Tuesday, July 7, 2020

Therapy Tips for Telehealth

Using telehealth as a therapist can have its challenges. 

Here are some telehealth therapy tips to help:

Know your platform – Whatever telehealth computer system you are using, it makes sense to practice working with it so that you understand all of the features and nuances of the platform. Learn how to share your screen for instance and also make sure you know how to use comments and screen backgrounds. A lot of these features can be very helpful, especially in group therapy

Prepare your telehealth environment – Using telehealth is not usually physically as comfortable as sitting in an actual room with your client(s). So, it makes sense to prepare your telehealth setting ahead of time to make it as comfortable as possible. For example, if you are running a group make sure you have a drink handy, as well as a pad and pen to take notes if needed and even have things like pillows and blankets for your comfort especially with longer sessions like IOP groups which can be 3 hours or longer. It may make more sense to have two devices handy in case you need the extra screen to look something up during the session. Having enough outlets and chargers nearby is also something to consider. Of course, also make sure your environment is confidential in addition to being comfortable.

Log on to sessions early – When possible try to allow some extra time to make the online telehealth connection, send links, and troubleshoot problems when clients are unsure how to connect for the session on the telehealth platform. Its best to be the first to log on so you can anticipate problems ahead of time and be ready for them and then help others to walk through technical issues on their end.

Have back up plan for technical problems – For example if the sound is not properly working, make sure you have a cell phone handy with a number that you are comfortable letting the client(s) know about. If using a personal cell phone and you don’t want the client to know your number, get a Google Voice number 

Be ready to do more listening than usual – This is especially if you are more of an active talker in session as a therapist. There may be a delay using telehealth at times, so it can be difficult to interject in sessions if that is something you are used to doing. It can be much more challenging to slip in follow up questions if the client is on a roll and for some reason the telehealth platform is not cooperating when you attempt to do so. You may find yourself having to carefully choose your moments to speak in session when telehealth issues disrupt the flow of the therapy communication.

Prepare, prepare, prepare! – Preparation is a good practice when it comes to therapy in general but during telehealth sessions preparing ahead of time has even more importance. This is especially true when using activities or other forms of media, as in group sessions. Everyone who has done telehealth so far has learned that some ideas that work well in person may at times not translate as well to telehealth – especially when the telehealth system is glitching or problematic. It is best to have back up simpler activities in case something you planned just is not working well. www.takingtheescalator.com has a lot of stuff to choose from including group activities, power points, podcasts, and some videos for therapy sessions.

Have some “go to” questions and phrases ready to keep things going when sessions are lagging or just not flowing ideally -  When using telehealth for therapy, it is important to increase your “awkwardness tolerance”  - There are bound to be more awkward and uncomfortable moments when using telehealth, as communication can at times be strained or challenging when compared to talking in person. Having some prepared questions and other ideas can help break through these moments. Some prompts to start these types of questions/statements that can break things out of a funk may be something like: “Can you give me an example of…”. “It would be great if you could show/describe/expound a little more about …”, “Do you mind if I ask you about…”, “I would be really interested to hear your thoughts/views on…” – The key point is to be ready to kick start communication when it hits a lull due to telehealth issues.

Take advantage of telehealth “letting you in” – We often never get to see our client’s homes. Why not use telehealth to allow them to show you around if they are comfortable? Let them show their pets, their children, their backyard, or anything that they want to show you that is appropriate. These types of things can enhance the engagement process and help with building the therapeutic relationship. A real-life example: A therapist was working with a challenging teenager via telehealth and the teen was preoccupied complaining of hunger. The therapist allowed the teen to go to the kitchen to make a snack while they talked. This flexible approach ended up really helping the session build momentum when otherwise it had stalled. Allowing a restless client to take the session outside can be another way to let telehealth work for you instead of against you. (Always keep confidentiality in mind by reminding the client of this when new locations chosen)

Get in the habit of being more descriptive and ready to follow up for clarity and understanding when needed  (But not too much, don’t overdo it)- Keep in mind that using telehealth doesn’t allow us as therapists to have access to nearly as many nonverbal cues in communication which can be a challenge. Therefore, it makes sense to be prepared to take the extra time to follow up and ask your client(s) about their level of understanding of whatever it is you are discussing in session. Motivational Interviewing skills such as empathetic reflection, open ended questions, and summaries are essential tools for therapists in telehealth. Lack of nonverbal cues often necessitates making sure you are connecting by following up a little more than you may be used too when compared with in person therapy when a client’s body language, gestures and facial expressions are much more clearly seen in context.

Be flexible and positive (even when you don’t feel like it) If clients complain about telehealth, it can be helpful to show empathy by validating their concerns and even sharing that you too would prefer to be in person. However, the overall attitude about telehealth that you express is one of the most important factors in its success in your therapy sessions. Even if you do not like telehealth, embrace the challenge with as much positive energy and enthusiasm as you can. By contrast, if you go into telehealth sessions with dread and apprehension, it will likely show to your clients. It can help internally to remember to be grateful that telehealth is allowing you to keep working when otherwise you may not have been able too. Always try to look at the bright side of things even when telehealth can feel like an emotional grind as well as a technological nightmare at times. Telehealth, with all its flaws is still a much better reality than a world with no telehealth in times of need, so it is important to keep that in mind. “Let’s all do what we can to make the best of this” is a great way to look at telehealth challenges both with yourself and with your clients especially when things may not be going as smoothly as planned in telehealth sessions.

Practice self-care – We tell our clients all of the time to use coping skills and to establish healthy outlets to get through challenging times. We, as therapists need to practice what we preach for ourselves, especially when using telehealth which can be stressful. Have a plan for mini “doses” of self-care throughout the day by taking “two minute vacations” and giving yourself time to refresh by breathing, getting up for a minute to walk around, having a healthy snack, or doing whatever you know how to do to relax and refresh your mind, body and spirit. Also, at the end of the day a routine of healthy self-care, fresh air, exercise as well as positive outlets to disconnect and detach so you can “recharge” can make such a difference in a telehealth therapy environment.

Taking the Escalator Tools for Therapists (Click to view)


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  2. Telemedicine vs Telehealth, in contrast, is limited in context to just delivery of clinical care. Telemedicine, therefore, is restricted to delivering care through the use of telecommunication technology.