Back in the day, the rule from the American Psychological Association was that psychotherapy was only conducted in person. Clinical licensure was restricted to the practitioner’s state of residence. Insurance companies would only reimburse for in-person psychotherapy.
The recent pandemic with the worldwide infectious spread of the coronavirus, COVID-19, changed all that. It’s hard enough to keep up with modern cybertechnology, let alone with changing regulations in the field.
So, our goal, as practicing clinicians, is to provide the best clinical care, in the least restrictive environment, with concern for the health and safety of all involved. What exactly does that mean?
First, the gold standard of clinical care continues to be face-to-face psychotherapy. However, with masking, social distancing, and handwashing guidelines, patients coming to your office to see you may not only be challenging. It also might be lethal.
Where all parties are vaccinated and the pandemic circumstances are abating, there is less risk to in-person psychotherapy. With this level of clinical care, both patient and clinician get the most input for effective clinical care. Verbal, as well as nonverbal communication is maximized. Emotional nuances and “tells” are picked up. Comfort, acknowledgement, even relief from treatment is tangible.
Second, zoom calls carry most of the benefits of in-person clinical care. If you can get past the question of whether or not the other on the line is wearing pants, the interaction is there to make for good treatment. What’s also there is a host of possible distractions. The space for zoom calls, especially from your patient’s point of view, is not dedicated. Other people in the family could walk through the backdrop of your screen time with your patient. There could be distractions at critical moments in your clinical care. It will take both patience and structuring for zoom teletherapy to be efficient and effective.
Third, regular telephone calls would be a way of checking in on patients. While this kind of teletherapy can be useful in certain circumstances, the limitations are evident. Of course, without zoom, clinicians are limited to only verbal feedback. Visual and nonverbal components of the intervention are absent. Where patients do not have zoom capacity, this is a fallback option. Additionally, there is ample room for distraction during the call. Either clinician or patient could be multi-tasking without the other knowing. Finally, the call on cell phones could be made from anywhere. The variables are boundless, with negative impact on therapeutic outcome.
Finally, therapeutic intervention could be through social media, or, old school, through letters and journaling. Again, this form of teletherapy gives the patient access to the clinician’s expertise. However, exchanges are not necessarily private and confidential, despite any available safeguards. Texting, emailing, tweeting all risk exposure and breaking confidence. Paper and pen letters back and forth, or patient sending daily journal entries to their clinician for comment and feedback would be less likely to be intercepted than social media options. Also, none of the social media, or old school, options have the benefit of multisensory input into the therapeutic exchange.
Of these four options for clinical intervention, use in-person psychotherapy where ever possible. You get the most input from your patient and you have the most opportunities for strategic interventions. Use zoom telephone calls where time and circumstances preclude in-person psychotherapy. Help your patient develop the most dedicated context for the call and be aware of potential distractions. Focus of the verbal/nonverbal/physical/visual date available and make the most of the exchange.
Standard phone calls, social media exchanges, and journaling are treatment options that might be best used as clinical care is winding down and patients are close to discontinuing clinical care. To some extent, these options put you in the position of being your patient’s professional best friend or confidante, rather than their doctor.