The Pros and Cons of Teletherapy for Mental Health

By: Dr. Elizabeth Farrah Louis

The nature of mental health therapy continues to evolve especially during the COVID-19 pandemic. Due to the magnitude of the pandemic and uncertainties at the start of it, mental health providers and insurance companies had to accommodate clients and patients. Legislation was formed to safeguard the transition from in person to virtual settings. Some common virtual platforms include BetterHelp, TalkSpace and others. While more local options including private practices, clinics, hospitals and other institutions, virtual tools such as Zoom, Google Meet, Mend, and Doxy.me. emerged. Concerns about secured platforms, keeping in mind privacy and confidentiality are important considerations that continue to be addressed. While the rise of teletherapy was occurring, I was living and working in Rwanda completing a National Institutes of Health Fogarty global mental health research fellowship. I was not fully aware of the amount of progress of remote therapy. Once I relocated back to the USA at the end of 2020, I had to play catch up to ensure I understood policies and guidelines around telehealth and my role as an online therapist. However, I soon recognized differences and similarities of therapeutic relationships presented in therapy between providers and clients. For example, rapport building is crucial in building a therapeutic alliance. Usually, my interaction with patients were in-person and I was able to have a real-time interpersonal interaction, yet with a screen was only able to view their faces and there is a screen between us. Yet, for some patients they prefer options such as audio or video formats to participate in mental health therapy. I became more comfortable as a psychologist to adapt to preferences but also had to use my clinical judgement in understanding some limitations of certain interventions to address mental health disorders related to anxiety and trauma. There are special populations such as working with young children, patients with some developmental disorders such as autism, and the elderly where in-person therapy provides more benefits and accommodations. 

There are some important considerations to understanding the nature of the work from the perspectives of mental health providers along with experiences of clients. As a mental health provider, I want the best for my patients and clients especially when it comes to their safety and ensuring their therapeutic needs are being met. This may mean that I call two or three times given that internet or cellphone services do not always work, it means sometimes using text message to communicate, meeting them at a central place in their community to teach them how to use the telehealth application, to help them complete an application for immigration status or translate the documents they cannot read in English, making time to connect with interpreter services prior to contacting the patient, and ensure that I am in secure location with optimal secure internet. Also, there are times I have mailed clients materials that we will use as interventions such as dialectical behavior therapy manual and the cognitive processing therapy manual or mail information that I have translated in Haitian Creole.

Some of the pros of telehealth within the field of mental health include the following:

• Easier access for some patients/clients in their settings 

• Reduce cost on transportation and save time of commuting 

• Provides opportunities for providers to take unscheduled/informal breaks at the comfort of their homes or other secure locations

• Use of technology tools in real time

• Use of interpreter services with faster/easier access

• Flexibility of schedules and convenient

• Providers from other states can support under resourced settings 

• Decrease office expenses

However, some of the cons consist of:

• Difficulty to assess patients via audio and/or video only – limited ability to fully perform a mental status exam and suicide assessment 

• Challenges to address severe mental health presentations

• Providing therapy materials – may have to email or mail them out

• There’s lack of 100% privacy or is limited 

• Interruptions from providers or clients/patients’ settings

• Clients/patients driving on the road, on public transportation, or in other unsecure settings

• Clients/patients not disclosing their location which can impact if they are in crisis or if they are in the same state of the provider for insurance purposes

• Settings not always equipped to provide accommodations for people with different disabilities, developmental needs, and age-appropriate adaptations

Overall, given these selected pros and cons, which I am sure there are more, communicating with clients and patients about telehealth etiquette when you first start with them along with periodic check-ins is crucial to maintain support, a therapeutic relationship and meet them where they are at. There may be accommodations or adaptations in the delivery of mental health therapy and the implementation of interventions that will be needed and explained to clients and patients in a manner where they can understand and learn important skills. Furthermore, being keen to communicate with clients and patients your role within a virtual setting along with taking extra care to recognize when their presentations or lack of engagement may warrant concern and further assessment is imperative. Engaging in mental health therapy can be draining for mental health providers. Be sure to take breaks, be mindful of the amount of screen time, purchase items that will be protective of your wrists, back and other areas of your body and practice self-care that is appropriate for you (e.g. stretching, going on a walk, attending a gym class, taking a nap, working on an art activity, cooking a meal and dancing). 

Teletherapy for mental health is here to stay whether regardless of the pros and cons. Nevertheless, our attitudes and approach towards it is instrumental in our work with clients and patients. May you continue to broaden your skills set as you revise, adapt, or create new techniques and interventions to support clients and patients. I also hope that you never lose sight of the reasons you decided to be involves in mental health work. May the essence of who you are as a mental health provider and a person thrive in any setting and may you feel supported by your chosen communities. Thank you for your steadfast service! 

With appreciation,

Elizabeth Louis, PhD

About:
Dr. Elizabeth Farrah Louis is a Haitian-American licensed clinical psychologist and senior consultant at ASWR.