Starting June 2017, Seattle Direct Counseling services will transition from 20% telehealth services (online and phone) to 100% telehealth (not counting presentations, interviews and podcasts, and email communications). This transition begs the question, “What should I look for in a telehealth therapist?”
Here is my short list of things you should look for when seeking a therapist who uses telehealth options as their primary way of delivering mental health and coaching services using accepted technological platforms and devices.
Assuming your search guides you to a licensed mental health practitioner with up-to-date licensing and appropriate credentials for your needs, here are a few areas I would focus on to help narrow your search.
Superior Attending Skills
As with any mental health counselor, you want someone who attends to you. Attending involves a set of skills that demonstrate engagement with a client. You should look for appropriate eye contact, hand gestures, body positioning, and verbal reflection that “fits” the moment with with you. Of course, these attending skills are what you would look for in a video session.
For example, if you’re telling a story about yourself that is filled with sadness, you should see something in the therapist’s facial expressions and words that acknowledges that s/he hearing you, opening a path of empathy to you, and engaging with your feelings about your story.
Over a video camera, all of this should come through clearly. Over the phone, a therapist should use more audible cues and questions, such as querying, “You sound sad. Is that correct?” or, “You voice sounds like you’re feeling pressured. Is there something going on that’s causing this?”
The right word at the right time makes a big difference. A good therapist often helps her client to identify and name feelings, behaviors, and events for what they are, which helps to bring them “to the table” for further discussion.
An articulate counselor and/or coach helps the client gain insight to what is being seen, felt, and experienced. With identification of a challenge or problem, the client has the means to gather additional information about that problem.
This also means that a therapist should match her language to to the client’s comfort level and ability, offer multiple descriptions and examples of complex or unfamiliar tasks and terms, and be willing to recreate a series of thoughts into smaller pieces.
While it might be easier to treat mental health conditions in a strictly formulaic way, we all know that it doesn’t work that way. Here’s where intuition can be helpful, even if a portion of that intuition is really another name for experience.
Well-seasoned counselors have seen the gamut of human experience with a wide variety of mental wellness issues, and therefore she bring much insight to the moment in therapy where a client finds herself “stuck”. Clients seem amazed that their therapists just seem to know what they need, and then believe that they have some sort of “magic juju” to their method.
More than likely, it isn’t magic juju, but a combination of compassionate care, attentiveness, familiarity with patterns through experience, AND intuition in anticipating the variety of feelings a person might be going through. When a client asks, “How did you know I was thinking about that?” chances are she didn’t know for sure. Intuition can be useful, especially when it is bolstered with other pieces of data about the client’s world.
While I don’t feel that technology provides a block to that intuition, I think the counselor has to be that much more aware of communicating clearly when intuition is taking place. Why? Clients should know that they can develop these skills in themselves as they learn how to trust their own “guts” in operations like listening to themselves, sorting through feelings, and making decisions.
For brief therapy and common mental health issues, a less-experienced counselor can be more than enough to help a person work through an uncomplicated round of therapeutic sessions. For everything else, experience plays a key role in helping clients move through challenges in new and meaningful ways.
The reason why Counseling Associates are required to go through many hours of supervised training is to help them gain the experience of a seasoned veteran therapist. Like medical doctors, therapists have internships and periods of supervision in order to help a wider variety of people. Even in 17 years of private practice counseling, I haven’t seen everything under the sun, yet I will say that the experience I have is key factor in my effectiveness with clients, whether F2F or over the phone or Internet.
Two areas I see experience coming into play is with relationship counseling and with counseling through depression and anxiety management. In both cases, painful experiences drive clients to want to plow through their problems like work horses on a tight deadline. Experienced counselors can help bring awareness to the client about pacing their sessions, what progress is possible within a timeframe, and what kind of work is involved in healing relationships and building strategies for coping.
Comfortable With Technology
This one should be a no-brainer, yet you would be surprised how many people work in healthcare who just don’t “get” how technology works. In today’s clinical settings, technology plays a critical role in the delivery and quality of care. Follow up, electronic records, billing, and scheduling are routinely handled by humans who input information into computer systems.
Within the telehealth hour, you should expect a counselor to attend to you while simultaneously using the technology available to run the session seamlessly and smoothly.
I like to have my eyes on my client for most if not all of the session, which means that I touch-type occasional notes, indicate if I’m going to send information or resources after a session is over, accept and acknowledge payment for sessions via established applications, and provide follow up care. Thankfully, I have the experience of being a telephonic Triage Nurse. Quick typing, quick thinking, and using those attending skills (mentioned above) work powerfully together for the client.
Additionally, a distance provider should know his or her state laws regarding ethics, safety issues, and any related HIPPA regulations.
Finally, there should be some guidelines for what happens if there is an interruption of service, such as a dropped call, power loss, or interference in the connectivity.
Of all the elements to look for in a telehealth therapist, this one is the least scientifically measurable one. Do you feel like you “click” with the therapist after one to three sessions? If you don’t, can you name why you don’t? And if you can name why, are any of those elements truly important to your progress in therapy?
Let’s say that you like everything about your prospective therapist except the therapist’s lackluster fashion and appearance, and some cultural gaps and differences between yourself and her. She “gets” you, probes the right areas with a good mix of interest, care, and pacing. And you have this nagging feeling that in the “real world”, you probably wouldn’t be friends because you don’t have much in common.
You like indie bands; she hasn’t listened to a single song that makes your world turn. You scrape along with depression; she seems to you like the epitome of a stable but boring human centipede.
This can feel like a tough one from the inside. Let me share a secret with you. You do not have to feel like you’d be best buds with your therapist in the real world for this person to be the best therapist for you.
The real “click” is if you sense that the therapist is offering you what you NEED, versus filling the hole of friendship and understanding through similarity. She should be able to offer you a different perspective, talk about things you want to resist and disagree with, and help you hear yourself. If you sense that the therapist you want to hire to help you is willing to “go to bat” for you regarding the most critical aspects of your life, that is the real “click” you are looking for.
So… how do you find out if your prospective therapist has these qualities?
I would ask for a complimentary consultation of 15-30 minutes over the platform that you are going to use: telephone or video camera over the Internet. Honestly, I think telehealth providers would do well to offer the consultation with no obligation. The consultation isn’t designed for a deep dive into therapy; rather, to explore the above elements through a short sample of conversation and connection to see if you can build a trusting relationship of healing between yourself and the therapist over time.
Thinking about trying this option? I invite you to request your complimentary consultation with me in the month of June 2017.