

Online therapy doesn’t differ too much from in-person therapy. It can feel a little awkward at first, but some awkwardness is a bit normal in therapy as we get to know each other.

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Think about what you want to achieve in therapy
What would you like to see different about yourself in attending therapy? Or is there something specific you’d like to discuss, address, or explore? It’s also extremely helpful to be present in sessions. Sometimes life happens, but trying to be mentally and physically focused will positively influence your growth in therapy.

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Be your most authentic self, and let your emotions show
This is one place you don’t have to put on a fake smile, or bottle up your emotions. Your emotions allow me to learn more about what is important to you, what past events still hurt, and also what brings you joy. Part of therapy is helping you navigate difficult emotions and lean in to positive emotions. For our sessions, it’s best to find a setting where you can fully be yourself and let your emotions out.

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Keep the dialogue open
I’m not a mind reader. I can do my best work when you’re open and honest about what’s on your mind, whether it’s the state of the world and your place in it, or just a social media post that made you feel bad. Finding your voice, sharing your opinion, and communicating assertively are also a great practice for your other relationships outside of therapy. 

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Do your “homework” between sessions
I know, I know, homework?! Blech! I actually hate referring to these tasks as “homework” because it feels so formal and school-like, but tasks between sessions are an important part of your growth. Tasks are usually pretty simple, practicing a simple skill or watching a 5-10 minute video, things like that. But to put it bluntly, if you aren’t completing the tasks we discuss between sessions, you probably won’t see the changes you’re hoping to see.

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Be patient
Progress takes time. And work. The struggles that brought you to therapy weren’t created overnight, and it takes some time to work through things, or unlearn unhealthy thinking patterns. Progress is also not linear, so be kind to yourself when setbacks arise. Changes, especially long-lasting changes, take time. And work.

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Try not to focus solely on symptom relief
The symptoms may be what brought you to therapy, and we will definitely explore tools to cope with the symptoms. But often the symptoms are not the root of the problem. For lasting change and growth, we still need to figure out what caused the symptoms to begin with. Sometimes this means exploring unhealthy cycles or choices, unpacking past trauma, or sometimes exploring parts of your childhood. The majority of our therapy will be focused on the here and now, but exploring a bit of your past can help us make connections, understand why you’ve felt stuck, and help you make the lasting changes you seek.

 

Scheduling a free 15-minute consultation is a great way to ask any further questions, and also determine whether we will be a good fit to work together. This can be hugely important, as research shows that your comfort level can be a major predictor of how much you benefit from talk therapy. (1)

 

 

 

References

(1) Ardito, R. B. and Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research. Frontiers in Psychology, 2, 270. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/

(2) Godleski, L., Darkins, A., and Peters, J. (2012). Outcomes of 98,609 U.S. Department of Veterans Affairs Patients Enrolled in Telemental Health Services, 2006–2010. Psychiatric Services, 63 (4). 383-385. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201100206

(3) Nancy Redd and Shannon Palus. (2021, June 17) The online therapy service we’d use. New York Times Wirecutter. https://www.nytimes.com/wirecutter/reviews/online-therapy-services/

(4) Mary K. Tatum, M. S. (n.d.). (2021, Sept. 02)  Best online therapy programs of 2021. Verywell Mind. https://www.verywellmind.com/best-online-therapy-4691206.