Perspective means everything when we experience life's many challenges. Where are your thoughts?

​Is Telehealth the new Standard for HealthCare?
 
I must admit, as a practicing behavioral health professional who meets with clients both in my office and in the community, I struggle with the practice of telemedicine/telehealth.  I am able to identify my personal biases on the topic of face-to-face mental health services vs. telehealth, but I wanted to share the concerns I have with the evolution of the way medicine and mental health professionals practice moving forward.
I would like to stay within my scope of knowledge and outline some of the most common pros and cons of the practice of telehealth services from a master’s level practitioners’ perspective before giving my personal opinion on the practice.
Telehealth services have been around for a while now.  I can remember having a discussion with a supervisor early on in my career about the confidentiality concerns, laws, and regulations revolving around the use of telemedicine with a nurse practitioner we were teaming up with. 
Here are some highlights of some of the most common downfalls for telehealth…

• COVID-19 concerns- going into public places- the lobby of the practice
• Home distractions such as electronics, video games, television, pets, family members, phone calls, etc.
• Our busy schedules get in the way with sudden changes in our daily lives-Most clinicians charge for late cancelations
• The most important part of human interaction is the non-verbal communications that happen -We may miss important cues in telehealth
• Telehealth is dependent on internet providers and services- If service is unstable then sessions are disrupted
• There is a large learning curve for the generational gap with elderly users
• When dealing with the world wide web, users run the risk of cyber hacks and insecurities-
• It is easy to exit counseling sessions if things get heated in therapy- (i.e., someone slams the laptop closed after being triggered)

Here’s a Look at some Positives for Telehealth Services…

• The hassle of arranging appointments (phone calls, consultations, phone tag, voicemails, etc.) diminishes
• Waiting Rooms- unplanned waits before appointments
• Easy Access: People who need services in rural areas or may have difficulty getting to a location to receive services would benefit from virtual appointments
• Family therapy or group counseling sessions become much more efficient with the use of the virtual platforms available to users- (i.e., video conferencing in a family member or friend to assist in the therapeutic process)
• Substance Use Counseling-Many practitioners who treat active users in recovery for substance use addiction would rather meet with their clients via telehealth to ensure they are not traveling to appointments while under the influence
• Less cancelations of appointments
• A client who suffers from depressive related symptoms may not have the motivation to go to appointments- It would be more convenient to have a telehealth session instead

Let me be clear, I have used telehealth services in my private practice to reach clients in the community.  I can remember a perspective client reaching out to me on the other side of Texas to consult about helping him through some problems he was having in his personal life.  He Google searched a mental health professional he could identify with, and he found me.  Because he was more than a 16-hour drive away and we were a good fit, I met with this gentleman and the therapeutic relationship worked for us.  
I read an article on LinkedIn recently that said 83% of patients want to continue using telemedicine services even after the pandemic. I know the public wants it.  I am not sure people consider what goes into the practice of traditional and non-traditional talk therapy and medicine practices.  There is no possible way to get an assessment of the overall presentation of an individual simply from a video conference call.  I am not 100% against the practice, I just don’t recommend it.
Here comes the bias. 
Yes, I am a Licensed Professional Counselor here in the state of Texas, but I have the background in community clinical psychology.  In counseling psychology, the literature teaches us to focus on the non-verbal cues that a client communicates during the therapy session. Those cues may be the identifiers that encourage the clinician to probe deeper on a specific topic that may come up during the session. In person, face-to-face therapy is most effective when both client and therapist want to share the space to work on presenting problems and concerns together.  If a client chooses to stay at home when capable of going into the office for their appointments, this concerns me. Given the choice to either come into the office or do virtual appointments, most clients would choose the option that makes therapy most convenient and comfortable for them.  I push back on this as a therapist.  Are you motivated for change? Are you willing to put in the work to feel better or level-up?  At times, therapy can become challenging and extremely uncomfortable. I prefer to help my clients through these moments in each session until I feel confident in their mental health prior to doing follow up virtual appointments.
In closing, Telehealth is the new way for practicing behavioral health, but it will not be the standard of practice at Minor to Major LLC.  We take pride in wanting to engage with our clients on a personal level that digs deeper than surface matter. By recommending in-person appointments here at our offices we encourage clients to be more invested in the recovery process.  Clinicians who prefer to practice in home virtual sessions due to the cost efficiency of the services rendered or the convenience of the practice are becoming comfortable in their respective professions.
Allow me to clarify: If the reasons for rendering the services via telehealth are unrelated to some of the recommended reasons for using the virtual therapy platforms, this is lazy counseling and dare I say Malpractice on the behalf of the clinician.  Let us not be lazy with your healing and recovery, let’s be intentional.  
-by Jere’My Rankins MA LPC