Great Therapy in Your Pajamas

We live in a world where we can do almost everything in our pajamas, and what better and more comforting thing than to be able to do therapy in your pajamas? As a consumer of services this way, I 100% agree that it can be awesome, especially if you have a tricky schedule, live in a city with nasty traffic, reside in a remote area, or just hate leaving the house. The good news is that multiple studies show that Telehealth can be just as effective as face-to-face services for counseling.

In our current situation, with the COVID-19 pandemic, it’s difficult to say when there will be many options besides Telehealth for mental health services. As with any service delivery option, this can work better for some people than others, and the definition can vary.

Qualified Providers

Finding a therapist for Telehealth should be similar to finding a therapist for in-person therapy. Ask friends or other providers (primary care physician, dentist, etc.) if they know someone who does particularly good work.

Unfortunately, as of this moment, most providers who offer Telehealth for therapy don’t have a common credential that makes them easy to identify. A lot of training companies offer various certifications, and many therapists do complete at least some of their classes, but not all of them offer directories. If you are concerned about your provider’s training in providing Telehealth services, the best approach is the direct one: just ask about their training and experience delivering services this way.

The main things to ask about are the platform the provider uses to ensure that (at least on their end) your information is protected. I currently use VSee Messenger as my primary platform and Telehealth by SimplePractice as my backup. I also use Hushmail for email and gather all of my client intake information through the secure client portal provided by SimplePractice. All of these platforms are HIPAA-compliant platforms.

While some patient portals, particularly those marketed to physician’s offices, will pull general information from patient charts to use for marketing research, SimplePractice does not do that. It means I pay more to use it, but that’s a reasonable compromise to protect your privacy.

Methods Used

Once again, the most researched and (likely) most effective method for delivering psychotherapy via Telehealth mirrors in-person delivery: you and the therapist talk either using a videoconferencing platform (like the ones mentioned above) or by phone. Sessions typically last for whatever the standard length of a session is for that practitioner—for an LPC, probably 45 mins or 53 mins.

Telehealth can also refer to asynchronous communication such as email or text. Buyer-beware, these methods are not backed-up by research by any peer-reviewed journals and some experts warn that they can be problematic.

The main companies that (heavily) market these “unlimited” text-based services are TalkSpace and BetterHelp. You’ve probably seen their ads on Facebook, Instagram and even TV. Here are a few things to keep in mind about these services:

• No direct contact info for your therapist. Everything has to go through the platform.

• Your therapist may not even know who you are or where you’re located which poses a serious safety issue.

• It’s very limited. As a subscriber, you typically can book one 30-minute video appointment with your therapist per week. You can type as much as you want, but they may or may not get back to you on the schedule you would prefer, and just being real, they may or may not read everything as carefully as they should. Plus, your epic share could be responded to with 6 minutes of an audio response.

Another huge downside for counseling or therapy provided by text is insurance companies don’t cover it. So, for a lot of people, it’s just not an affordable option.

Finances

In general, insurance companies are expected to cover Telehealth at the same rate they would cover face-to-face sessions, but you need to check your coverage before making an appointment with any provider. This is always true. Insurance companies can be extremely picky about who you see or whether or not you need an authorization. Most professional associations such as the American Counseling Association (and their state divisions) as well as the American Psychological Association (and their state divisions) have been pushing for insurance companies to eliminate an authorization requirement for behavioral health services because it’s a hurdle that could deter someone from getting services they need. During it’s original authorization, the ACA made requirements like that illegal, but, as you know, changes have been made to that law that favor insurance companies covering less, leaving states to make their own decisions, so now it’s confusing all over again. Please call the phone number not he back of your insurance card before you make an appointment so that you avoid any negative surprises. One thing I can share is that here in Denver, CO, all insurance companies are required to cover Telehealth the same way they would cover face-to-face services, so whatever your coverage is for in-person therapy remains the same.

If you are interested in setting up a consultation to discuss Telehealth options at my practice, I would be happy to speak with you. I am also pleased to share that I have been able to successfully deliver EMDR sessions via Telehealth. You can read more about that here.