The Pros and Cons of Teletherapy
The term teletherapy refers to mental health counseling over the phone or online. Teletherapy is one subset of an overarching field of telehealth: health-related services and information distributed the same way. Both have increased since access to medical care has been limited due to recent pandemic actions and shelter-in-place orders. For the purposes of this post, I am discussing therapy sessions delivered via telephone or video, not online via apps.
Initially, I felt that the concept of teletherapy was great as it gave people continued access to mental health services, which are certainly needed during these unprecedented times. As I read more and spoke to therapists I knew, however, I realized that there were both pros and cons to the situation. I have only experienced therapy sessions in person, so I reached out to some who I knew had personal experience with both.
Just as it’s important to find a therapist who’s a good fit, it’s important to consider the pros and cons of teletherapy to determine if it works for you. There’s no one-size-fits-all when it comes to therapy, so what works for one may not work for another. In my opinion, if it’s a matter of teletherapy vs. no therapy, get the help wherever you can. It may be a temporary arrangement given the state of the world, or you may find that it works better for you long-term. Either way, here are both sides to help you decide.
Continued Access to Therapy
This is probably the biggest pro for teletherapy. It allows therapy sessions to continue, offers increased flexibility, and removes commute time. Both therapists and clients are grateful that their work can continue despite the lack of physical access.
Kaitlyn McQuin, who has been outspoken about her transition to teletherapy, explains her situation this way:
At first, I was nervous about not physically being in my therapist’s presence, because I feared connection would be lost and I wouldn’t feel as comfortable sharing through a computer screen, but those fears quickly subsided as soon as I had my first session. I keep certain things consistent to get me in my therapy mindset. I wear my therapy cardigan (which is just a normal cardigan, but one I’ve worn to all my sessions because it’s cozy), light a candle, play some music in the background (mostly for privacy because I live with a roommate), and prepare myself to share. Most times, it’s even easier for me to dive right into my emotions since I’m in the comfort of my own room.
Providing therapy online provides an option to certain populations who may normally have barriers. Elderly, rural, student, and disabled populations are just some who may benefit from teletherapy.
Insurance companies sometimes offer lower rates for teletherapy vs. seeing a therapist in person. Each insurance plan is different, so make sure to check with yours to see your particular benefits. In the experience of Dr. Ashlee Reed, “most insurance companies have offered full coverage for tele-therapy services in this time, waiving co-pays that may otherwise have been a barrier to receiving treatment.”
Even if you don’t have insurance, self-pay rates for teletherapy tend to be lower than in-person sessions.
Privacy & Confidentiality
Teletherapy may work well if you are living by yourself or with those you have a positive relationship, as in McQuin’s case above. Unfortunately, this is not the case for everyone, which can make opening up to a therapist difficult. Teenagers and children may not feel as safe opening up if they are having sessions in a house within earshot of their parents. Clients who have damaged or violent relationships with someone they live with are less likely to speak openly about those people while in the same house. Cori Nelson, a therapist-in-training, emphasizes that “confidentiality should be thoroughly discussed to ensure the safety and privacy of the client.”
I think we are all familiar with the issues of technology. Calls dropping, video stills, and sound issues are just a few of the problems that can arise during a teletherapy session. Clients in rural settings may have unreliable internet. According to Reed, “a video connection going out in an ill-timed moment with a client can be challenging. A sound issue requiring asking the client to repeat in a moment of heightened emotion can be frustrating for the clinician as well as the client.”
Lack of Personal Connection
A big part of the therapeutic relationship is the rapport between therapist and client. Physically being in the same space allows for the observation of more subtle cues such as body language and eye contact, things which are harder to take into account when separated by a screen. Phone sessions provide no visibility into those things at all. Nelson is someone who bases a lot of her work around that personal connection. “For me personally, a con is that I can’t do a lot of hands on activities that would require the toys/supplies in a therapeutic playroom. I love doing arts, crafts, role-playing, structural, and other forms of hands-on therapy.” If the type of therapy that works best for you is more hands-on, it can be harder in a virtual setting.
