Has Telehealth Therapy Lived Up to the Promises Made in 2020? My Personal Experience as a Telehealth Clinician

Telehealth Therapy: Is it for you?

The year 2020 brought unprecedented changes to the world, and the field of mental health was no exception. With lockdowns and social distancing becoming the new normal, telehealth therapy, once a niche service, was thrust into the spotlight. Promises were made: increased accessibility, greater convenience, and continued effective care. But has telehealth therapy truly lived up to these promises? As a Licensed Clinical Social Worker (LCSW) who has worked exclusively as a telehealth provider for the past three years, I've had a front-row seat to this transformation, and I'd like to share my personal experiences and observations.

Before the pandemic, I worked in public, non-profit, county-funded programs, providing in-person therapy to youth and their families. Our clients benefited from direct contact with a caring adult in a safe, private setting. When COVID-19 hit, we, like many others, scrambled to adapt. We transitioned to virtual platforms like Google Video, Zoom, and GoToMeetings. However, this shift brought challenges. Suddenly, clients who were used to the privacy of an office were having therapy sessions on tablets, often with family members nearby, monitoring their progress. This created a significant barrier to open communication, as clients no longer felt safe sharing their experiences. When restrictions eased, we returned to in-person services as quickly as possible, but the experience highlighted the complexities of providing effective care remotely.

Living in rural San Bernardino County, California, meant long commutes for me and my clients. Driving 80-180 miles a day was not uncommon. Personally, I missed the potential of telehealth, recognizing its ability to connect with clients without the burden of extensive travel. After my career shifted to exclusively telehealth work, I found a new sense of balance. I established a HIPAA-compliant home office, utilize a secure Electronic Health Record (EHR) system, and connect with most clients via video, with some opting for phone sessions. This has dramatically reduced my commute time, saving me at least 75 minutes and potentially up to 2.5 hours per day. This benefit extends to my clients as well, reducing their travel time and associated costs. Furthermore, telehealth offers a valuable alternative when either the client or the therapist is experiencing minor illness. Rather than canceling a crucial session, we can connect remotely, ensuring continuity of care.

This brings me to the core benefits of telehealth therapy:

Convenience and Ease of Access: Telehealth therapy offers unparalleled convenience, especially for working families. Clients with young children no longer need to arrange childcare, reducing the financial burden of therapy. It allows parents to prioritize their mental health from the comfort of their homes, eliminating the need for commutes.

Effectiveness:  In my experience, telehealth therapy is effective for most clinical situations. Research supports this, demonstrating that clients with anxiety, depression, trauma, and even bipolar disorder can benefit from remote therapy. While research continues, the evidence suggests that telehealth can be a powerful tool for addressing a wide range of mental health concerns.

Appealing to Younger Generations:  Millennials and Gen Z, who have grown up with technology, are more receptive to telehealth options. As this form of communication becomes increasingly normalized, privacy concerns are being addressed, with family members respecting the need for a confidential space during sessions.

Affordability:  Telehealth can sometimes be more affordable, particularly for those without insurance. The ability to choose a therapist online, regardless of location, expands options and may lead to finding a therapist with more affordable rates or sliding scale fees. While some telehealth platforms are trying to bridge the affordability gap, the cost of therapy, even reduced, remains a barrier for many.

However, telehealth is not without its challenges:

Barriers to Access: While telehealth can be more convenient for those already receiving mental health services, new clients, especially those in underserved communities, face significant roadblocks. Internet access and technological literacy are not universal. The digital divide leaves many behind, particularly in communities with limited resources. As the provided statistics show, a significant portion of the global population still lacks internet access, and older adults may struggle with the technology required for telehealth.

The Clinician Shortage: Telehealth does not solve the underlying shortage of mental health professionals. Even with increased access to virtual therapy, finding a qualified therapist, especially one who understands and reflects the client's cultural background, can be a challenge. The scarcity of clinicians of color, as highlighted by the statistics, is a critical issue that needs to be addressed.

Concerns about Therapy Apps:  Direct-to-consumer therapy apps offer convenience but raise concerns about privacy and boundaries. The promise of constant access to a therapist can blur professional boundaries and may not be healthy for either the client or the clinician. Furthermore, the collection and sharing of sensitive data by some apps raise serious privacy concerns.

Inequity and the Need for Broader Support:  While telehealth has expanded access for some, it has also highlighted existing inequities. My own experience working with clients who lack internet access and other resources reinforces this. Telehealth cannot succeed in a vacuum. It needs to be part of a broader system that addresses the social determinants of mental health and provides comprehensive support for all members of the community. It has been pointed out, the circumstances of many clients did not change during the pandemic. They still needed help, and they still lacked the resources to access it.

In conclusion, telehealth therapy has shown great promise and offers numerous benefits, including increased convenience, effectiveness, and access for many. However, it is essential to acknowledge and address the challenges, particularly the digital divide, the clinician shortage, and concerns about privacy and equity. Telehealth should not be seen as a replacement for traditional therapy, but rather as a valuable tool that can complement and enhance existing services. Moving forward, it is crucial to invest in infrastructure, address disparities in access, and ensure that telehealth is integrated into a comprehensive and equitable mental health system. Only then can we truly say that telehealth has lived up to the promises made in 2020.