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Online Therapy

An Invitation to Therapists Regarding Telehealth

A Personal Perspective: Maybe it’s time to remember in-person therapy.

Key points

  • Telehealth has been a necessary survival tool during a pandemic.
  • Therapists are encouraged to reflect on what they might be missing in telehealth.
  • Therapists are invited to remember the importance of in-person interpersonal connection and its relationship to healing.

By Karen Z. Hyland, Ph.D., Director of Clinical Services

Julia M. Cameron/Pexels
Source: Julia M. Cameron/Pexels

Video technology has been a lifesaving (and career-saving) tool during the turbulent times of the pandemic. Our clients could continue with much-needed treatment.

As clinicians, we were able to keep our jobs and income. The pandemic caused a spike in demand for therapy, and thankfully, telehealth helped meet the psychological needs of our communities.

We made telehealth work—in many cases, very well. We adjusted to serve our clients as best we could. Our clients did the same—they have been resilient and adjusted to psychotherapy online.

As the option to return to in-person therapy resumes, many therapists and clients are questioning why we would need to. Some enjoy telehealth. They feel it is effective, and both therapists and clients like the convenience, the lack of the commute, and the comfort of staying at home.

Just because we made telehealth work, though, does not mean that it provides the most effective and powerful form of therapy. Telehealth during the pandemic was a survival tool, and it served us well amid a crisis. Survival tools, however, are just that—tools for survival. They are not typically used for optimal functioning or if there is a choice in the matter. It’s time for us as therapists to think deeply about which situations and clients telehealth is right for and when in-person therapy is the more ethical and effective decision.

Research shows that K-12 students have learned less and are falling behind academically through remote learning. Remote learning has been another survival tool for the pandemic but, on the whole, not as effective as in-person schooling. One wonders if a similar thing could be occurring with telehealth for mental health treatment. Are people really getting better, staying better, or are we missing something?

When I hear colleagues say telehealth is "just as effective" or "a preferred method" of conducting therapy or that they have given up their office and "might never go back to in-person sessions," I worry that we are forgetting so many of the deep and powerful factors that contribute to healing; for example, the gift of sitting, fully embodied, with another human being amid their pain.

Several colleagues refer to telehealth as “therapy lite,” and I agree. I encourage you to consider what nonverbal communication might be missing when observing someone through a screen. Can you see a tear well up, a flushed face, picked cuticles, an agitated leg?

It is for many reasons like these that no grandparent would say that Facetime with their grandkids is "just as good" as seeing them in person. None of us will choose to meet our friends for ‘happy hour zoom’ if we have the option to go to a restaurant and have a meal with them.

Armin Rimoldi/Pexels
Source: Armin Rimoldi/Pexels

Why is this? Something happens in person that is completely and utterly lost on an electronic device, and telehealth often provides a suboptimal experience and therapeutic environment for clients.

In our caseloads on telehealth, we have had clients come intoxicated to the session, chop vegetables, bring drinks like it is happy hour, finish lunch, communicate with their boss in between sentences, have their first psychotic break, be in a real crisis, and need to be hospitalized.

We have had clients interrupted by children, pets, delivery people, and showering spouses. We have heard clients peeing, seen them not wearing pants, and asked them to put on a shirt. I have done sessions with clients in closets, parks, cars, and stairwells—all places clients have gone to try to secure privacy.

This is understandable—because we have been in survival mode. But as we move back into our daily activities, begin to see family and friends, go to restaurants, attend weddings and worship services—I implore our profession to consider what has been lost during telehealth and whether a shift to permanent telehealth for the sake of convenience for all, is worth it.

Some colleagues claim that "the world has changed" too much to go back to in-person sessions. However, interpersonal relationships (of which therapy is one) cannot be truly nurtured over a screen. Human beings are interpersonal. We need to see and be with each other. There are ways in which technology can bring us into a "changed world"–but not by replacing the powerful healing experiences we can have by being with our clients in time and space.

Please review this blog for more points to consider: https://www.psychologytoday.com/us/blog/the-therapy-journey/202204/anot…

To find a therapist, visit the Psychology Today Therapy Directory.

References

Mckinsey & Company (2021). Covid-19 and Education: The Lingering Effects of Unfinished Learning.

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