Teletherapy Considerations During Coronavirus: 10 Things to Think About

The rapidly changing coronavirus situation has affected so many of us across the globe. Many students and young adults have had their schedules upended and have been forced to study and work from home. Given the recent closures of many universities and school systems, students are now also faced with the task of seeking out different forms of mental health care. With the new physical distancing recommendations that are sweeping the nation, young adults may have to look to various forms of teletherapy, rather than meet in-person for scheduled sessions with a provider. Teletherapy can take many different forms and can include phone and video sessions, text, chat apps, or email therapeutic interventions. Psychologists and co-founders of The Shrink Space, Beth Jago, PsyD and Aarti Khullar, PsyD sat down to discuss 10 different teletherapy considerations during coronavirus. Below we break down some of the differences between in-person therapy and online therapy and we share important things for students to think about as they are making the switch from in-person to online therapy.

1. THERAPEUTIC CONNECTION 

This is often regarded as the most important aspect of therapy and the single most important factor leading to meaningful therapeutic change. 

• In-person therapy allows for more interpersonal connection, as you can view the body language of your therapist and they can notice yours. Therapists can get a more accurate read on your emotional state in the moment as well as notice how you may be responding to them when they are in the same room with you. 
• Some nuances can become lost in translation during teletherapy sessions. Without the combination of visual body language and tone it is difficult to fully comprehend where the other person is coming from. When in-person, therapists have more verbal and non-verbal information to draw from when they are reading you and responding to your questions or sharing feedback with you.
• For some young adults, especially those who use technology regularly, teletherapy can feel easier than talking to someone face-to-face, particularly about personal issues & private information. The distance of teletherapy can actually allow some young adults to open up more readily about issues that are difficult to discuss.

2. SPECIFIC MENTAL HEALTH CONCERNS

There are certain presenting concerns that may be better suited to in-person sessions rather than teletherapy. Some of these teletherapy considerations during coronavirus may not be possible with the physical distancing limitations put in place and teletherapy may be the only option temporarily. It’s important to talk with your therapist about any of your concerns.

• Severe or acute forms of mental health concerns are often more appropriate for in-person therapy due to the associated risks that tend to be present with severe forms of mental illness. For example, folks who are in acute distress are more likely to require hospitalization or other higher levels of care that are not as easy to assess for and provide via teletherapy. 
• When teletherapy is used in conjunction with (rather than as a replacement of) in-office therapy, it can be helpful if patient concerns are not too severe. For example, teletherapy can be ideal to provide continuity of care when a patient is currently unable to come to the office due to travel or safety considerations.

3. ACCESSIBILITY

For some individuals, therapist offices are not easily accessible on a regular basis. At present as most in-office sessions are limited, teletherapy considerations during coronavirus have become important for us all.  

• Teletherapy can be a powerful tool to increase accessibility so that young adults can get the care they need from the comfort of their own homes. 
• Beyond the limitations of the coronavirus and the associated physical distancing, other things such as social anxiety, physical/medical issues, work-related issues, limited childcare, and rural environments can create difficulty accessing therapist offices. Scheduling and travel becomes much easier with teletherapy options.

4. COST 

Cost is an important consideration for any type of treatment. You’ll want to consider the urgency and chronicity of your mental health concern when you are determining how much of a financial investment you may need to make and how much money you can afford to put towards your treatment. 

• Traditional forms of in-person therapy can be expensive, especially if you do not have in-network benefits or if your chosen therapist does not accept insurance.
• Teletherapy may be less expensive than traditional, in-person therapy, depending on the format of teletherapy. Some forms of teletherapy such as text, chat, or email are often less expensive because they are not structured in the typical 45 or 50-minute session format. For these forms of teletherapy, patients may pay based on the number of texts they exchange with their therapist or the number of words they write. These teletherapy formats may not be appropriate for everyone, so please consider your specific mental health needs.

5. CONFIDENTIALITY

Confidentiality is an essential component in any therapeutic relationship because this helps to create a safe space in which you can trust that the information you are sharing with your therapist is being kept private and secure. Confidentiality becomes an important teletherapy consideration during coronavirus as technology is a necessary component of treatment.

• Privacy and confidentiality can be heightened concerns with various types of teletherapy because not all types of technology provide encryption and platforms that allow security of your digital data. You’ll want to ensure that whatever digital platform you and your therapist are using is HIPAA-compliant. Some forms of email therapy may not be HIPAA-compliant unless emails are being encrypted during transmission and stored on a secure server. 
• For teletherapy sessions, a private environment is also important. If you live with family, a partner, children, or roommates, consider which area of your home will be the best for your privacy and comfort. For instance, does the door to the room close securely or lock? Is your space set up so that others in the home can’t overhear you and impair your privacy? You may consider using a white noise machine or app on your phone to drown out sounds outside your room so you can have more privacy to open up. A popular white noise machine that therapists often use can be found here. If all else fails, do you have access to a parked car you can sit in while you speak with your therapist?

6. TYPES OF TREATMENT

There are some forms of treatment that are reliant on various elements of the physical space in the therapist’s office or on the in-person interaction between you and your therapist. The following forms of treatment may not be as effective when conducted via teletherapy, so please consider what you are seeking treatment for. Again, these specific teletherapy considerations during coronavirus should be discussed with your provider as there may not be an in-person alternative at the moment.

