By Chay Tanchanco, LMFT
Following the shelter in place directive in the Bay Area, Foresight as well as many other mental health facilities have made the decision to move its services to telehealth, that is, meeting with your therapist on video or audio chat.
It is both an incredible ally in the continuity of emotional support as well as potentially daunting medium or, at the very least, elicits some questions or hesitation. In order to make the best decision for your mental health, I’ve compiled some information, tips, and questions to address with your provider.
If I am in a mental health crisis, should I still see my therapist?
In light of COVID-19, certain adjustments need to be made for ethical issues concerning potential crisis mental health needs, especially suicidal ideation and harm to self. A virtual therapist will not be as able to get you the help that you need and keep you safe in the environment until the emergency services arrive the way that we would while you are physically in the office with us. If you are in crisis, it is important to have a safety plan with your therapist and follow the steps to find more immediate support (family or friends, people who have been indicated as safe or who would call for assistance). Understanding this, it is possible that keeping your appointment, even though it’s online rather than in person, can grant a sense of normal routine and safety that would otherwise feel further disrupted. Each case would be between you and your therapist to decide what is best.
What about insurance?
The Health Insurance Portability and Accountability Act (HIPAA) is the legislation that regulates the confidentiality of records and transmission of medical information. They just relaxed the restrictions on video chat services used to provide telehealth at this time of COVID-19. Typically, video chat services must be HIPAA compliant, in order to be compensated by insurance. Services such as doxy.me and zoom.us are HIPAA compliant and designed for work meetings and medical appointments. Since COVID-19 is a public health emergency, health professionals are now being allowed to use services such as Google Hangouts, Apple FaceTime, or Skype to conduct appointments.
I’m uncomfortable with technology, don’t have good enough WiFi or internet coverage, or I don’t feel I have enough privacy doing therapy at home. What are my options?
This is a reality for many people, and you have to make a judgment call around what adjustments you would be able to or willing to make. Can you wire in to your router or sit closer to the WiFi? Can you ask roommates or family members to give you privacy during your appointment time? Will you be more comfortable with just audio vs. doing both video and audio? Are there options to send written messages to check in instead? Is it mentally healthy to forgo your appointments until you can see them in person again? If you are more comfortable using the phone, can we switch over to a phone call instead?
There are questions that each person can either discuss with their therapist or close friends or family to weigh out what is right for them. Ultimately, a good therapist will support whatever is best for your mental health.
How will I benefit most from telehealth?
Some basic tips for preparing for your telehealth appointment:
Test your connection, video, and audio beforehand. Most programs have an option to either indicate your sound or preview your video. Sitting at your computer 5-10 minutes before your appointment can help alleviate some of the anxiety and worry for being late or things going wrong.
Prepare your space. If you are going to do telehealth, it’s important to make the room as comfortable and private as possible. Just as when you walk into your therapist’s room, it makes a difference how clean the space is, where you situate the camera and your seating position, and the sense of safety you have in your space.
Establish with your therapist what to do if there are freezes, lags, or lapses in your connection. Often the best course of action is to hang up the call and retry as soon as there are more than 10-20 seconds of lag. It can be awkward at times, especially through emotional conversations. If your Internet is struggling, it is sometimes helpful to turn off the video function and simply operate through audio only.
Be kind to yourself about the adjustment. It is normal to feel uncomfortable or awkward or even just ‘different’ when you do therapy at home. Sometimes people are pleasantly surprised, while others find the technological aspect frustrating. It is, as with all things, okay to feel however you feel. A therapist who understands will do their best to connect with you emotionally as best they can, feel the awkwardness and frustration alongside you, and persist to continue on with the support you need most.
If you do opt out of telehealth appointments until the shelter in place is lifted, then I would suggest talking to your therapist about resources, either websites or books or podcasts or shows, etc. to supplement your mental health care until you return. You can also ask about checking in for a shorter amount of time, rather than having a full session.
In a time of uncertainty, it is good to maintain some sense of order and normalcy. Telehealth can be a way to keep up with the mental health support that you have worked so hard to get, in a time when you may need it most.