Telehealth: Online Therapy  

Telehealth is a vague, misleading name for what might more accurately be called Face-to-Face Computer Counseling or Internet Therapeutic Counseling. As virtual options such as remote work and telehealth go from a pandemic-driven necessity to an accepted part of daily life, social workers have had to navigate this transition with patients and, at the same time, maintain the quality of their care.

While the pandemic pushed a sudden move to telehealth, patients and mental health professionals have found since that virtual therapy can be as effective as in-office visits, and for some patients, even helps ensure they can more easily access the treatment they need. However, some therapists report their concerns with counseling from a remove. They believe that therapy over the internet presents challenges to the authenticity, intimacy, confidentiality, and continuity of the interaction between therapist and client. Here's what some concerned case workers had to say.

CW#1. "There is no doubt that technologies like Zoom and Google Meet and Skype have all enabled therapists to serve clients through the pandemic and also reach out to remote clients and clients who were not ambulatory even after the pandemic subsided. The drawbacks I encountered were mostly technical in nature.

• Sometimes the client didn't have a robust Wi-Fi connection, and we would keep losing contact.
• Sometimes the client didn't know how to work the face-to-face technologies and would have to rely on a grandchild or child who would have to be present or nearby during counseling sessions. This, of course, did not add to the comfort or privacy of the sessions and would diminish their effectiveness.
• Some clients simply couldn't afford a modern computer or a reliable Wi-Fi service. These clients tended to just fall away and discontinue therapy during the pandemic.”

CW#2. "I have found that when I don't share the same space with a client a certain degree of intimacy is lost, which I feel leads to a little less trust. A face-to-face exchange is always the most natural experience. Body language and physical closeness enhance the feeling of intimacy that is so important for establishing trust with a client."

CW#3. "My experience with telehealth has been a little frustrating. If nothing more, either the client will be interrupted by someone or something intruding in their environment or, to be fair, someone will interrupt me if I'm conducting the session from anywhere but in my office. In other words, I must do more pre-session preparation and have my clients follow a series of ground rules that cannot be broken. Otherwise, confidential counseling sessions turn into spontaneous social affairs.

• I once had a client suddenly introduce me to her next-door neighbor and the neighbor's dog, Tag, right in the middle of a session.
• Another time, a client put me on hold while she answered a call back from Amazon.
• The last straw was when a client hung up on me when she didn't like what I was saying.

Telehealth is an important advance in making counseling sessions available to those who need help, but it must be approached as an entirely different discipline from in-person counseling. It takes some training and practice on the part of therapists."

CW#4. "I believe I have worked out most of the snags in the telehealth portion of my practice except for one nagging issue. The only way to put it is to say that I "feel", without any evidence, that I am losing "touch" with clients who have drifted to telehealth sessions exclusively. I believe as I go forward, I will require clients to come into the office once a month or once every two months so I can look them in the eye and get a better feel for their state of mind. I'll let you know how this works out down the road."

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Always ask the experts. That's our rule. When it comes to case workers they always know best about their work. They are the experts.