• Play therapy
• Music or art therapy 
• Animal-assisted therapy
• Eye Movement Desensitization and Reprocessing (EMDR)

7. INSURANCE COVERAGE

If you are using insurance to help cover some or all of the cost of your treatment, you’ll want to check your specific insurance plan benefits in advance of your first session, whether this takes place in-person or via teletherapy. There are specific teletherapy considerations during coronavirus when it comes to insurance coverage, and many of these changes support patients.

• Many insurance companies cover the cost of treatment for mental health issues and substance abuse concerns when sessions are conducted in-person. When you seek out teletherapy services, sessions may not always be reimbursable or covered by insurance plans. However, there are some cost-specific teletherapy considerations during coronavirus, as many states (including NY & IL) are mandating that telehealth services be covered by insurance plans. For a list of states that currently mandate telehealth coverage, see here. It’s always best to check with your state laws and/or with your insurance provider before any services are rendered.
• No two states are the same in terms of telehealth insurance coverage. All 50 states plus the District of Columbia offer some type of Medicaid reimbursement for telehealth live video services. Due to parity laws, many private health plans also offer some reimbursement for telehealth services. Read more about your specific state’s telehealth laws and reimbursement policies here. 

8. DISRUPTION/TECHNICAL ISSUES

With any form of teletherapy, an additional technical element is introduced into the therapeutic relationship and this can have an impact on you and your therapist. Technical issues are something to be aware of so that you and your therapist can create contingency plans for how to approach situations when technical issues arise. 

• Sometimes your connection can be impaired and sessions may be interrupted or cut short due to wifi connectivity issues, slow internet speed, timing out of various apps, websites, etc. Talk with your therapist about what to do if you encounter these issues during a teletherapy session. Will your therapist reestablish the connection with you? Or should you reach back out to your therapist? Do you plan to reschedule for another day/time? Are you billed for sessions that get interrupted or are incomplete?
• Video pixelation issues or spotty connections can impair visual and tonal connections between you and your therapist and it may be difficult for them to accurately hear/see you at moments and vice versa. You may want to talk to your therapist about how these issues affect your connection and/or your therapeutic work together.
• Ideally, you’ll want a strong, stable wifi connection or a wired ethernet connection to ensure the best video/app quality. 

9. LICENSURE CONSIDERATIONS

Licensure status is an important consideration when you are deciding which mental health provider to choose. Licenses indicate general standards and regulations for mental health providers’ education and offer documentation that a provider has met requirements to offer therapeutic services. Another teletherapy consideration during coronavirus is that many states are allowing for temporary licensure of providers who offer teletherapy services.

• There are some providers in the mental health space who are pre-licensed, which often means they hold a graduate degree but are in the process of accruing clinical hours while working under the license of a supervisor. 
• There are also providers who are licensed; the particular type of license they hold will depend on their graduate degree and the type of provider they are (i.e. psychiatrist vs. psychologist). 
• In most states, your therapist should be licensed in the state where they are located as well as the state in which you have permanent residence (if this is different from your therapist’s location). For more information check out your state legislature’s website.

10. SETTING

If you are considering teletherapy during coronavirus or any other time, you’ll want to think about your setting. You’ll want to ensure you are comfortable, you can focus on getting the care you deserve, and you can make the most of the time you have with your therapist. 

• Ensure you have adequate light in the room where you are setting up to meet with your therapist virtually. Although the therapist can only see a snapshot of you, you want to make it count so you can stay as connected as possible.
• If you have pets, consider if they will be distracting or whether you want to include them in the session. If not, ensure that you can securely close the door to your room so they remain outside and avoid disrupting your session. 
• Consider whether your setting is quiet enough so that you can hear your therapist and vice versa.
• Consider the background of your setting when you are meeting with your therapist. You’ll want to think about what your mental health provider will see during your telehealth session, as this may factor into the conversation.
• For both teletherapy and in-person sessions, consistency of your setting can be important too. This may not always be possible depending on where you are located. For an optimal therapeutic alliance, meeting at consistent days/times and locations can help to create a frame for therapy so that you know what to expect, and you can feel comfortable and emotionally safe. You might consider discussing with your therapist if you need to meet in different locations frequently, for example, if you travel for work or if you need to alternate between teletherapy and in-person sessions. 

We invite you to connect with our mental health providers on The Shrink Space who are located in various regions throughout the U.S. With coronavirus impacting so many aspects of our lived experience, we have more providers than ever who are offering teletherapy services to students and young adults. You can search for and connect with therapists who offer various forms of teletherapy by clicking on the “More” filter and selecting “online therapy” under ‘Therapeutic Modalities.’

We understand that at the moment, you may not have another option besides teletherapy even if this is not your preferred treatment format. Many of the therapists on our database offer both in-person and teletherapy, so we encourage you to ask them if they are able to start a therapeutic relationship via teletherapy and then later transition to in-person therapy as things improve. You can read more about resources for coronavirus here on our blog and you can access additional crisis resources here. Please reach out to us with questions.