Telehealth follies

By Ellen Anderson, Ph.D
May 2nd, 2024

The pandemic propelled many therapists into providing services via telehealth, typically through videoconferencing. Indeed, many colleagues have left the office, never to return. The advantages of telehealth sessions for clients have been well documented. Telehealth increases accessibility for those clients living in rural areas, those without transportation and those who are homebound because of physical restrictions or mental health conditions. But what of the follies of telehealth?

Many psychologists did not have formal training in delivering services via videoconferencing but instead adopted it out of necessity during the pandemic. I approached telehealth with apprehension.

I do not enjoy Facetime, did not like videoconferencing when I was in an office setting and am generally curmudgeonly about such matters. I expected technological challenges but found that it was relatively easy to use telehealth–except when it was not.

Most therapy sessions are uneventful (from the technology perspective) but it is not uncommon for the internet connection to be interrupted, for example when the Airpod microphone Bluetooth connection on the PC suddenly reverts back to the phone.

Similarly, the client’s phone connection to the session may be suddenly interrupted by an incoming phone call or text message. I find it most unfortunate when mine or my client’s face becomes “frozen” on the screen, necessitating reconnection to the session. Most eerily of all, there are occasions where I enter the session and can see and hear the client, but they are unable to see or hear me via the videoconferencing platform.

Technical challenges aside, the pitfalls of psychotherapy delivered via videoconference range from silly to concerning. I enjoy seeing my client’s cats vying for their attention by walking back and forth in front of the computer screen.

My dogs usually snooze away at my feet but there is always the risk of chaos if someone rings the doorbell. Some clients take sessions in their car and as long as they are not driving.

I have learned to roll with this, if the pros outweigh the cons. On the plus side, it allows people with little free time to get therapy on a lunch break from work or prior to picking up their children from daycare

On the list of cons, mobile devices in the sun overheat and the car is inherently distracting. I often need to ask patients to avoid holding their mobile phone because the movement on screen gives me motion sickness and can create interference with the microphone function.

Privacy is a necessary prerequisite for therapy but some patients appear unfazed by a family member entering the room when they are in a therapy session. At times, the family dynamics seem to be well illustrated when a spouse or parent strides purposefully into the session. I have had client’s sessions interrupted by rambunctious toddlers as well as perfectly peaceful sessions with a sleeping infant nearby.

Cyber security is also an ongoing worry in an era where Bluetooth connections can be “bluesnarfed” or hacked to steal data from the device. Perhaps most ominous in the age of artificial intelligence is the possibility that a patient can easily videotape the session without the therapist’s knowledge or consent. Though illegal in most states, it is impossible to prevent. While the client and I worked through it, I had never seriously considered that a client might violate trust in such a manner.

By the summer of 2024, all New England states except Massachusetts will have enacted Psypact legislation and it appears the practice of telepsychology has passed the rubicon.

Virtual psychotherapy sessions will continue to proliferate across our region as well as the country. The American Psychological Association has developed telepsychology guidelines and examples of telehealth policies for psychologists can be found on The American Insurance Trust’s (The Trust) website.

Some psychologists will continue to swim against the tide, preferring to provide psychotherapy face-to-face. I too prefer face-to-face and maintain an office, but as the New England weather warms, I am more likely to deliver telehealth sessions from home for my own benefit as well as that of my patients. It is undeniably appealing to be out in the garden when there is a break in my day. But more importantly, despite the numerous follies of telehealth, many more people can access mental health services if they are available virtually.

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