Teletherapy: Does it Work and Will it Become a Permanent Part of Psychotherapy?

I’m a clinical social worker and have been seeing some clients via various technology vehicles, such as Zoom, Skype and FaceTime for close to three years now, although I primarily saw clients in my physical office. When clients were either on vacation elsewhere [especially snowbirds who might be staying several months at a time during winter in Florida or Arizona] or one client who was receiving medical treatment in Italy, I saw them using a computer, laptop or smart phone. Occasionally, due to heavy snow or hailstorms or highway closings, I saw a few local clients electronically from time to time. It was a convenient way of working and served the clients well, although some older clients resisted the use of technology.

Since the onset of the pandemic [I have essentially stayed home since March 12, 2020], I have done all my work electronically. This means that I have never met some clients in person at all.

I am now using Zoom exclusively for all client sessions, as well as for ongoing training and meetings, and don’t intend to give it up.

I am actually closer—14 inches—from my client which provides a physical closeness that would never occur in my physical office. I have found there to be an intimacy between us that was not necessarily present before. Electronic sessions mean much greater convenience for clients who do not have to travel by car or transit to my office. They are saving time and lots of psychic energy by not negotiating or fighting traffic or worrying about whether or not the bus or subway is on time. There are no parking fees. For some clients, this may mean a saving of more than 2 hours travel time for each one hour session. For a working person, that means not having to take three hours off work in order to see the therapist.

My colleagues and I are using Zoom to meet with our clients. We looked at several new videoconferencing sites, but all were constructed for use by physicians and their online screens where I can see the client and the client can see me are tiny. Medical doctors may spend 6 or 7 minutes with clients and much of that time is spent at a computer completing files. They may not need to actually see the client for very long. Therapy or counseling or psychosocial assessment is different; typically I meet with my clients for 60 minutes and I need to actually see the client and wish to pick up on non-verbal cues, like shrugs, or eyes wandering or irritation in their demeanor. I cannot see those cues on a 2 x 3 inch screen.

For me as the practitioner, working from home has been ideal. I don’t have to drive to my office. Getting ready for a client essentially means going into the space where I am working that day [usually office, but on hot days this summer, I have taken my computer outside and work just as easily from there]. Fortunately, I have no privacy concerns; my deck is far enough away from any neighbour to be completely private.

For my clients, most see video conferencing a bonus, especially those who would otherwise have quite a distance to get to my office. Privacy has sometimes been a concern for the client; just this week, I met with one client when he was in his car. His wife was working at home; his daughter was also home so privacy for him meant sitting in his car in the driveway and connecting with me on his smart phone. It worked and, if necessary, we will meet that way again.

I have also found it much easier to schedule early morning, starting at 7:00 am or evening or weekend appointments. Clients are grateful for this flexibility, so it can work well for both of us. There are no special alarm codes needed to get into an office building ‘after hours’ and it is far easier for me to ‘stay late’ to see a client.

Does teletherapy or video counselling ever not work? I have been working with a teen [who I had not ever met in person] for about 6 weeks when I realized I would like to see her in person. Because it is summer, we are now able to meet outdoors with appropriate physical distancing and this has definitely been a benefit in our work together. My older clients have become so comfortable with seeing me by zoom, that they are now using the same technology to visit with their own families and friends. The resistance to videoconferencing [really, technology] that I saw before has disappeared.

None of us knows when we will be able to return to ‘normal’ or our ‘new normal’. My intention is to definitely continue to see clients electronically and I will likely only see clients face to face in a physical office when there is a special need for that kind of interaction. My license permits me to see clients province-wide; tele or video therapy permits them to access my services with a click!

By Michaele-Sue Goldblatt, MSW,RSW
July 10, 2020