I have been an in-person therapist for a long time, and at a variety of levels of care. In 2020, when we all transitioned to virtual living, many of my clients and colleagues discovered a new way of communicating – some liked it, and some did not. I was one of the (few, it seems) therapists that likes a virtual platform. Here are some pros & cons:
- It is harder to develop trust and rapport – the more barriers there are to communication (like a screen), the harder it is. That said, it all depends on how much you put into it – it is certainly possible to work through that, especially if both parties are comfortable with the technology.
- It does have some limitations when working with clients with eating disorders, namely that it does still require some in person assessment with doctors, nurses, or dieticians to determine medical wellness and stability. If I am seeing a client in person, I can also make assessments regarding some aspects of that (things like general appearance, mobility, mental status) but even in-person need to rely on the rest of my team for other medical information. As the American Psychological Association (APA)’s requirements dictate, I cannot see a client in outpatient care without assessing their medical stability to be at that level of care with qualified professionals.
- “Zoom fatigue” – there is a lot of research out there about how working in exclusively virtual platforms is more fatiguing than in person – mainly because of the impact of sitting in front of a screen and how activating that is for your brain.
- Your insurance company and the law (state and federal) have more to say about what is needed to make tele-therapy appropriate and secure. It does take some work and an appropriate, HIPAA compliant platform to make tele-health viable. That is the main reason you cannot just FaceTime your therapist – there are a lot of laws governing online communication for all healthcare providers. Your insurance company may have separate rules for coverage, too, that you will need to look into.
- Technological issues – there are always glitches, and it can be very frustrating. It is important to have a backup plan if communication fails for some reason. I once had my computer die entirely in the middle of the session – and it would not turn back on! I had to use my phone, but it took a while to log back on and communicate with the client, so we lost a lot of productive time in that session. FYI for my clients, I will email you if I do not hear from you after 5 minutes and call you 5 minutes after that. If there are glitches with my Zoom (or other compliant platform), I will call you and try to do that session over the phone or reschedule if needed.
- Clients need to be prepared on their end – meaning they must be in an appropriate place, with access to their computer or phone, preferably alone in a quiet place. If you think about it, your therapist’s office is usually calm and stress free as far as the places we go on a regular basis – you want to recreate that as much as possible, and I admit that it is not quite the same.
- You cannot beat the convenience and flexibility! It is easier to schedule, easier to get to, and right there on your computer or phone.
- Research indicates that it is just as effective as in-person therapy for most mental health concerns, and 96% of telepsychiatry patients were satisfied with their online sessions https://pubmed.ncbi.nlm.nih.gov/16848938/
- Clients act differently in their own space – sometimes we can do things in their own environment we would not be able to in an office, like meditation and grounding and exposure activities.
- Procrastination is less of an issue – you have your journal and your workbooks and your computer and all your sensory tools in your own home, and that can make it much easier to access coping skills.
- People tend to be a bit less guarded – for all the calm of a therapy office, the whole process can be a bit daunting, especially if you are nervous about being seen in the waiting room. We are all much more used to virtual everything than we were a few short years ago. We tend to share more when we are comfortable, so it helps people who would be intimidated or anxious get through those feelings more quickly, especially if they are comfortable operating online.
- Different cues – reading body language is an essential part of communication because non-verbal behavior tells us so much about someone’s mental state and gives us so much involuntary information. Though we do miss out on some of this in virtual therapy, there are other ‘tells’ that people have that give us information. Most of the time, people are not trying to hide their thoughts in therapy in any case, so to make it easier, I just bring it up at the beginning! It is another way to build trust – just like we talk about confidentiality, rights and responsibilities, potential outcomes, etc. we also talk about limitations and make sure we are all on the same page. Sometimes, it even makes people share more, having all of that out in the open.
All in all, I am glad virtual services are here to stay. It helps all of us access mental health services, and that is the most important aspect. Options are good, and whatever makes you the most comfortable, open, and willing will help your therapy work that much better.