Ultimately, there are many variables when considering teletherapy. It’s important to consider your situation and decide what’s best for you. As always, therapy is personal and it’s important to figure out what will offer the most benefit to the client.
McQuinn, who was quoted above, also noted that although it’s been great having therapy at home, she is “eager to get back into her office…not only to see her in person, but also because she has really cool affirmation cards. I always pull one before each session. But, having therapy from my own bedroom has been pretty amazing, so, until then, I’ll take it.”
6 comments on “The Pros and Cons of Teletherapy”
Thanks for this rundown! I’ve been wondering about teletherapy for a while. I guess it’s different for everyone – what might work for one person might not work for another! ❤️✨
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Well as a clinician who has been providing telehealth services since this has started, not from home but from my office. We have had some issues but nearly what people may think. I also SUD work as well (primarily) and we have continued our groups in this format as well. And the feedback we have received has been good. In fact not much has actually changed, our folks have not missed a step. They are doing pretty much the same as if they were coming into the building. Are there some who are not? Of but they would be doing that if we were in person as well. In the 30 years that I’ve been doing this I’ve learned, the behavior that is displayed in group is the behavior that is displayed in life.
Now I have had some individual folks who would prefer face to face. Our therapist who works with children and adolescents is doing quite well. However, they have made adjustments to how their sessions work and have seen some interesting things in their rooms, because the kids were excited to show off their rooms.
On the other side of it, for me as a therapist, telehealth has been more exhausting on my body than face to face therapy. I don’t get up as much as I would if people were coming in the office. As someone who is also into physical fitness, I understand the impact that has on the body, the lack of movement. Also many are presenting with increased anxiety and depression so we are seeing more people of course, so it does have an impact on us and I have been physically exhausted more so in the last months. Several of my colleagues have said the same as well, referring to it as “Zoom Fatigue”. Of the the technical word is vicarious trauma. So there are many different aspects to telehealth. It has allowed our folks to stay connected to their therapy and recovery meetings, which many people have been so grateful to have. And as I have said many times over, if this pandemic had to happen, this was the best time for it to happen. If this were 1986 or even 1990 we would not have had the technology to provide us with the access to keep us connected to each other or to mental, medical, SUD services in the manner that we have been able to today. That’s on serious gratitude.
Thank you for such a thoughtful response Tammi!
Thank you. And my apologies for the typos. 😉
Thank you, Erin, for writing about teletherapy since it’s a significant topic right now. I am a Licensed Clinical Social Worker & Master Addiction Counselor & have been in private practice for 12 years & in the field of social work for 30 yrs. Prior to this pandemic, I did 80% in-person sessions & about 20% telehealth. Currently, I’m seeing all of my clients who chose to continue sessions during quarantining via telehealth. I’ve always loved what I do, but like Tammi, I feel much more exhausted physically & mentally doing telehealth exclusively. I don’t like sitting in front of a screen all day & miss the energy, body language, & emotion that I can feel in my office, face-to-face vs. via a screen where those factors are greatly diminished. Not to mention telehealth feels more monotonous & boring sometimes & that has nothing to do w/ the client.
I agree w/ everything you wrote in this piece except for some of what you said about insurance coverage for telehealth services. Particularly, “insurance companies sometimes offer lower rates for teletherapy vs. seeing a therapist in person.” That’s an exception vs. the rule for most insurers. However, during this pandemic, many insurers have waived all co-pays, & insurers who don’t usually cover telehealth, or do so only through a certain contracted platform, have relaxed their normal rules. This is temporary & will likely end as early as 6/15/20 or as late as 9/30/20, depending on the insurer & what happens as states go through phases of re-opening. It’s further confusing because coverage, co-pays, & other specifics of a client’s particular policy vary by state even if the insurer is one that covers the entire country like Aetna, Cigna, BCBS, & United Healthcare.
