Therapy on a Screen?
This week I have spent more time in therapy sessions through video than ever before. While I have been doing Telehealth for about two years now, never have I done back to back sessions for days. Naturally, people want to know how this works, if it is effective, if it's appropriate for younger children and if it's confidential. In this article, I will share some of the questions that I have received this past week about Telehealth as we are all adjusting to new ways of doing things.
How does this work?
Parents want to know if their seven year old will really benefit from a "video chat." Teens wants to know that their parents aren't listening in on them. Children want to know if they can show me around their house. Adults want to know if they will achieve the same results not being face to face in a room with their therapist. Most people who are in therapy want to know if they should or can continue as the world shuts down in many ways. People who have never been in therapy want to know if they can start now. There are a lot of questions so if any of these apply to you I am happy to share best practices and my experience.
1. Do you use Skype or Facetime?
No, it is important to use a HIPPA compliant, confidential service and those types of apps do not meet the necessary standards. In my practice, I send each client a unique link to each session that they just simply click on and we connect. It's that easy!
2. How long do sessions last?
Sessions are usually the same length as face to face sessions which in my practice is 55 minutes. In the cases of younger children where their attention span may be shorter I have suggested that I do a shorter session with them and then spend the rest of the time with the parents or just do a half session. For many younger children the continuity, consistency and familiar face is very important to their treatment.
3. Does this cost more or less than face to face sessions?
It may vary from person to person but in general the session fees are the same.
4. If I wind up liking this can we keep doing it after it's safe to stop social distancing?
Sure, I think that Telehealth has gained in popularity over the last year or two because it is convenient, effective, works well for people who travel, and has low barriers for entry. Again, research has supported that the outcomes are just as good as face to face sessions. A few years ago I would never have believed it but now that I am doing it I see it for myself.
5. Is Telehealth as effective as face to face sessions?
Yes, it appears to be. Seems like this applies to both Telemedicine (generally refers to the medical field) and Telehealth (includes mental health). In some states it is required that the patient and provider meet in person at least once for an initial session before starting this practice. In Colorado, it is strongly encouraged but not required. I have done it both ways and it works either way.
6. Can you do play therapy with my young child on video?
This past week the field of play therapy and our own office has adjusted to setting up therapeutic home play therapy spaces so that when a therapist gets on with a child they may be able to use the toys and materials that are typically found in a therapeutic play space. In my case, I have facilitated my sessions in my office space so that the kids that I work with see me in a familiar space using familiar materials to them.
7. Do I need to have a special camera or laptop to connect? Do you have tips to make things go smoothly?
You don't need anything beyond a phone or laptop with a built in camera. However, you will also need Wifi with a fairly strong signal. I have had some glitches such as screens freezing up, dropped calls, and slow connection. I would suggest finding a comfortable, private space in your home where you have a strong signal or even the ability to connect with a hard wire. To make the session feel more intimate you may want to use a headset to better ensure confidentiality of what your therapist is saying and also be able to speak more softly in case you are concerned that someone may overhear you. It may also work well for you to take notes.
8. Where will my therapist be?
Right now during this Coronavirus pandemic your therapist is very likely to be
at home. For some clients, that can be a distracting element to their treatment so some therapists may have some sort of blank barrier behind them. As for me, while I can still go into my office I will so that my clients see me in a familiar, comfortable, predictable setting.
9. What if we get disconnected?
If your video connection gets dropped, no big deal, just click back on that link- it's good for the whole hour.
10. There is so much going on, I am mainly worried about our physical health and our finances, can we take a break right now?
I understand that these are unprecedented times and that there are other issues needing your attention. However, I would assert that the positive benefits of therapy on your central nervous system, immune system, need for social connection, stress levels, anxiety and depression may be worth considering. If anything, reduce the frequency or even the length of the sessions but completely stopping right now (unless you absolutely have to) would not be what I advise. And for your children, having a constant, familiar, trusted confidant who they can still connect to may be an important part of them going through this with resilience and less fear.
I know that many of you are worried, stressed and wondering how long this will all last. Trying to work or keep your house functioning while the kids are out of school is a huge challenge for most families. Remember to take care of yourself first and the rest of the family after you are recharged.
Next week I will be writing about how to lead your family through this time, I look forward to sharing those tips with you.