Socially distanced mental healthcare has its pros for clients and providers alike
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I remember sitting in graduate school classes and feeling like The Ugly Duckling. I was twenty-one and was going to become a social worker; my peers were mostly on their second degrees, or had prior work experience but they all had one thing in common—they weren’t afraid to speak their minds.
In classes, I was bombarded with different opinions on social justice, and while I had thoughts and opinions too, I was nervous to speak in front of 50 classmates. Sometimes I felt compelled to speak my mind, to stand up for what I felt was right (or to satisfy the “participation” part of my grade), but when I did so, my pounding heart brought me back to the little girl who was shy in school, who clung to her one best friend to survive. A social worker who has social anxiety? I learned to laugh and to work on myself because, more than anything, I wanted to help others to navigate their own emotional experiences.
As a clinical social worker, I was trained to be hyper-aware of my own feelings and thoughts while sitting with a client. As I process the intricacies of the conversation and interpret my client’s thoughts and feelings, there is always my own anxiety in the room. Considering what my own body language and posture is saying to the client has become necessary to feeling more relaxed and confident during a session.
The author. Image by Unknown (courtesy of Samantha Elhyani)
When telehealth and phone therapy became the modality of delivering treatment to clients due to the COVID-19 pandemic, I was reluctant to change but curious to see how it could benefit clients and therapists. My own social anxiety went up in a poof of smoke. My coworkers and colleagues, however, identified various frustrations with telehealth. They felt that telehealth stripped away key information from sessions, such as the client’s body language, observing where they choose to sit in the office and therapist’s presence as a source of comfort to the client. Parallel to the fall of socializing alongside the rise in social media, telehealth and phone therapy may feel distant and fake.
I was floored when we resumed the in-person therapy option at my clinic and only a small percentage of my clients were interested in switching from telehealth or phone therapy back to in-person sessions.
I began speaking to my clients about their preference for telehealth and phone therapy, and I realized that therapy was far more convenient this way. I currently work primarily with women — the Champions of Multitasking — and I see how telehealth allows them to see a therapist while at home with their young children or to do therapy on their way home from work to maximize limited time. Especially with new mothers, telehealth is an excellent way to reach individuals who might otherwise forgo addressing their mental health due to lack of childcare or time. Clients who are financially struggling or don’t have a car are suddenly able to see their therapist without worrying about the cost of transportation.
And telehealth benefits me as a therapist by increasing the quality of the session. I am able to take notes guilt-free, ensuring that vital parts of the session are addressed. Further, my mental status exam gains a new dimension when I see clients in their home environments. When I see my client with MDD speaking to me from under her covers in bed, I learn volumes about her current mental state. When I hear children screaming in the background, I get a taste of what my client’s daily stressors are like. My clients are able to talk to me with their pajamas on, and their comfort level may remove the barriers of formality of in-person therapy.
Therapist confidence may be crucial to the efficacy of the session. A 2016 study found that severely anxious clients had better outcomes when working with qualified therapists versus interns, perhaps due to higher anxiety in interns (Mason et al., 2016). I was enjoying the switch to telehealth not only because of the benefits to the client, but because I myself was more at ease, and thereby able to feel and to appear more confident in session.
Some therapists still feel Telehealth deprives clients of the comfort of their presence in the room. I wonder if that is something clients actually feel is lacking, or if they appreciate the convenience that telehealth offers.
Other therapists find it difficult to sustain a phone conversation when the client is not in front of them. I like to write a list of questions and a session plan for clients I know are not as verbal to help to sustain a meaningful, full-length session. In phone sessions, I also try to insert more verbal cues so the client knows I am listening, since he or she cannot see my face or eye contact.
Therapists may also struggle to maintain client accountability to show for their sessions if they are done over the phone or computer. Having no-show policies in place and clearly explaining their benefit to clients may mitigate no-show rates. These issues may be more prevalent in clinics that accept insurance as clients are not paying the full cost of the session on their own, perhaps minimizing client accountability.
Telehealth and phone therapy have not been without their challenges, but there are unique bonuses to telehealth and it may endure as a commonly used therapy option even as the world slowly begins to open up again. While I aim to fight through my own social anxiety each day with the clients that choose to come into the office, I also appreciate what telehealth and phone therapy have to offer in the interim.
Samantha (Shoshi) Elhyani is a licensed clinical social worker with over five years of experience in working with adults with substance use disorders and recent experience working in a local women’s health clinic. She lives in Rockland County, NY with her husband and two young children.
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