For 30 years, clients have presented themselves to my office intent on seeking help and relief from a veritable array of mental and psychosocial issues both past and present. These regular office sessions served as a catalyst for in most instances, creating a strong bond that these patients came to rely upon as a vehicle for improved symptom management, clarification, and resolution for whatever was on their problem list.
In mid-March of this year, this routine ended abruptly, when clinics and private practice offices after a period of shutdown, reemerged “virtually. “Speaking for my own practice, the switch to virtual has brought mixed reviews. Some patients made it very clear to me that the absence of working with me “in-person” was disconcerting at first, “I can’t see your facial expressions as clearly;” “I miss the intimacy and privacy of the office setting;” “it doesn’t feel as professional to me.” On the other hand… “I feel much more comfortable discussing my sensitive issues in the comfort of my own environment;” “Joe, I sure like not having to make the drive to your office.”
Covid As A Catalyst
I can unequivocally say that had this pandemic not happened, I’d be doing business as usual. I cut my teeth believing in the “magic” of the in-person interaction, thinking of tele-therapy as a second line approach relegated to only special circumstances. But my position on this has undergone some revisions, and now I can see the wisdom in creating a broader relationship with clients through the use of a hybrid model, which includes in-person, video and e-mail. This makes care substantially more accessible.
Advantages Of Tele-Treatment
Clients, who typically have a hard time engaging during in-person visits or struggle with getting to an office setting in the first place, are considered good candidates for tele-treatment. Those with PTSD and other manifestations of trauma, those with agoraphobic tendencies and even those who are suspicious about the safety of an office setting are good candidates for virtual treatment. It can also be quite the advantage to people with disabilities. Poor candidates would be those with disorders along the psychotic spectrum, acutely manic people, those with conduct problems, and others with multiple distractions that would markedly interfere with their capacity to focus during sessions.
Engaging With Clients During Remote Visits
Much like when employing a Motivational Interviewing strategy, it’s best to not jump in right away with clinical “business.” Ease your way into the session by noticing what’s in the client’s surrounding environment — whether it photos you see on a side table, an interesting piece of art on the wall, or a pet that suddenly makes an unexpected appearance. If you work virtually with the client regularly, you’ll likely notice an array of things that will help you ease into the session and make a connection.
Licensure
If you’re working with a client physically located in another state, you must ordinarily be licensed in that particular state — although this regulation has been suspended during this Covid crisis. This will eventually change back to the norm, however. It is acceptable to provide one or two telephone or e-mail contacts pro bono, similar to what we’d do for clients we’d see in-person, who happen to be traveling. If the client will be away repeatedly however, you’d want to turn the client over to a colleague licensed in that other state.
HIPPA-Compliant Platforms
Again during this pandemic, any system you choose to use is acceptable. This too will revert to the norm, so it’s best to get a HIPPA-compliant system. Nothing elaborate or involved is either necessary or required — there are several excellent ones available at reasonable pricing schedules per month. As for billing, this is going to vary from state to state. You’ll likely be required to modify psychotherapy coding to indicate it was done by tele-treatment.
The Overall Verdict
Tele-treatment has earned very high marks — even higher than with traditional in-person care. And with the considerable improvements in the technology itself and advancement in how it’s transmitted, satisfaction numbers will continue to rise. Yes, we’ll still want our clients to resume office visits, but there are advantages to both forms of treatment, so it’s key for clients to have choices that offer ease and flexibility — two factors that work favorably for us treatment providers too!
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.