Tracy Quinney explores what is phubbing and explores strategies when our fr...
September 25, 2020
February 9, 2022
If you’d asked me two years ago to write about the benefits of having a therapy session using telehealth, I think I would have politely declined.
However, when COVID-19 struck, our duty of care to still conduct therapy sessions with our clients gave us little choice than to get out of our comfort zones and embrace online video technology. Our team, like many of you, were somewhat concerned that the magic and sacred, private nature of the therapy space with such clear boundaries could never be simulated to give the same impact.
I found it challenging for three reasons:
Since those first days of conducting a therapy session using telehealth, much has changed and much has been learned. We have all had to work our way through adapting our process and finding ways of translating the power of the therapeutic relationship to this forum.
I have moved from approaching telehealth as a compromise and a significant challenge therapeutically to embracing the opportunities it presents.
I can’t deny that sitting in a therapy room with someone brings an energy and safety that is hard to describe – it absolutely is different and something that will never be replaced.
However, I realised early on that the only way to continue to provide continuous care to my clients during COVID was to test my theory, like a true scientist practitioner, and see what happened and dive in the deep end – there was really no choice! Over time I practiced what I preached, using mindfulness in action, noticing, exploring, experimenting, paying attention to the things that worked and didn’t work and as I did this it gradually shifted from being unfamiliar to familiar and the learning curve continued.
And, surprisingly to me, I am now seeing some very clear benefits that make telehealth possibly a better mode of therapy for some clients in certain situations.
Let’s look at some of the experiences that have shown me new opportunities that are possible through online sessions, and then finish with some tips on how to prepare for your first telehealth appointment.
A telehealth session is one where the therapist and the client meet using an online video consultation or, sometimes, using a telephone.
It’s fair to say that most of the time we make use of video because that grants all participants the invaluable benefit of seeing each other’s facial expressions and more closely resembles the communication pathways that allow us all to feel safe, engaged and to read each other more accurately.
When you are talking about sensitive, very private matters, requiring us as therapists to navigate complex emotions and subtle responses, the face and the voice are such critical factors in giving us rich information. As a therapist, sometimes the words carry much less information than the nature of the breathing, the eyes, the smile or the grimace, the head movements and the restlessness in the chair. These are the kinds of things that help us make sense of what we hear and give deeper meaning for us to explore further.
We also are able to pick up when the body language and facial signals don’t match what we hear. I certainly believe that our body certainly keeps the score. Subtle expressions and movements allow us to read someone with the voice and the posture as additional indications beyond the narrative. As a therapist this is absolute gold. Eyes can tell you a lot but sometimes the mask may hide important information that just makes it harder for you to express things and be understood quickly.
Throughout this COVID safe era, some clients felt safer (physically and emotionally) seeing me via telehealth than practising face to face with a mask. While reducing their risk of exposure to the virus, they have told me they were able to read me better and they also appreciated the benefit of being able to cry without the discomfort of the mask. They’ve also been able to express their joy through more than just their eyes, enabling all of us to breathe more easily and relax into our conversation in their own space.
However, I have had a number of clients, especially those I’ve worked with for a long time, express concern about meeting using technology.
One of the most common worries was about the loss of the sense of comfort of being in our beautiful rooms. Another was the extra sense of trust required to have a practitioner, even someone they’ve known for years, “enter” into their private world and see their office or home. Our homes can be a very private space, allowing an insight for others that can be scary and confronting to have exposed but conversely, as I have discovered, it also gives invaluable information if I am invited into their space. Sometimes it allows for work that needs to be done in the context of someone’s life and natural environment that office work simply does not translate to in the same way.
Another common objection was that the process of conducting a therapy session using telehealth would not feel the same and they would not achieve the same level of benefit from this process. I’m pleased to tell you there is a significant amount of research since the 1960’s that has increased since the pandemic began to show that the outcomes of telehealth versus face to face therapy are equivalent and sometimes there is longer engagement and retention with telehealth. Research has shown that a therapy session using telehealth is successful for a range of mental health issues including anxiety, depression, panic disorder, adjustment disorder, Post Traumatic Stress Disorder and many other common issues that we see people for every day. What is also interesting is the idea that the strength of the therapeutic alliance was often shown to be as strong, sometimes stronger.
Research is one thing, but real life experience is often our best teacher in my opinion. Recently I had the most profound awakening as a therapist – it was one of those most precious moments where you are a part of something that enables a profound shift in someone’s wellbeing and life that you didn’t quite see coming. I never would have thought telehealth would be the forum where this would easily happen, but I was so wrong. For me, on that day, something changed for me and my client – it was one of those turning points where my perception shifted quite dramatically and something that felt difficult suddenly makes sense. The key was in being open, mindful and determined to take a risk and do things differently when conducting a therapy session using telehealth.
