What is telehealth and how is it used in psychotherapy?

Telehealth (in both physical and mental health settings) has been around for many years, but was quickly thrown front and center by the Covid-19 Pandemic. Although many aspects of life have returned to their pre-Pandemic status, it has become clear that telehealth is here to stay. While there are pros and cons to the telehealth medium, it has unquestionably made psychotherapy services more accessible to individuals whose work schedules, life circumstances or physical locations pose an obstacle to weekly appointments in an office.

How does it work?

Telehealth in the context of mental health services may also be referred to as telebehavioral health or telemental health, and refers broadly to mental health services (psychotherapy, psychopharmacology) provided using telephonic or video platforms. This allows for the client and the therapist or other provider to be in separate locations for regularly scheduled sessions.

The use of telehealth for psychotherapy allows for continuity of the therapeutic work in the face of obstacles to in-person visits, like the Coronavirus Pandemic, but also in response to other challenges that may arise in the course of any therapy. Some practitioners and clients are more comfortable with telehealth than others, and some argue that different therapeutic approaches are better suited to the use of this technology than others. There is much discussion about the pros and the cons, and while there is not likely a single correct answer to any of these questions, individual circumstances, preferences and treatment needs should drive the decision to utilize telehealth as a primary or partial component of therapy.

How does telehealth work?

Telehealth uses technology that is very similar to things that most of us are (at least now) very familiar with. You get on the phone with your therapist. Or you log in via a link that your therapist e-mails you for a meeting at a specified time. You can do this from the comfort of your living room couch. Or desk. Or kitchen table. Or sitting in the bathroom, when privacy is hard to come by in your NYC apartment. You may also gently suggest that your family members/roommates go get some fresh air for an hour.

Wherever you choose to have your sessions, it is important to find a quiet, private place away from distractions and other household members, so you can focus on the work of therapy. Ideally, make this place your sanctuary for the duration of the session. Dress comfortably, but appropriately (read, be dressed), and be upright, rather than laying down (unless in analysis). Wrap up in a blanket. Have some tea. Grab your earphones if you would like. Settle in for session.

Most smart phones and tablets/computers have video conferencing capability these days, and high speed internet and strong Wifi connections are far more common. This is really all that is required to make the jump to a telehealth system.

However, there are a few other considerations that are important to discuss…

Is it secure?

Therapy sessions using internet based technology has inherent privacy risks, but there are measures that can and should be taken to minimize this.

Not all video platforms are the same. The versions of Facetime and Skype that you may use to connect with friends and family are not considered secure for medical services, though had been allowed temporarily due to the pandemic. The application that your therapist uses generally should be HIPAA compliant for the protection of your privacy and safety.

In my practice, I use Sessions or a HIPAA compliant version of Zoom. They both work well, are secure and are easy to use both for therapist and the client. Equally important, they are both compliant with safety and privacy regulations in New York State.

Here is a technology check list for telehealth using video:

• Computer, phone or tablet with internally integrated speaker, microphone, and camera
• External microphone (if your device does not have one integrated)
• External camera (if your device does not one integrated)
• Headphones (if your device does not have high quality speakers integrated or if you prefer the additional privacy)

An additional necessary component for video sessions is access to a high speed internet connection. Before your session, close all other browsers and applications to ensure a better connection speed.

Although WiFi is compatible with most telehealth platforms and works well much of the time, when possible I recommend using a wired Ethernet connection because it is simply more reliable.

Fortunately, throughout the course of the COVID- 19 pandemic, many of these items and requirements have become a standard setup in many of our homes and offices. If they have not, I am able to troubleshoot challenges with you, or to discuss whether in-person visits would be preferable.

What does it cost?

Fees for telehealth services are comparable to those for in-person visits. If you are experiencing financial hardship, please don’t hesitate to ask about sliding scale.

Is telehealth covered by insurance?

This is an important question for your insurance carrier. During the COVID-19 pandemic, most insurers swiftly transitioned to coverage of or reimbursement for telehealth sessions for many medical and mental health services, and that has remained the case thus far. It is highly recommended to contact your carrier to ask coverage and reimbursement related questions prior to initiating therapy. If you are unsure or what to ask, I can offer guidance.

Can I see my therapist via telehealth while in a different state?

Your therapist is only able to provide telehealth services to clients in the state or states where the therapist is licensed to practice. During the COVID-19 pandemic, many states created temporary licensing or reciprocity agreements to allow continuity of care for those that have relocated out of state, but most of these have now expired. The specifics of your circumstances is a topic to check in about with your current, or potential therapist.

I hope this helped to clarify a few things about telemental health and that you get the help you deserve!

Other resources:

Theranest Infographic– A visual guide for preparing for your telehealth session

Quick “Getting Started With Therapy” Guide – If it’s your first time looking for help

Therapy Under Lockdown – A great read about using telehealth from a therapist’s point of view, from The Guardian

How Mental Health Is Going Digital – Plus some tips on how to combat isolation during the pandemic