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Taking the Plunge: How to Make Teletherapy Work

By Robert Hindman, PhDBeck Institute Clinical Psychologist I recently read a New York Times article that confirmed something I’ve been thinking about throughout the Covid-19 pandemic: maybe telehealth therapy is here to stay. When Beck Institute decided to close our in-person clinic in suburban Philadelphia and move to conducting therapy through telehealth due to Covid-19 […]
The post Taking the Plunge: How to Make Teletherapy Work appeared first on Beck Institute for Cognitive Behavior Therapy.

By Robert Hindman, PhD
Beck Institute Clinical Psychologist

I recently read a New
York Times article
that confirmed something I’ve been thinking about
throughout the Covid-19 pandemic: maybe telehealth therapy is here to stay. When
Beck Institute decided to close our in-person clinic in suburban Philadelphia and
move to conducting therapy through telehealth due to Covid-19 precautions, I
was somewhat skeptical. On the one hand, I knew that research has demonstrated
CBT telehealth outcomes to be equivalent to in-person
sessions
. These studies provided a measure
of comfort. In addition, three
quarters of surveyed mental health professionals
are taking on this adjustment
with me. On the other hand, I just couldn’t imagine having the same impact over
a video platform as during an in-person session. But experience soon taught me
that there are many benefits to conducting CBT sessions remotely. If you’re
treating clients via telehealth, I’ve compiled some tips here.

woman taking notes

One of my first hesitations about virtual CBT sessions concerned
therapy notes, which are an integral part of good CBT. Before becoming a CBT
clinician, I conducted psychotherapy sessions without taking notes. Though the
sessions may have been helpful, clients would come to the next session
reporting the same problems, forgetting some of our previous discussions and
what we had agreed they’d work on. After implementing note taking, I quickly
realized that my clients seemed to improve more quickly, maintain progress
between sessions, and remember our plan of action much better. Clients said the
notes were extremely helpful, especially for those who had previously done
therapy without note taking.

My therapeutic style includes writing out charts, tables,
and diagrams, when indicated. I was unsure that this activity would translate
well virtually. With the help of a more tech-savvy client – you wouldn’t know I
was a millennial based on my tech skills alone – I used our telehealth platform’s
“whiteboard” function, allowing me to draw diagrams, such as the cognitive
model of a panic attack. After our session, I was able to easily share our
notes through encrypted email.

Telehealth has also improved the impact of my therapy
sessions when conducting exposure exercises. In-person sessions are inherently
limited when conducting exposures, as they may only apply inside the therapy
office. Any in-vivo exposures outside of the office would need to be planned
during the session and conducted by the client between sessions. During
telehealth sessions, I’ve had clients use their phone or tablet, so I was able
to guide them through an exposure as they were engaging in it. One client
agreed to walk over a high bridge, an activity she had been avoiding. During this
exposure, she said, “I can’t do this!” But I was there with her, virtually, and
helped her evaluate her thoughts on the spot, so she could complete the
exercise. Afterwards, we collaboratively created a coping card for the next exposure.
 

Another significant benefit of conducting therapy via
telehealth is helping clients who would otherwise not be able to come to
in-person sessions due to distance. Since I started conducting CBT over
telehealth, I’ve been seeing client from all parts of Pennsylvania.  Additionally, because many states have relaxed
their licensing requirements due to Covid-19
, I and the other Beck
Institute therapists have been able to obtain temporary licenses and virtually
treat clients from all over the country. This is especially necessary as we
confront a mental health crisis at a time when nearly
one in five US adults live with a mental illness
, and many have barriers to
access care.

My initial hesitancy to try telehealth sessions has
disappeared. I often prefer them, in several ways, over standard sessions, and
I can see this being part of my ongoing practice even after resuming in-person CBT.

References:

Acierno R, Gros DF,
Ruggiero KJ, et al. Behavioral Activation and Therapeutic Exposure for
Posttraumatic Stress Disorder: A Noninferiority Trial of Treatment Delivered in
Person versus Home-Based Telehealth. Depress Anxiety. 2016;33(5):415-423.
doi:10.1002/da.22476

APA Staff. (2020,
June 5). Psychologists embrace telehealth to prevent the spread of COVID-19.
Retrieved from https://www.apaservices.org/practice/legal/technology/psychologists-embrace-telehealth

DeAngelis, T.
(2020, March 18). What the COVID-19 telehealth waiver means for psychology
practitioners. Retrieved from https://www.apaservices.org/practice/legal/technology/covid-19-telehealth-waiver

National Institute
of Mental Health. (2019, February). Mental Illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Wilser, J. (2020,
July 09). Teletherapy, Popular in the Pandemic, May Outlast It. Retrieved from https://www.nytimes.com/2020/07/09/well/mind/teletherapy-mental-health-coronavirus.html

The post Taking the Plunge: How to Make Teletherapy Work appeared first on Beck Institute for Cognitive Behavior Therapy.

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