More health plans offer telehealth as a service, including for mental health concerns, as research shows telehealth is effective. With virtual care, patients receive care quicker than with an in-person appointment.
But will the increase in telehealth services improve mental health treatment, with more people accessing it in the privacy of their homes and a more viable option for those in rural areas? Or will it become less effective with the subtle nuances of body language missed on a video?
Dr. Elliot Kaminetzky, a licensed psychologist, provides teletherapy locally and internationally and is a strong advocate of an online modality. As a clinician who also treats OCD and anxiety, he finds it “particularly helpful in exposure therapy, and hoarding treatment because sometimes the triggers are located exclusively in the home environment.”
While there may be issues in the home contributing to mental health problems, for others, it is more comfortable to be in their own homes. “They have the 'buffer' of a device to talk with a therapist and they are more relaxed and ready to open up," states Mary Gorder, the CEO of Drs. On Calls. She acknowledges that therapists might not get all the body language cues, but "believes the pros of using telehealth for mental health far outweigh the cons.” It is simply more convenient to receive services where one resides.
In addition to patient convenience, the shift to online care makes sense as many people already communicate this way. Kaminetzky mentioned that “we are becoming socialized to the idea that intimate communication could transcend the barrier of telecommunication.”
Dr. Jameson Mercier, LCSW mentioned a figure of “2.5 billion smartphone users by next year." Rather than waiting weeks or months to see a provider, with a smartphone, “all you have to do is reach into your pocket or purse. Mental health treatment will improve because wait times will be dramatically reduced. Waiting too long to see a therapist or psychiatrist is not recommended as it often leads to an exacerbation of the client’s symptoms. Consequently, this means clients get worse and require even more treatment than if they were seen sooner."
Quicker appointments for clients when they are not limited by geography is a clear benefit. Gorder notes “it takes about three months for mental health professionals to accept new patient appointment bookings, as many of them are extremely busy, but with telehealth, patients are able to see a doctor immediately and for much less than an in-person visit. This alone means that telehealth is making mental health treatment infinitely better because it allows more people who need this type of treatment to have access to it.”
But Caleb Backe with Maple Holistics is hesitant to recommend it in every situation. “Anyone who has had a bad Skype connection can imagine how difficult it would be to conduct a therapy session with frozen screens, sound issues, etc. Also, most of our communication is actually done through body language, and a lot of this gets lost when two people meet virtually. Additionally, making people physically come to sessions requires them to invest more time, energy, and money into their treatment. And when individuals feel committed to getting better, they experience improved results. “
Kaminetzky also does not advocate for its use in every situation. “It’s not appropriate in all circumstances, such as severe suicidality, and there are those who feel more comfortable when sitting in front of their therapist, but that does not mean it doesn’t have an increasingly important role in dissemination of quality therapy."
Richard Brouillette, LCSW started doing telehealth two years ago and now more than half of his practice is online. As a practitioner who is also board certified in providing tele-mental health, he received training on safety, privacy, and technology considerations, thus avoiding the Skype issues Backe mentioned.
He does not view text, email, or phone as primary forms of telehealth psychotherapy because, like Backe, he believes "you need to see the person you treat to get important visual cues.” With the talking heads of video chat (generally the neck up), clinicians do not see all the body language, but Brouillette says, “Human beings say a lot with their eyes.”
But will this be a replacement for in-person care, as younger generations are raised with smartphones, video and social media? Brouillette doesn’t think so. He makes the comparison to “predictions that e-books would replace real paper books.” While there is an increase in ebooks, people still buy - and in some cases, prefer - paper books. Rather than a replacement, Brouillette predicts that “online therapy will compliment in-person therapy."
To help clients feel the connection, Brouillette focus on three things: “eye contact and how to look at the camera; framing our bodies so that the upper half is visible (so that you can see shoulders and the movement of the chest with breathing); and being sure there is a microphone that picks up your voice well. Just like when you are reading a book, words can transport you to far-away places; when in an online session together, words and images can bring you together so that you forget you are online.”
With a properly trained mental health provider, online therapy may be the perfect solution for clients who cannot easily access treatment in person, are more comfortable in a digital environment, or simply need to get treatment quickly. If it encourages people who need help to get it, this could be one of the technology advances that genuinely benefits a significant number of people.