Coronavirus speeds move to online counseling, but therapy over computer brings its challenges
Here’s another Covid-19 impact that is transforming the world as we knew it: Psychotherapy has become a “virtual” experience to comply with the strictures of social distancing. It’s created challenges for therapists and clients alike when they “meet” via telephone or video chat.
Still, the change seems inevitable when health experts say people should stay 6 feet apart to prevent infection. Outpatient therapists at Cambridge Health Alliance are “in the process of transitioning to televisits” conducted over the phone for all but “urgent cases,” spokesman David Cecere said in an email Friday. It’s happening in other departments as well. “We are practicing social distancing wherever possible, spacing out offices, using different waiting rooms and ceasing group visits at this time,” keeping employees and patients safe “while ensuring patients still get the care they need,” Cecere said.
Across the state, “the vast majority” of psychologists and other mental health providers “have switched over to all or primarily telemedicine” in the wake of the epidemic, said Jennifer Warkentin, director of professional affairs at the Massachusetts Psychological Association. It helped that Gov. Charlie Baker last week ordered most commercial health insurance plans to cover telemedicine the same way and at the same rate as in-person visits, and Medicare relaxed restrictions on coverage, she said.
Long time online
Virtual sessions are nothing new to one Cambridge psychotherapist. “I’ve been doing it for the past 10 years and have been 90 percent online for at least one and a half years,” said licensed social worker Michael Langlois, former member of the advisory board of the Cambridge Commission for Persons with Disabilities. “I love it. I’m an early adopter.”
Posts on a Reddit site for therapists describe a host of uncertainties and difficulties. One commenter said more than half of patients had canceled their virtual sessions. “A few folks have zero interest in telehealth, a few lack safe and/or private spaces to use a platform from, etc.,” the message said. Other posters wondered how to do virtual “play therapy” with young children via video communication, or keep teenage clients away from their apps when they were online for a session. One teen “played Fortnite intermittently between comments,” a post said.
Some therapists on the site asked about training and sought advice about what telemedicine application to use. “Is it ethical to provide teletherapy without training?” asked one commenter, adding that the supervisor also had no training.
Langlois agreed that “everyone is having some challenges,” but said his colleagues are “really rising to the occasion.” They are willing to tackle a new way of doing treatment instead of “leaving patients in the lurch with nothing” because of the coronavirus emergency, he said. “There’s a willingness to learn,” Langlois said.
Reddit also offers a site for therapy clients, and many of them panned the change. “I hated phone therapy,” one said. “Considering just canceling and asking him to have his secretary just call and schedule when this mess is over.” Another commenter complained of hearing the therapist’s dog and child during a video session. “Already knew he was married by the ring, but didn’t really think he was much of a kids’ guy. Ugh,” the post went on.
Still, some comments praised the experience – if not always for a good reason.”Phone session curled up in a dark closet is exactly what I want therapy to be all the time,” said one post.
To Langlois, “every impediment that is mentioned is an opportunity for conversation.” As for misgivings such as the commenter disturbed to hear a dog and a child during his online session, “it is going to bother some patients when they get reminded that their therapist has a larger life than they were thinking,” he said. Still, clinicians “need to pay attention” to clients’ discomfort.
He conducts video sessions from his dining room table, a space dedicated to his practice, he said. He uses GoToMeeting for videoconferencing and Hushmail for email communications, he says on his website.
For those who weren’t conducting online sessions, “almost overnight it’s been a huge transition,” said Warkentin at the state association. The change to telemedicine “has been a steep learning curve for a lot of members,” she said. The state organization and the American Psychological Association have offered materials to help, and many Massachusetts therapists were already looking into moving to online sessions, she said.
One issue has been patient privacy. Warkentin said three free platforms for conducting online sessions, and some paid options, comply with the provisions of the Health Insurance Privacy and Accountability Act. This week the federal government said it wouldn’t strictly enforce that law for telemedicine during the emergency; Warkentin said the change came at least partly because tremendous demand for the compliant applications was causing them to crash. Despite the exemption, “we still have an ethical obligation to protect patients’ privacy” and some commercial health plans require it, she said.
Warkentin, who practices psychology in Needham, said she wanted to move to telemedicine before the coronavirus crisis because it would help her clients, mostly older people who may be homebound. “I hope that at the end of this we can continue to offer telehealth as we are now,” she said.
Langlois expects telemedicine to stick around after the Covid-19 emergency ends. “The universities and social work schools will take more interest,” he said. The growing necessity of having an Internet connection also means that society must ensure that everyone has a computer. “I’m not sure every patient has the finances to be able to afford a computer or a cellphone. We need to make sure that happens.”
Warkentin said she hopes people will seek help especially during the Covid-19 outbreak. “The mental health community in general recognizes this is a difficult time,” she said. “Quarantine is important for physical health, but it can take a toll on emotional health.”