One of the most wide-reaching side effects of COVID-19 has been its impact on mental health. Understandably, a global pandemic has people dealing with more anxiety and depression than usual—not to mention the additional difficulties it’s causing for people with other conditions like obsessive compulsive disorder and post-traumatic stress disorder.
People already in therapy may have made the switch to teletherapy over the past two months, but for those new to this type of service—or those who are new to therapy in general—talking to a mental health professional via video chat may raise a lot of questions about privacy and efficacy. To give you a better idea of what teletherapy involves, we’ve spoken to several experts, including a pioneer in the field. Here’s what you need to know.
What is teletherapy?
Teletherapy—also called telepsychology, telehealth or telemedicine—involves speaking with a licensed mental health professional remotely. Right now, most teletherapy is done via video chat. Dr. Mary Alvord, a psychologist with more than 35 years of experience, was an early-adopter of teletherapy, and has been actively promoting the service since 2005. And since March 8, Alvord has trained approximately 10,000 psychologists and other mental health providers in the practice of teletherapy.
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According to Alvord, the Department of Veterans Affairs spearheaded the use of teletherapy, as well as the research on its efficacy. Teletherapy for the general public began in the late 1990s as a way of reaching people in remote areas who wouldn’t have otherwise been able to access mental health services. The incorporation of video chatting capabilities in the 2000s gave us the version of teletherapy that we’re familiar with today.
While teletherapy itself isn’t new, it went from one way to receive mental health services to the only option, thanks to the pandemic. For example, prior to COVID-19, Alvord says that 10 to 15 percent of her practice was via teletherapy appointments. Since the beginning of the pandemic, Talkspace, an online therapy platform offering teletherapy services, has seen a 250 percent increase in live video sessions, according to a rep for the company. They have also seen the total number of users double year-over-year since mid-March.
Changes to HIPAA
Prior to COVID-19, one of the biggest challenges with teletherapy was that under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all appointments had to take place using specific encrypted online platforms that comply with a set of privacy requirements (like Doxy.me, VSee or Updox). While it makes sense to protect patients’ privacy, getting set up on a HIPAA-approved platform presents another barrier for mental health professionals, especially when it comes to what is covered by the health insurance plans they accept.
But in March 2020, HIPAA guidelines were relaxed, now permitting teletherapy to take place over FaceTime, Zoom, Skype, Facebook Messenger video chat or Google Hangouts video—previous modalities that were not permitted—with a view to making mental health services as widely available as possible during the pandemic. HIPAA also loosened restrictions on interjurisdictional practice—meaning that if you usually live and see a therapist in New York City but have relocated to Montana, your therapist should be able to obtain a temporary license to practice in the state.
Rachel D. Miller, a marriage and family therapist in Chicago, works with a practice that did not previously offer teletherapy services, but started making them available in mid-March as the stay-at-home mandate went into effect in the state. Like other practices, Miller’s wasn’t able to offer telehealth prior to the pandemic because insurance—specifically Blue Cross Blue Shield of Illinois, in their case—typically doesn’t cover this service. But given the current situation, Blue Cross Blue Shield of Illinois has agreed to cover teletherapy until the end of 2020, Miller says. Check with your health insurance company to see if any similar adjustments have been made since the start of the pandemic.
If you had previously asked your therapist about the possibility of doing teletherapy appointments and it wasn’t an option, it would be a good idea to check again now if you haven’t done so already, as the easing of HIPAA regulations may make it possible.
Is teletherapy effective?
In short, yes. According to Alvord, there has been extensive research since 1996 on teletherapy concluding that it is just as effective as in-person therapy, or even superior in some cases (like parent-child interaction training). However, Alvord does note that while teletherapy is the equivalent of in-person therapy for many, others struggle with the format.
“The most important aspect of mental health treatment—either in-person or via face-to-face—is the therapeutic relationship,” Dr. Rachel O’Neill, director of clinical effectiveness at Talkspace tells Lifehacker. “A strong relationship between the therapist and client will likely lead to better overall treatment outcomes.” Teletherapy also offers the opportunity to receive mental health services regardless of where a person is located—in some cases, making it a person’s only option. “I am definitely more comfortable with the format these days and love the increased access it provides my clients,” Miller tells Lifehacker.
The advantages of teletherapy
After practicing psychology for 45 years, Dr. Moe Gelbart, director of practice development for Community Psychiatry, California’s largest outpatient mental health organization, says that COVID-19 has rapidly and dramatically changed the way the profession operates.
“The levels of fear, uncertainty, and the unknown combined with social isolation has rightfully increased all of our anxiety and depression,” he tells Lifehacker. “On top of that, sheltering at home has cut many of us off from our loved ones, our friends, our co-workers, and our needed and trusted psychiatrists and therapists. Fortunately, telemedicine is available and easy to access, which may not be widely known or understood.”
Another major advantage of teletherapy is the amount of time it saves. Between the travel time to and from the office and the wait time while you’re in the office, a normal trip to the therapist could take a total of several hours. But, as Gelbart explains, not only are these wait times eliminated, but you can also engage in activities at home while you wait for your appointment to begin. In addition to that, teletherapy may make it easier for families living in different geographic locations to participate in the same session.
Alvord also points out that teletherapy gives people more options when it comes to finding culturally competent mental health professionals. “It’s really important to understand people’s values and their culture,” she says. “And if you can have providers who truly understand a culture and provide services, people aren’t just more comfortable, but there’s a greater understanding and, I think, greater advocacy.”
And while some people fear that telemedicine is impersonal, in his experience, Gelbart has found the opposite when it comes to teletherapy. “There is actually a stronger bond and connection as you have each other’s undivided attention,” he says. “Everyone I have worked with has said they were amazed at how connected they felt.”
The disadvantages of teletherapy
Before jumping into a teletherapy arrangement—particularly if it’s someone you’ve never worked with before—Alvord stresses the importance of finding a licensed mental health professional. This is especially crucial when locating potential therapists via an app: Make sure the person you’re speaking with has been vetted and is licensed and qualified to practice.
And although it’s not an option right now, Alvord recommends seeing a potential therapist in person for your first visit. “There’s a distinct advantage of seeing somebody in person first,” she explains, noting that it can be difficult to pick up on nonverbal cues without seeing the whole person.
“When I can only see someone through a screen there are many things like body language, eyes tearing up, fidgeting, things happening in the environment outside what I can see, etc. that can be easily missed,” Miller says. It can also be a challenge to work with volatile families or couples virtually, and doesn’t offer the same opportunities to comfort clients by handing them a tissue or sitting next to them on the couch. “These are things that ensure I will likely never give up seeing people in person once it is safe enough to do so again,” she explains.
Lastly, as Miller points out, there can be logistical issues. A spotty WiFi connection can disrupt and derail a teletherapy session, and the lack of privacy at home means that some clients aren’t able to open up the same way they are at an in-person session. But in most cases, there are solutions to these problems, and the benefits of teletherapy outweigh the concerns.
How to find a therapist for teletherapy
If you’ve never worked with a therapist before and want to start now, we have a whole guide on how to select a mental health professional that’s right for you. And according to Alvord, those looking to start therapy now should go about finding a practitioner similarly to the way as they would during non-pandemic times. Find someone who specializes in whatever your particular needs are (anxiety, depression, etc) and make sure that they are a licensed psychologist, psychiatrist or social worker, “because clinical competence is the primary concern,” she says. And though it may not matter right now, Alvord also suggests finding a therapist in your area, so that when the pandemic is over, you’ll have the option of seeing them in person too.