We're living in unprecedented times. People are wearing masks; stores and restaurants are shutting their doors; and many people are working from home.
And many, if not most, therapists are doing psychotherapy remotely. In fact, I know many therapists who are converting their whole practices into video conferencing. Some are even vacating their offices completely. In the near future, it may be hard to even find a therapist working from an office.
Insurance companies are currently allowing tele-health because of the pandemic, which is also unprecedented. Whether they will allow remote therapy in the long-term remains to be seen.
But remote therapy (aka tele-health) has never been evaluated for effectiveness. A tiny number of therapists have offered video therapy over the last few years. But it's never been practiced on such a wide scale. Some important questions: does it work? Is it as effective as therapy in the office? And are there instances where tele-health is inappropriate or even cause harm?
No one knows defintively the answers to these questions. As I mentioned, remote therapy has never been researched in any depth. In this blog, though, I will offer my impressions.
There are some instances when tele-health may be appropriate. If there aren't any risk factors (such as self-harming behavior, suicidal thoughts, debilitating anxiety, or severe trauma), tele-health may be a good, stopgap measure until after the pandemic is over.
Here is an example of when tele-health may be fine:
Henry, age 32, is in a loving marriage, and has as good job. While he is stressed about the pandemic, the fires, etc. his anxiety isn't debilitating. His main reason for seeking therapy is that his wife is ready to have a child; he isn't sure.
Remote therapy offers Henry an opportunity to voice his concerns. The therapist explores his fears, and together they probe the reasons for his hesitancy. After a few sessions, Henry decides that, while still nervous, he feels ready to become a dad.
Note that Henry has a specific problem. He doesn't necessarily need the added comfort, support, and careful assessment of an in-office relationship. The therapist also doesn't have to be concerned about his risk potential.
In contrast, let's meet Jennifer, who reaches out for tele-health. She has a diagnosis of Bipolar Disorder and has struggled with overwhelming anxiety and depression. Jennifer has mild thoughts of self-harm, although no current plan. She complains of being up all night, unable to sleep, and having no appetite. Over the last few months, Jennifer has lost 20 pounds.
From this description, a therapist should be very cautious of offering Jennifer therapy over a screen. Without meeting Jennifer, it would not be possible to sense the level of her anxiety and distress. It also wouldn't be possible to see her non-verbal behavior, which can offer clues to her risk potential.
While Jennifer's symptoms are on the extreme side, there may be other instances where tele-health is not appropriate. For instance, if you want in-depth, intensive therapy around trauma, I would be wary about remote therapy. Discussing traumatic events, without being with another person in the room, can be triggering, even possibly destabilizing. Remote therapy is more appropriate for approaches like problem solving, cognitive behavioral, and supportive therapy. If you have any risk factors, make sure to inform the therapist before you schedule an appointment.
Lastly, is tele-health as effective as in-house therapy? I can't say for sure. In some cases it may be. For Henry, the person above, a few sessions over video helped him resolve his concerns about becoming a dad. But for some people, therapy over a screen may be ineffective or even may leave the person feeling more lost and alone.
There are also the inherent problems with the new technology. The video can suddenly freeze; the audio can go silent; and reception can be poor.
In addition, therapy isn't just about giving advice. While advice can be given, therapy is also about a therapeutic relationship that can be healing. Being with a live person who is empathic and caring can be a great comfort.
But given the pandemic, tele-health may be an appropriate and reasonable option for some, imperfections and all. (In terms of my practice, I am offering in-person therapy, video, or phone. Fortunately, I have a very large office, so social distancing is not an issue. If we decide to schedule an appointment, we can discuss which choice is appropriate for you.)