The COVID-19 crisis has led to a paradigm shift in the way behavioral health care is provided. With in-office visits now inadvisable, care providers have begun to adopt telehealth technologies on a scale that’s never before been seen. While this rapid change has allowed mental health professionals to continue serving the needs of their clients, it has also created many questions about the most effective way to provide care from a distance.
Perhaps the biggest challenge of telemental health care is how it alters the dynamic of the consumer-provider relationship. In a virtual session, nonverbal communication is more difficult to utilize and detect, which places a greater emphasis on the words spoken in the session. The environment is also less controlled than in an office setting, which makes it harder for participants to focus and allows more opportunities for distraction. Finally, the balance of power is different in a virtual session, as consumers have more agency to ignore provider recommendations, end the session prematurely or skip it altogether.
These issues can be compounded if care providers are simultaneously struggling to adapt to remote work. Working remotely comes with unique advantages and challenges, and many behavioral health professionals may be unprepared for the realities of working outside the office. In addition to effectively engaging consumers over phone or video chat, providers must also take care to manage their environment and behaviors in order to be successful under these new circumstances.
The good news is that telemental health sessions can be just as effective and achieve the same outcomes and as in-person care when conducted correctly. Kristen Yost, a therapist for Cummins’ Marion County school-based program, has developed her own methods for working around many common telehealth difficulties. We spoke with Kristen to learn what obstacles you should expect during a telehealth session, how to engage consumers under the altered dynamics of virtual care, and what remote work practices will help you excel under the new telehealth paradigm.
Best Practices for Engaging Consumers via Telehealth
As mentioned above, bringing the consumer-provider relationship into the virtual realm changes the nature of this relationship. Consumer engagement is a continual concern even in face-to-face treatment, but a lapse in engagement during virtual treatment can be more damaging and more difficult to recover from. Therefore, providers must take special measures to keep consumers engaged with treatment when sessions are being conducted virtually.
There are several points in the virtual treatment process where consumer engagement can dwindle. First, consumers may be reluctant to engage with virtual services at all, which could be due to anxiety about the telehealth process or the belief that virtual services are not necessary. “If they were engaged in services before, it would first be helpful to identify the underlying reason for this change,” Kristen says. “It may be anxiety about transitioning to teletherapy, a dislike for talking on the phone, or concern that others may overhear conversations. If these are the barriers, then identifying and working through them would be therapeutic. Otherwise, it may be helpful to work with the consumer to revise or identify new goals, as changes in the environment and daily living may have resulted in a change in needs.”
Second, some consumers might engage with treatment during their sessions but become difficult to contact between sessions. If a consumer doesn’t join the session or answer their phone at the scheduled appointment time, simple forgetfulness could be to blame. “I will work with my consumers to set a reminder alarm on their cell phones for our session. It’s helpful to have them set a reminder to go off before the actual time of the session so they are ready at the scheduled time,” Kristen suggests. “I also ask my consumers to answer the phone even if they aren’t able to meet at that time; that way we don’t have a lapse in communication.”
Finally, other consumers may be difficult to engage during their session or express a desire to end the session early. Kristen explains what she does to work with these kinds of consumers during virtual sessions:
“For my consumers who tend to process information internally (as opposed to those who process by talking out loud), there can be a discomfort when too much emphasis is placed on dialogue. For these consumers, I love doing timelines and/or visuals to guide discussion and understand past history. The option for consumers to share photographs or special objects offers additional ways to engage. For my consumers who communicate via resistance, I use motivational interviewing and rapport-building techniques while also setting firm boundaries. Humor and sarcasm, if appropriate, can be helpful to change the mood and tone of the session. If there is insistence on ending the session, I provide the option of taking a five-minute break. Regardless of how much time they give to the session, I make note of the small successes, and I strive to end on a positive note. And for my consumers who struggle to focus, I make these sessions as active and engaging as I can over the phone. For those with video access and their own deck of cards, I may supplement dialogue or skill-building with a card game. It can also be helpful to add some type of physical activity, such as every time the consumer engages in an undesired behavior, they will then implement a physical activity of their choice. This serves the purpose of bringing attention to the thoughts, feelings or behaviors we are trying to change while also enhancing focus and engagement.”
Best Practices for Adapting to Remote Work
Of course, keeping consumers engaged with treatment is harder if you as the provider are also struggling to stay engaged. Remote work is a new arrangement for many behavioral health professionals, and some might be surprised to find that working from home requires a different type of discipline than working in an office environment. Fortunately, providers can take a few simple precautions to improve their focus and productivity when treating consumers virtually.
It can be tempting when working from home to relax your regular morning routine. Waking up late and working in pajamas sounds nice, but departures from your normal work preparations can instead prime you to be unproductive. “Every day feels like the weekend if I don’t create my own structured work routine at home. I’m trying to make it feel as much like a typical workday as I can so that I keep that mindset,” Kristen says. “This helps me maintain consistency with my own behaviors, which also creates a feeling of familiarity for my consumers.“
If possible, it’s also best to work in a different area of the home than where you spend your leisure time. Just as maintaining your normal work routine can help you stay in a working mindset, having separate environments for work and leisure can improve your focus and productivity during working hours. “Setting up an area of my home that I use specifically for work helps me create a conscious separation between work and home. This helps with productivity during the workday and also makes it easier to transition out of ‘work mode’ when my workday is done,” Kristen says.
One more thing to consider is the privacy of your workspace. Anyone else who lives in your home should know when you are working and when it is and isn’t acceptable to disturb you. Setting and adhering to these boundaries is important for the confidentiality of your sessions as well as your productivity, as Kristen explains:
“My family understands the nature of my work, and they are respectful of my need for a confidential space. I make my consumers aware that although I am working from home, their privacy and confidentiality is important to me. I let them know about the measures I have taken in order to provide a secure and safe place to open up, and I ask my consumers to follow suit by finding a space in their homes away from distractions and other people. My hope is for our teletherapy sessions to have the same safe and comfortable atmosphere as when we meet in the office.”
Although teletherapy requires some adjustment on the part of care providers, it is an extremely valuable asset when seeing consumers in person isn’t possible. We encourage behavioral health providers to utilize these tips in their day-to-day work to overcome some of the most common obstacles of telemental health care!
Looking for more tips to help improve your professional skills and behaviors? Take a look at our posts on multitasking and the Imposter Syndrome below!