Telehealth for Mental Health
Telehealth. Online therapy. Virtual therapy.
It has many different names, but all gets at the same thing. It’s therapy provided long-distance, usually by video. Some therapists are 100% online only, some are 100% in-person only, and some offer more of a hybrid approach so that clients can choose what is best for them that particular week.
How does telehealth work for mental health?
There are many types of mental health therapy, and most of them involve more of a talk-therapy style. This can easily be done through telehealth as the therapist and client are able to have conversations about issues needing to be discussed, and can talk about tools, skills, or strategies to help. Sometimes therapists may screenshare different resources or worksheets with clients to help provide more information, similarly to handing clients worksheets in the office setting.
Since telehealth most often includes video, the therapist is able to see the clients face during the conversations and notice facial expressions or other non-verbal communications that help them to better understand how the client is feeling.
Some therapies that are typically thought of as in-person modalities, such as part or play therapy, can be modified to be accessible online.
How do I know if telehealth is right for me?
While many clients enjoy the convenience of telehealth and are open to it right from the start, others may be a little more hesitant. Some clients feel that online classes or work Zoom meetings were ineffective for them in the past, and got in the way of them learning what they needed.
Telehealth is different as it’s a much more intimate one-on-one conversation. Many clients who try telehealth feel it’s just as comfortable to participate in therapy virtually as it would be in the office. Some even find it more comfortable since they are able to have their pets next to them for comfort during tough conversations.
Here are some questions that may be helpful to reflect on:
How does it feel to talk on video or the phone with close friends/family about personal topics? Am I able to feel a sense of support from them long-distance?
When I’ve doing online learning or meetings in the past, what about that worked or didn’t? With the things that didn’t work, ask your therapist how they can modify things to work better.
Do I have a private space where I can talk about the personal things I may need to without worrying that someone else can hear? If I might need extra privacy one week, where are all the places I could go to get that?
Am I comfortable with navigating technology (logging into accounts, downloading apps, giving permission for devices to access video/sound)?
If you’re unsure how it feels for you, it can be helpful to give it a try. If after a few sessions you’re still not sure or feel more confident that it’s not the right fit, you can ask to switch to in-person or request a referral to an in-person provider. Since the intake session can have a different feel from a “regular” session, it can be helpful to try at least 1-2 “regular” sessions after the intake to get a better feel for how it may look/work.
When is telehealth not appropriate?
Telehealth isn’t appropriate for all clients, or all mental health issues. Telehealth presents some limitations that can impact the care a therapist is able to provide. Many times, therapists are only able to see clients from their shoulders up on video. If, for example, a client starts to feel increasing anxiety about something being discussed, they may start bouncing their leg or fidgeting more with objects in front of them. Depending on the position of the camera, the therapist may not notice this unless the client verbally tells them how they’re feeling.
There are other things that therapists may be able to see or observe in-person that may be more difficult for them to notice with telehealth. During the intake assessment or initial consultation call, your therapist may ask about specific risk factors that they want or need to be aware of before moving forward with telehealth.
What are important things to know about telehealth?
LOCATION: When it comes to telehealth, therapy clients often log in from the comfort of their homes. Sometimes clients may log in from work if they have a private space, or from their car. There are a couple important things to keep in mind when choosing the location of where you will physically be when the appointment occurs.
PRIVACY: it’s important that wherever you are, you have privacy. If there are other people in your home that you don’t want eavesdropping, you may choose to go outside or in your car in the driveway. If you have a private office at work and ability with your schedule to take a break from work, you may choose to log-in there. Therapy can involve talking about vulnerable topics sometimes, so privacy is key!
ADDRESS: it’s also important that your therapist knows where you are when appointments occur. If your therapist only has your home address on file but you’re logged in from work and you pass-out during the session, the therapist won’t be able to send a paramedic to you. Sending them to your home address if you’re not there won’t help you! It helps to email or message your address to your therapist before the session starts if you are not at home or somewhere you regularly participate in sessions from. If you log in for the session from your car parked somewhere other than your home, be sure to also share the make/model of your parked car so the therapist can better help the paramedics to find you if that’s needed.
STATE LICENSING LAWS: the “rule” is that the location of the appointment is determined to be where the client is located at the time. If you live, work, and usually participate in therapy session in Illinois, your therapist is licensed in Illinois. If you travel to another state and log in for the appointment, your therapist may or may not be licensed in that state. If they’re not licensed in the state where you physically are at the time, the session would need to be rescheduled until you’re back home or another state they are licensed. Some therapists are licensed or able to practice in several states, some just one state. Some professions or types of licenses may have “compacts” now or in the future which would allow therapists to see clients in all states that are included in that “compact.” Ask your therapist which states they’re licensed in, and be sure to discuss plans for rescheduling sessions if you’ll be traveling.
DEVICES: Most video platforms used for telehealth appointments are accessible on any device with a camera and microphone (or ability to plug in headphones that have a microphone). Some prefer to use a computer or tablet that can stand up on its own, some prefer to hold their phone in their hand. You can choose what’s right for you. If you use a tablet or phone, some platforms may require a specific app be downloaded to log in. Be sure to ask your clinician if this will be necessary before the first appointment!
RULES: Different therapists may have slightly different rules for telehealth, but here are some common ones to keep in mind or ask about:
The appointment is only for the client it is scheduled for, or couple or family if that is the type of therapy provided. Please do not bring friends or family to the telehealth sessions without talking to your therapist first. Again, privacy is key! Make sure you have a private space where you can participate in the sessions alone with your therapist (or with others you and the therapist planned to have present). If you have people waiting on you to get done, make sure they have another room they can wait in on the other side of a closed door.
Sessions cannot occur while the client is driving. Our human brains are not good at multi-tasking so if we’re focus on therapy, we’re not going to be focused on the road. If we’re focused on the road, we’re not going to be focused on therapy, and not get the benefit we’d like. If you’re participating from your car, please make sure it’s safely parked somewhere before the session starts. Sitting in stopped traffic doesn’t count!
As with in-person appointments, clients cannot be under the influence or using substances/drinking alcohol during sessions. If a therapist becomes aware of this, they may choose to end the session early and reschedule for another time.
COST: Sometimes people wonder, are telehealth visits cheaper than in-person visits? With mental health telehealth, the cost will very likely remain the same and the knowledge, skills, and resources of the therapist remain the same regardless of modality.
What platforms are used for telehealth?
There are many video platforms out there in this day and age, but not all of them are secure enough for telehealth. Telehealth platforms have increased security settings to prevent others from accessing the virtual meeting room. Some therapists may use higher-level versions of Zoom or Google Meet. Some may use a secure video option within their therapy portal/websites. Some may use another telehealth specific platform, such as Doxy or PsychologyToday Sessions.
Be sure to ask your provider which platform they use as their primary platform, and which platform(s) they use as a back-up in the event of technical difficulties.
Are telehealth sessions recorded?
No! At least not without the explicit permission of both client and therapist. Therapists cannot record sessions without consent of the client, and most therapists include things in their intake/consent forms asking clients to agree not to record. If something is being discussed you’d like to reference later, please ask your therapist before recording or ask if they have a resource they can send you after. If they’re screensharing something with you, you can ask them to email you a copy when the session ends.
INTERESTED IN SCHEDULING A CONSULT WITH MINDFULLY BALANCED THERAPY?
Great! You can click here to schedule one in the next 2 weeks, or contact Kimberleigh by email at khagar@mindfullybalancedtherapy.com.
