Is online therapy just another pandemic hardship, or a blessing in disguise?
From the October, 2020 issue
Pre-pandemic, a counseling session at the Women's Center of Southeastern Michigan gave many clients a break-from "their kids, a messy house, a messy relationship," says therapist and executive director Marnie Leavitt. It was a "peaceful and calm space."
These days, clients connect from home via screen or telephone, and interruptions are common. Maybe the computer battery dies, Leavitt says, or the client is distracted by a family member or pet. "For me, personally, I don't like it," she says-she'd still rather see people in her office.
But virtual sessions quickly became the norm during the pandemic. "While all parties look forward to having the opportunity to meet in person again, everyone is satisfied with the telehealth service in place," emails Sarah Hong, who supervises Thrive Counseling at Jewish Family Services.
In-person therapy ended with stunning abruptness when the state shut down last spring. "Friday, March 13-the last day I reported for some time-100 percent was done in person," recalls Hong. "Starting the following week, we were 100 percent virtual."
Making the switch required some frantic training and technical support. Fortunately, a recent grant allowed Thrive to pay for things like second phone lines for therapists working from home and even to help struggling clients pay Internet bills. But that didn't make it easy.
"The first week, the fatigue was overwhelming," recalls psychologist Julie Nagel, whose private practice focuses on stage fright and other issues. "I'm just not used to staring at the screen, and everyone was scrambling to learn to get on."
Half a year later, Nagel is more relaxed and also more computer savvy but is still struck by the peculiar intensity of teletherapy. In real life, "you're never this close-face to face-with anybody for a long period of time."
The switch to virtual "went much more smoothly and rapidly than I might have predicted," says psychiatrist Greg Dalack of the U-M Depression Center. It helped that the psychiatry department (the center's administrative home) "had been slowly
moving toward digital visits." More important, insurers came around quickly to covering virtual therapy-though Dalack regrets that they declined to cover some of the Depression Center's forty group therapy sessions, ending them.
Growing demand for therapy during the pandemic has made it even harder for people without insurance. The Women's Center will see them, but it has a waiting list. Exacerbating the situation is a shortage of psychiatrists, the physicians who prescribe medications to relieve depression and anxiety. "We have a two-month waiting list," says Dalack.
Inevitably, Covid-19 is now a presence in many sessions. "The virus exacerbates basic themes of loss and security," says Nagel. "You can hear these themes-normalcy, loneliness, wanting to go out and do something. It's always there, like a background noise."
Other problems have emerged when, for example, people who lost their jobs move in with family members and relationships grow tense. "You have young people living at home who never thought they'd be living at home again," says Hong.
Leavitt notes that the changeover was easier for middle-class patients, who have good computer systems and plenty of private space, than for people on borderline incomes. But even some of her clients are relieved to be meeting virtually, because they'd found transportation a hassle.
"It's possible the advent of [virtual] visits will be a silver lining to an otherwise horrible situation," says psychologist Adrienne Lapidos. In an article for theconversation.com, Lapidos described her ambivalence when a patient "apologizes for the messy room visible behind her." Lapidos-who keeps her own camera focused on her profile, against a blank wall-wonders, "Would a glimpse at my messy room decrease her feelings of shame? Or would it just increase mine?" She chose not to find out.
Much as she misses the in-person visits, Nagel says, she and her colleagues "are in no hurry to rush back and take a chance [of infection]. Friends of mine have been talking about the logistics of going back and about how weird it would feel to sit in a mask and a patient had a mask on, and what is the ventilation? What is the safety factor for everyone involved?"
Thrive has added a new therapist to deal with the rising need. "We are accepting new clients!" Hong emails. While both clients and therapists look forward to in-person meetings, she believes, both "have adjusted very well."
Everyone interviewed believes that while teletherapy will never replace in-person meetings, it will remain a significant tool post-pandemic. Dalack emails, "We need to refine the use, determine how we will use it in the post-Covid future, but I trust it is here to stay."
Nagel agrees. "The horse is out of the barn," she says. "I think therapy has changed forever."
[Originally published in October, 2020.]
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