Prior to the COVID-19 pandemic, I only provided counseling services in-person. My overall impressions of telehealth were neutral to negative. However, the pandemic challenged me to view the counseling process from a different perspective.
As we know, everything changed when COVID arrived. From March 2020 until Fall 2021, I, like countless other mental health providers, was forced to make an abrupt pivot to only using telehealth counseling services. I was initially skeptical about how effective I could be as a counselor in this new world, and I was worried about how this change to exclusively virtual communications would impact my therapeutic relationship with clients.
However, since I undertook this transition, I have shifted my thoughts and feelings, and I now have a more positive outlook on telebehavioral health. I appreciate the convenience and flexibility it provides. My clients appear to have similar feelings and thoughts, and several have mentioned they would likely not have participated in counseling if telebehavioral health was not available.
I will be discussing in-person and online therapy (and more) on a new show launched by my friend, Neil Parekh and Dawn Helmrich Neuburg, “Shining Light on Shadows: A Candid Conversation About Mental Health.” You can watch the show live Thursday, August 8th at 7pm ET / 6pm CT or watch the recording on this website or catch it on Facebook, Twitter*, LinkedIn, YouTube, Instagram* and Neil's website. *We won't know the exact urls for Twitter and Instagram until we go live on Thursday evening. For now, these links go to Neil's Twitter and Instagram accounts.
I am part of two counseling centers: NeuroPsych Wellness Center and The HUB. Both provide mental health services in different parts of Fairfax County. Both continue to assess the role that telehealth plays in counseling. Health insurance coverage of telehealth and client needs are factors in the decision-making process. Most clients still appear to prefer telehealth sessions over coming in person. Therefore, most of my sessions are via Zoom.
Although telehealth has its advantages, there are important considerations as well:
Confidentiality – It may be difficult to ensure the client is in a safe and secure environment where they can communicate their thoughts and feelings without disruption.
Technical difficulties – This may disrupt the counseling process and cannot be anticipated.
Assessment issues – It may be more challenging for the counselor to accurately assess the client because counselors cannot see their whole body and therefore it is harder to pick up on nonverbal cues.
Therapeutic relationship – While some clients may prefer telehealth because it may cause less anxiety and feel less intimidating, others may benefit from the accountability of in-person sessions. In addition, it may be more difficult to build the therapeutic relationship without the opportunity for connection that only in-person counseling could provide.
To better connect with clients on the telehealth platform, my counseling approach has shifted to become more directive or straight-forward. If I am at all uncertain about how I am interpreting a client’s thoughts or feelings, I directly ask. For example, I say, “I am not sure how you are feeling or what you are thinking right now, do you mind explaining it to me further?” Generally, clients have been appreciative of the opportunity to clarify their perspective.
To emit levels of sympathy, empathy, and understanding, I find myself amplifying my facial expressions, nonverbal cues, and verbal statements in general. For this reason, I believe remote counseling can be more exhausting. Reflexively, I place more effort in self-care, so I can recover and refuel for future sessions.
Overall, I believe it is a positive movement that telehealth has become more normalized, largely because it means that more people are comfortable accessing counseling services. Because telehealth has allowed clients more options, they can feel empowered, and counselors can “meet them where they are.”
It is important, however, for counselors to be clear-eyed about its challenges and to take extra steps to ensure we can still develop meaningful relationships with our clients and be effective in our work.
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