There is a major difference between clients finding a therapist online through one of the services like Better Help, Talk Space, Doxy, etc., & having teletherapy sessions w/ a therapist the client either first saw in-person or sought out through a group or individual practice that also offers telehealth & takes insurance. My income is almost exclusively from insurance reimbursement since I chose to practice in a manner that allows client’s to use the insurance coverage they have already paid a lot of money for. As a result, I’ve had to make it my business to understand all that I can about all things insurance & mental health & consider myself highly informed at this point. For clients who use their health insurance to cover therapy costs, there is no difference in the session fee & copay or coinsurance for an in-person vs. telehealth session. A client is paying for a therapist’s professional time & clients being seen via telehealth receive the same professionalism, skill, resources, & time as they would in-person. Telehealth sessions are not the “discount version” of traditional in- person sessions & some clients & therapists actually prefer teletherapy. A client being seen by a skilled, professional therapist via telehealth doesn’t receive less of his/her attention, time, guidance, resources, or professionalism Clients who seek out a therapist from a platform like Better Help that doesn’t accept insurance will pay less than they would seeing someone like me & paying privately, but not less than if they have insurance & choose to use it for therapy. While there are some exceptions, I’m speaking as to what is the norm & from my own experience.
Some insurers have chosen to farm-out their telehealth benefit because it costs the insurer less since most of those platforms pay rates far below what skilled, professionally-trained therapists should be getting paid. Just like every other aspect of insurance coverage, we pay more & the insurer seems to provide less. Therapists who choose to contract w/ platforms like Better Help & Talk Space are paid appallingly low rates. It has created a major issue for those of us who have spent years earning advanced degrees, obtaining & maintaining licensure & certifications, & honing our craft through experience & additional trainings, & are just trying to make enough to pay our bills & out of pocket expenses. Also, therapists are required to complete 25-50 (varies by state) continuing education credits every year in order to maintain their license. Those CEU’s are almost always paid for out of pocket by the therapist. Therapists who accept these insulting rates ($25-50 for a session) make it easier for insurers to keep paying us less & less for the same or more work. The rate for therapists who only accept private pay ranges from $100-300 per 50-60 minutes depending on geography & a myriad of other factors. With managed care & the control insurers continue to have, those of us who accept insurance get reimbursed between $60-90 for that same session, & if the therapist is part of a group practice, he/she receives only 60-65% of that amount. Add in the costs that go with being self-employed/independent contractors & it is no wonder many therapists either stop taking insurance all together or leave private practice for a better paying job that provides benefits since IC’s usually don’t receive benefits like PTO, health insurance or retirement plans, & have the added cost of the self-employment tax. The belief by many that therapists who are private practitioners make “a lot of money” is unfortunately, far from the reality. Most of us who got in to this field didn’t choose it to get rich any more than teachers choose teaching for the same reason. It’s our passion.
My apologies for such a lengthy comment, but I feel it is critical that people understand all aspects of therapy & the differences that are out there.
Amen! On March 16, 2020, I left private office practice and began my first teletherapy sessions the following day! I agree 100% with what you said. Our services are the same whether in person or virtually, meaning the effort, skill and expertise we use in our profession. What other profession is paid LESS when they don’t actually have an office? I have a friend who is an attorney working virtually. Do you think his clients ask for a cut rate because he never actually meets with them in person? NO WAY! My clients who transitioned with me to teletherapy love it. They get my skills in their own home without a commute. The children and teens love showing off their bedrooms and their pets & they make sure they have privacy prior to engaging in the session. Many people who do not have privacy speak to me from their cars which they do not seem bothered by. We are living in a different world now and I wish more clinicians would advocate for themselves and their profession instead of apologizing. I know of some who advertise cut rates for teletherapy!? Why? It is just as much work, plus maintaining a reliable internet connection and good soft & hardware necessary to do the job well are EXPENSIVE. Thank you for your “lengthy comment”. I too am APPALLED at the “cut rate” teletherapy companies operating; however, it is true….you get what you pay for!