When the country descended into lockdown in March 2020, most mental health practitioners had to shift their practices online, in some cases, literally overnight. According to a May 2020 survey by the American Psychiatric Association (APA), members who said they used teletherapy most of the time rose more than 80 points to 85% in just three months.
The pandemic has advanced the use of teletherapy by a decade,” says Michael Kocet, Ph.D., chair of the Department of Counseling Education at The Chicago School’s Chicago Campus.
The seemingly sudden transition to telehealth has actually been some time in the making. For Sarah Dalton, Ph.D., her shift to telehealth sessions three years ago was based on two factors. The first was time. As a faculty member at The Chicago School’s Online Campus, her schedule is hectic. Providing remote therapy allowed Dr. Dalton to see her patients before classes begin in the morning and in the evenings before she grades papers.
The second was distance. She is based in Pittsburgh, and many of her clients live in rural areas of Pennsylvania. “And I’m a sex therapist,” she says, “so there is really nowhere nearby that these people could go.”
For Jaymie VanMeter, Ph.D., faculty at The Chicago School’s Online Campus, telehealth provides greater access for communities that may not be able to easily seek care in the traditional model as well. “My youngest client is 10 and my oldest is 76. I see marginalized populations that might not seek me out otherwise, including LGBTQIA+ and those of lower socioeconomic status. I also have a number of Black male clients, a population that is often culturally reluctant to seek therapy.”
Early resistance
Dr. VanMeter, who began her practice in Oklahoma, is familiar with barriers to care and was therefore an early adopter of telehealth, but it did not come without resistance from the counseling community.
“I didn’t have my first computer until I was in a Ph.D. program,” she says. “So navigating that and the ideas of how quickly we’re having to readapt was really one of the things I wanted to do in education. Yet even in my own department at the time at a face-to-face university, there was pushback against the implementation of telehealth.”
However, when Dr. VanMeter came to The Chicago School three years ago, she found attitudes to be different.
We were training our students to do telehealth before COVID-19. We asked ourselves, ‘How can we help both our master’s level students and our Ph.D. students set themselves apart from what is becoming a highly competitive field?’
–Susan Foster, Ph.D.
“I loved the openness to creativity and the ability to use different mediums and formats to not only connect with clients, but also with online students and other faculty,” she says. “I gained a broader perspective of how the clinical world is moving and how technology is creating this united front that you don’t get in face-to-face settings.”
A natural synergy
Susan Foster, Ph.D., chair of the Counseling Education Department for The Chicago School’s Online Campus has been teaching online for more than a decade and sees teaching telehealth in an online setting as particularly appropriate. “Every piece of trend data I look at says that telehealth is here to stay, as is online education,” she says. “Using an online education platform to train for telehealth is a win-win.”
Dr. Dalton believes that the online format lends itself to a nimble curriculum. “The teaching is evolving all the time,” she says. “We don’t use textbooks in tele-behavioral health classes because even if you read a textbook from 2019, it would mean almost nothing now. We teach with podcasts and articles, and of course, scholarly research, but it’s always changing. We’re constantly updating information.”
The Chicago School has made telehealth an area of focus because it touches on all areas of the mental health field: teaching, leadership and advocacy, research and scholarship, counseling, and supervision.
“We were training our students to do telehealth before COVID-19,” Dr. Foster says. “We asked ourselves, ‘How can we help both our master’s level students and our Ph.D. students set themselves apart from what is becoming a highly competitive field?’”
In the introductory telehealth class, for example, the focus is on encouraging doctoral students to think about tele-supervision, tele-counseling, and online teaching. As they learn this material, they are also preparing for the board-certified tele-mental health credential, which is required for graduation.
When The Chicago School’s administration learned that the students in the teletherapy courses were becoming board certified, the deans and leadership embraced this component of the degree requirements. Core faculty are now trained and board-certified telehealth providers as well.
Reading the Zoom
Given that people of all ages and walks of life have been on screen throughout the pandemic, what more is there for a therapist to learn before practicing telehealth? The answer is a great deal. Dr. Foster stresses that the focus is on the ethical and effective delivery of telehealth, which is a lot more complicated than merely logging onto Zoom.
Additionally, Dr. VanMeter teaches her students to use technology in an optimal way to maximize the online therapeutic experience. For example, camera placement is important. She instructs students to be visible on screen from the bellybutton to the head and that their hands be visible. This area accounts for 80% of our body language, which is a vital part of interacting with patients. “It’s a skill that you have to teach,” she says, “so that the clients can see your hand movements. And you’re modeling this behavior for your clients so that they understand that this is an expectation, that we can observe their body language.”
It’s about access
In the early days of the pandemic, concerns about those patients who may not be suitable for telehealth, especially those with suicidal thoughts and histories of self-harm, persisted. Since then, practitioners have addressed these concerns on two parallel tracks: One is a focus on ethical screening practices and the other is a continuing effort toward training and innovation.
As part of her intake, Dr. VanMeter requires her clients to provide an emergency contact and consent in writing to reach out to that person should a problem arise. In seven years of treating patients online, she has had only one incident in which a client was suicidal, and she was able to rely upon the patient’s support system to resolve the incident safely. “We do teach our students the appropriate screening, to be an ethical and effective clinician. And that does include a risk assessment and harm assessment,” Dr. Foster says, though she is quick to add, “We fully believe that telehealth opens more doors than it closes.”
The objective has shifted from accommodation during an emergency to expanding access to everyone who may require mental health services. Dr. Foster attributes thorough training that covers these nuances to the success of so many therapists making a successful transition early in the pandemic. “We made miraculous things happen, getting lots of people training really quickly to go in and begin telehealth,” she says. “To continue to evolve, we have to have the training pieces in place.”
The Chicago School is training new clinicians who will begin practice in a world in which telehealth is a way of life and will increasingly be seeing clients who have known nothing else. Dr. Dalton sees her doctoral students as being at the forefront of this growing field. “I think that The Chicago School graduates will stand out because of their experience, the credential, and having so much experience throughout their program,” she says. “It is really exciting for them.”
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