I have experienced a number of clients (particularly with histories of trauma or issues where the in-room environment was associated with de-escalating distress) worry greatly about moving to telehealth. Due to isolation needs on my part or theirs telehealth became an essential requirement. I knew that some of my clients had, early on during the pandemic, held off therapy until face to face was possible again.
In a number of situations, I had been concerned that only having telehealth as an option was going to potentially exacerbate distress. In most of these situations, my client needed support immediately and I needed to find a way of crossing that barrier and create safety for him quickly, as this was the only option we had. We would have tried telehealth once or twice earlier in the peace and it had felt foreign and a little awkward at first. In hindsight, I think we both needed time to adapt and I needed to be more flexible and creative in my approach.
When faced with a client experiencing high anxiety and panic, I knew I needed to work a little differently to ensure he felt safe. On other occasions, clients in this situation said early on (a matter of minutes into the session) that they wanted to finish because it didn’t feel like it was working. He said he couldn’t get the sense of safety and connection he needed from being in the room with me. But then something changed. As I broadened my attention and asked him to do so with me, we used what he could see, touch, feel, smell, notice as resources in his natural environment, in addition to his somatic resources (connection with his body) to ground him. I worked with him to shift posture, doing it together to strengthen the sense that I was with him in order to feel more connected with his body, breath and strength. As I noticed the breath become more even, his smile and laughter came back and he reported a very rapid change in his anxiety and emotional state. I realised that his prefrontal cortex, his “thinking brain” was back online and that he was able to shift the focus to things around them that had positive, soothing and grounding associations to come back to the present. His reflection at the end of the session was that I had somehow crossed that barrier and he was surprised that my virtual presence with them helped them achieve such a sense of safety and reduce his anxiety. In a sense, in that moment I realised that telehealth provided a safe boundary, enabling me to enter his safe space virtually and to see and witness the impact of having the things he loves around him to facilitate emotional regulation.
As practitioners we are learning to be present and flexible. Being attuned to the client’s needs in whatever forum therapy takes is critical for the success of therapy. We are all challenging our assumptions and learning the power of this medium and how its accessibility may open doors to many who have not been ever able to access consistent care.
I am currently doing a course on Sensorimotor Psychotherapy which uses the body as a resource and therapeutic focus which is helping me inform my practice. I find it fascinating that I am doing a course like this online, in fact developed online as a result of the pandemic, but successfully translating the techniques to an online and face to face situation. Rest assured that now that telehealth has been supported permanently as a service that Medicare sees as appropriate for ongoing service delivery, our commitment to learning and improving our practice will be an ongoing part of our skill development.
Here are some tips for preparing for a therapy session using telehealth.
Telehealth has the power to provide a medium where wherever you are you can access therapy allowing you to continue your therapy if you travel interstate or are in another place and not requiring you to get into an office environment, creating greater flexibility.
It also has allowed many of our clients to be able to continue services when in quarantine due to being a close contact in addition to allowing us as therapists to continue working via telehealth from home when needing to quarantine for the same reason. Also when people have tested positive for COVID or been mildly ill we have seen many pleased to be able to manage a phone call or video call while keeping everyone safe and accessing support throughout a difficult time. Many people have noted the convenience of telehealth and the reduced anxiety about not having to travel to the appointment.
It also enables things that may not be possible – seeing how your anxiety may affect you or improve in your natural environment, learning about and naming the things around you that are resources that you may not have realised were there for you and even being with your pet as an anchor when distressed.
Finally the sense of safety that is created in a therapy room may be translated in an online space provided the therapist and the client are open to difference, are flexible and willing to see it as an opportunity for further skill development. Having a memory of your therapist supporting you through a difficult time while you are in your space is an incredibly powerful memory that may set up a blueprint that allows the safe space contained to the therapy room to translate to your home environment while maintaining appropriate boundaries. Essentially the screen is like a window into your space but when executed well it allows you to feel we are right there with you in your space helping you in situ.
Talking about resources in an office context compared to seeing and using them are very different things that translate very differently in terms of change. My client was so relieved and pleased to realise he now felt grounded and safe and that telehealth could also be a vehicle for change in a way that both of us had underestimated.
My advice – give it a go – you will never really know what it feels like until you try. Sometimes stepping out of our comfort zone to do something different pays off. Sadly the impact of the pandemic has been that the need for mental health services has increased significantly with waitlists becoming the norm. Telehealth offers an alternative that may also be more accessible more quickly.
We welcome you to join attuned on this journey to the discovery of the potential for telehealth to achieve the outcomes you are wanting to achieve through therapy.
All of our therapists practice telehealth. Anne-Marie Newham, one of our therapists has immediate availability and our team is ready to take your enquiries and book an appointment with her as soon as you are ready. We look forward to supporting you in your journey to better health and wellbeing.
– Alexandra Frost
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