Telehealth is Here to Stay: What Should I Know and Can I Voice a Preference?
Mental health professionals in Illinois were all abuzz last month because the Illinois government approved what is to us a groundbreaking bill: insurance companies in Illinois are required to cover telehealth mental health sessions at the same rate as in-person sessions. The measures put in place during the pandemic quarantine are here to stay.
If you want to read the bill the full text can be found here.
Now that telehealth is going to be a permanent fixture of mental health in Illinois, we thought we would try to address some of the likely questions people will have about doing mental health therapy via telephone or video.
Is Online Counseling as Good as In-Person Therapy?
The research has long show that telehealth is just as effective as in-person therapy for many issues, though certainly not all. Obviously, personal choice also plays a large factor. There are also differences between a session delivered via phone call and a video.
Research About the Effectiveness of Online Therapy for Mental Health Concerns
For those of you who are inquisitive, curious, or maybe just looking to pass the time here is a small sampling of research that has been done demonstrating telehealth to be effective for many mental health issues. As you will see, research on this subject goes back nearly 20 years:
The Effectiveness of Telemental Health: A 2013 Review
The Current State of Telehealth Evidence: A Rapid Review – published 2018
Telemental Health Care, an Effective Alternative to Conventional Mental Care: a Systematic Review
Benefits and Challenges of Conducting Psychotherapy by Telephone
What are the Benefits of Online Therapy or Telehealth for Mental Health?
The benefits to clients seeking mental health treatment are manifold and vary from the clinical to the practical. Here are the top ones that I have seen in my therapy practice:
· Clients can have therapy in a place they are comfortable in.
· Accessibility for anyone who cannot make it to a physical office for whatever reason.
· Less commuting time!
· Which then means more scheduling options outside of the after school/work hours that are always in high demand.
· Sessions can be held even while out of town, assuming you are still in-State.
What are the Challenges of Telehealth?
While my clients and I have found many benefits to telehealth during the pandemic quarantine there are still challenges. These are the top four my clients and I discovered:
· Connectivity issues – an interruption to the phone or internet connection takes up valuable session time or could disrupt an important moment in session.
· Distractions – a dog barking, a family member walking in, a child needing attention, etc.
· Client protection of confidentiality may be limited or compromised.
· The therapist may miss non-verbal cues.
There is something to be said for the energy of being in the same room as your therapist. Telehealth can lose that element that is important for some clients.
Even when conducting a video session, the therapist may miss non-verbal cues such as fidgeting that are out of camera view or an odor that suggests the client is under the influence of a substance or has not been able to wash themselves and/or their clothing. Additionally, the jury is also still out on whether telehealth is an effective mode of treatment for severe conditions such as psychosis or for social skill training.
The APA lays out some of these most important challenges here. There is also the simple fact the vast majority of therapists were trained to conduct in-person sessions. Those skills may not necessarily translate into confident and competent telehealth care.
I encourage you to advocate for your care by talking to your therapist about what they have done to increase their knowledge and competency around telehealth if they continue to offer it post-quarantine.
Is Online Therapy Secure and HIPAA Compliant?
Extra steps need to be taken to ensure telehealth is secure and confidential. A therapist’s office has a certain level of confidentiality built in given it is a separate location away from your home and family members.
From the therapist’s side – besides being in a private location everything needs to be HIPAA compliant. For traditional telephones that means a secure landline. For cell phones this means a secure connection with client contacts either saved elsewhere or behind an additional level of password protection. If the therapist is using a cell phone they will ideally use a HIPAA compliant app such as iPlum which markets itself as the #1 HIPAA compliant second line phone app.
For video sessions either a practice management software with a built-in HIPAA compliant video feature (such as SimplePractice) or an independent but still HIPAA compliant video software. Doxy.me rose through the ranks as a compliant and secure alternative to Zoom for all sorts of virtual health visits.
Tips for Privacy During Online Counseling Sessions
For clients – the key is privacy. This can be difficult when at home with family members. During the pandemic our clients utilized these methods:
· Scheduling sessions for when other family members are out of the house.
· Having family members leave the house for that hour.
· Participating in the counseling session from a vehicle.
· Reserving a conference room/closed office.
Another concern for clients is safety. It may simply not be safe to do therapy while inside or near the home. If that is the case, talk with your therapist to identify safe alternatives. Telehealth may not be the best option for you.
Who May Telehealth Be Particularly Suited For?
There are multiple life styles and situations that may be particularly suited to telehealth. This includes those living in rural communities or anyone with limited access to transportation such as those with disabilities, the homebound, or those without access to child care. And, of course, anyone who simply does not have the time to commute to an external office at any point in their day.
This brief from SAMHSA goes into the various challenges connected to mental health in rural areas. In totally it is somewhat beyond the scope of this article, though still worth a read. For our purposes here it points out the accessibility barriers to mental health – chiefly time and availability of resources. There are simply not many mental health resources in our rural communities. It is not unusual for the nearest therapist to be an hour, or even two, away. A three-hour weekly commitment it just not viable for most. But a phone call or video session that is only 50 minutes can be.
Here is just one study showing the efficacy of telehealth for homebound individuals. For anyone with transportation challenges telehealth can be essential as all that is needed is a secure, confidential place to talk and a secure phone/internet connection. The same can be said for anyone who has children old enough to be unsupervised in the other room but not old enough to be left home alone.
Do I Have to Use Online Therapy Services Now?
No. Per the new legislation, you cannot be forced to do in-person or telehealth sessions. Your therapist may have a preference, for example, if sessions will be over the telephone the therapist may want to see your face at least once.
However, that being said, if a given therapist only does in-person, or only does telehealth, or only on certain days that do not work for you then the relationship with that specific therapist may not work. If you have already been working together the ideal is you find a solution together. If this is your first time working with this therapist then finding someone who better fits your scheduling needs may be preferable.
Which Should I Choose: Online or In Person Therapy?
It all comes down to personal preference. Some clients will love the convenience of sessions from just about anywhere. Others will want to feel the connection that only comes from being in the same room as your therapist. If you are not sure which to choose talk to your therapists or the ones you are thinking about working with.
Here at Obsidian, we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us at the following:
Kari Holman –
(847) 450-0460
kariholmancounseling@gmail.com
Ilyssa Lasky –
(224) 255-4411