Telebehavioral Health: Common Misconceptions
Unlike the picture above, sometimes wrong is just wrong, and there’s a lot that otherwise well-informed people get wrong about telebehavioral health. You can call it Telehealth. You can call it teletherapy (but one of my friends always reads that at telpathy which some people may also think telebehavioral health is, but it’s not.)
Telebehavioral health is a mental health service provided remotely via some type of electronic means. It’s what just about every behavioral health practitioner is doing right now to avoid unnecessary risk to their clients. (I’m not trying to call any clinicians out here. Depending on where you are and what your situation is, maybe it makes sense to be in the office right now. Not judging.) However, I’m just saying there’s nothing magical about telebehavioral health and if you’re currently receiving services, you’re probably already doing it. Hopefully, you signed a consent.
#1 It’s not “real” therapy
This statement reminds me of people who ask if you believe in abortion. (If I lost you there, it was on purpose.) Think about it for a minute though: that doesn’t make any sense. I mean, especially the people most upset by it believe in it. They know it’s real.
Telebehavioral health is not the Margarine of therapy. The problem is, currently, the only way telebehavioral health really gets regulated right now, as far as how it’s delivered goes, is by what insurance companies will or will not reimburse for, and that’s not always an indicator of quality. For example, insurance companies typically will only reimburse for telehealth visits conducted via video chat, and in many ways, that’s understandable because that form of telehealth is the one that most closely mimics a face-to-face visit with a clinician. The problem is, video chat can be very distracting for certain people. First, how many of us really enjoy seeing our own face in the corner of the screen (not this girl.) Second, it has to be done while you’re looking at a screen which means you’re getting all those fun notifications popping up while you’re in session. Third, it takes more bandwidth than just audio. So, if you have a tight living situation, taking a walk around the block while you talk to your therapist isn’t going to happen if that’s your only option.
Therapy over the phone is a good alternative option for someone who is having trouble with bandwidth, is easily distracted, or constantly on the go.
The part insurance companies get right is that telebehavioral health needs to adhere to similar parameters of the therapeutic relationship as face-to-face therapy. It generally should be scheduled time, preferably 45 minutes to 60 minutes each week. Of course life happens and appointments need to be moved or crises arise. That’s a given regardless of format.
Asynchronous “therapy” and text-based “therapy” are not proven methods of effective service delivery. That doesn’t mean that they can’t work for some people. If you have a friend who is using BetterHelp or TalkSpace and just handles their behavioral health work that way, it’s probably better than not doing anything at all. It’s also possible that research may prove that for certain people, it’s as effective if not more effective than synchronous methods like live video or phone. One major problem with therapy that is not provided in real time is you don’t get the live response from another human being, and that is a big part of the learning process in therapy. We have the opportunity to test out new behaviors or just get a response/reaction to what we’re thinking and feeling and have it affirmed and validated by another person in the moment, and we can get real-time feedback.
Not to keep picking on TalkSpace and BetterHelp, but another problem with chat and email is the delayed response can actually create a lot of anxiety. So, if you have anxiety and you send your therapist something that makes you feel particularly vulnerable and they take longer than usual to respond, that might stir up thoughts of, “Oh no! I’ve finally done it. I’ve crossed the line. My therapist thinks I need to be committed!” When in reality, your therapist probably just has a sick baby or was busy working another job.
Unfortunately, a lot of the people who regulate the counseling profession and who work in insurance companies and law offices tend to be more suspicious of technology and/or slower to upgrade or catch on to new trends. This often trickles down and gets translated as any counseling or therapy delivered electronically is just like the other kind e.g. your therapist in Denver who you see weekly through VSee video chat is equivalent to the TalkSpace therapist who could be a robot with a headshot.
#2 Telebehavioral Health is “easier” for Therapists
It depends on the therapist. I had to buy a new chair and desk when the COVID pandemic hit and I now pay for an office sublease and two video chat services in case one of the crashes. I now can wear stretchy pants whenever I want and I don’t need to commute in Denver traffic, but overall, I don’t happen to think it’s easier. I think it’s much less work seeing someone in person without sound or video delays or wondering if a significant other is going to walk in the door.
So, I can’t speak for anyone else, but personally, my expenses have gone up and I’m a lot more tired at the end of the day. However, I think it’s important that we all continue to do the work. I know that people are stressed right now and need support and I know that I can provide that support. I also know that it’s important to remember to stick to my working hours and not allow too many extra inquiries to eat up my relaxation time because doing this can be surprisingly stressful.
Also, I need to prepare for and document all the sessions and consultations the same way I would for in-person work, and that brings me to my next point:
#3 When You Chicken Out and No-Show or Cancel the Day Before, it Doesn’t Matter Because Your Therapist Was Just “At Home”
If you don’t want an appointment, please don’t make an appointment. I realize that for many people, it’s not that simple. If it were, you wouldn’t call for a consultation or book the appointment in the first place. Please understand that when I receive a call or an email, I assume you need help and want a response within 24 hours and generally, I stick to that rule. When I get a desperate call for help and follow up 8 hours later only to be routed to voicemail and not receive any response, it’s discouraging. When I block off time for you on my calendar, that means someone else either on my current caseload or who would like to get in can’t have that spot. So, you are inconveniencing me and at least one other person I care about, and that upsets me.
How do you know you’re ready for a therapy appointment?
You have something you want to talk to someone about.
You’ve thought about how much therapy costs. You’ve called your insurance company and reviewed your budget. You also have set aside an hour per week you can devote to therapy. You’re doing even better if you’ve set aside an additional hour to do any supplemental work your provider suggests.
You know what results you’re looking for. You have a problem you want to work on and you are ready to make some changes in your life.
You want to talk about some difficult things.
You’re probably not ready for therapy if these are the reasons you’re seeking it:
You have a friend who you’ve decided has all the problems. Either you’re projecting problems onto your friend, or your friend needs therapy and they need to decide to go, not you.
You have an active addiction that is completely out of control. You need rehab. As part of your aftercare plan, it’s great to have an individual therapist, but you probably need more medical and psychiatric support first.
Your partner won’t stop nagging you about going to therapy. Your partner’s concerns may be valid and your relationship may indeed be on the line, but if that’s all you’ve got as far as reasons to go, I wouldn’t take you as a client because you aren’t owning that there’s something you would like to change
Your parents are threatening to kick you out if you don’t see a therapist. (See above.)
You want drugs. I don’t prescribe drugs. I support clients in their choice to see me in conjunction with a psychiatrist or psychiatric nurse. I think this is often helpful, but I cannot prescribe medications. Also, if you are just looking for a provider to give you a prescription for Benzodiazepines, good luck in Colorado. It’s almost impossible to get a prescription for them even if you’ve been hospitalized with a panic attack—just keeping it real.
I apologize if this post sounds a bit snarkier than usual. Since the COVID pandemic hit, I’ve received multiple inquiries regarding beginning telehealth and none of the new referrals have stuck. I suspect that the majority of these are from people who are cautiously dipping a toe into therapy for the first time or who aren’t sure what they want. It’s okay. You need to do what you need to do. All I ask is that if you have thought this through and you’re ready, I’m happy to hear from you and fit you into my schedule, but please do a gut check first. Maybe you’re just having a rough day or maybe you don’t really have the time or resources for therapy right now. Being honest starts with you.
