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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