Is Distance Treatment the Wave of the Future?
The following is a general discussion of the uses of technology in providing distance therapy. I think much of what the author has to offer is valuable as a point of discussion, though as I have been doing research on the same subject, I am not as cautious as she is with the value of distance therapy.
With advances in technology, distance learning on college campuses has exploded over the last decade. And as time passes, the mental health community is taking note.
Students want to study when they want and how they want. Distance learning makes education available to those who wouldn’t otherwise be able to get off of work, travel to class or spend hours in lectures.
That same increase in convenience and availability could have a real impact for people seeking psychological treatment. Is distance treatment ready to take off?
People who must maintain jobs, care for children or aging parents, don’t have cars or access to public transportation or want to learn material that is not offered where they live can all benefit from distance learning. These are often the same reasons people struggle to access mental health services.
And there is a large body of research that suggests distance learning and traditional classroom learning provide the same quality of education. Distance learning is no longer considered a sub-standard educational option.
So, how can these benefits apply to receiving psychological treatment?
Treatment available online or at a distance could certainly help people with difficulties in getting to therapy sessions and incorporating treatment into a busy lifestyle. It would also enable people to access specific treatment modalities not otherwise available to them.
And, according to the American Psychological Association, psychologists have begun using electronic communication such as email, Skype and various forms of videoconferencing to augment treatment. But, while technology surges ahead, licensing laws and guidelines for providing safe and ethical distance treatment are still catching up.
A recent article reporting on the use of phone therapy in Monitor on Psychology suggests that talking on the phone with a therapist can provide the same, or even better, results for some.
In this study, conducted by University of Cambridge researchers, British adults with mild and moderate depression and anxiety disorders who received cognitive behavioral-based therapy via the phone benefited as much, if not more, than those who received face-to-face therapy. Those with severe symptoms did not see the same results.
This study also found that telephone therapy was less expensive than traditional therapy and was conducted as part of a national initiative in Britain aimed at increasing people’s access to therapy.
The telephone is only one of many options for providing distance treatment. The number of mental health tools available is rapidly increasing. And many in the field agree that it’s time for practitioners to embrace technology and what it has to offer in delivering interventions.
One-on-one treatment cannot be replaced. Nor should it. However, the need for treatment providers to meet the changing and growing mental health needs of the population has caused the ΑΡΑ Insurance Trust and the Association of State and Provincial Psychology Boards to launch a task force to develop guidelines for tele-psychology practice.
Although these treatment options are appealing and there is a growing body of research to suggest that many are effective, it is important to proceed with caution. It is essential to ensure that individuals get the right treatment and that treatments offered have been studied and found effective.
I think I posted something similar to this not too far back but I thought it would be a good review and something to ponder.
There are some circumstances where a client should find a new therapist. And by therapist I mean a mental health therapist. I understand how difficult it is being a client in a new therapeutic relationship. There’s all that talking; bringing up the past, bringing up the present, talking about fears for the future. It’s hard. It’s tiring. And when you think you’ve shared it all… your therapist wants clarification. They ask you questions because in order to understand you properly, in order to tailor a treatment approach to you specifically, they need to know you as an individual.Each person has strengths, weaknesses, and quirks. And your therapist should be very sensitive to those.
Every therapeutic relationship is different. Some clients like a direct, confronting approach; others prefer a casual talk-therapy approach. It all depends on the client. But some therapists make outright mistakes in sessions. Sometimes they’re aware of it, sometimes they’re not. Mostly, therapists stick to their ethical guidelines, seek supervision in difficult cases and keep up-to-date with industry standards. This is a good thing. Regardless, each therapist has their own approach to providing therapy and for you, the client, sometimes you need to make a decision about what kind of therapy or therapist, is right for you.
1. Something about your therapist annoys you or distracts you so much that you can’t focus on therapy.
Maybe your therapist has a body piercing, a speech impediment, an accent, dresses too casually, or laughs too loud. Maybe they disclosed to you that they love Lady Gaga’s music and that disturbs you and keeps you up at night. Maybe you’ve developed a crush on them and you can’t stop thinking about them in inappropriate ways; this is not a joke, if this happens you need to tell your therapist immediately. Whatever it is, if your therapist is wearing or doing something that distracts you from therapy, you might need to reconsider your choice. A part of therapy involves personality fit between therapist and client, you might not find a perfect therapist for you, but you can at least get close. If it’s something your therapist can change, like their hot pink hair color, please ask them to change it.
2. Your therapist doesn’t make eye contact with you.
If your therapist doesn’t look at you or hold your eye contact from the first session (except for if you’ve specifically elected for psychodynamic theory laying down) then they probably aren’t professional. Honestly, I wouldn’t see them again. All therapists need basic listening skills. They should have good body language, good eye contact, & use encouragers such as ‘okay’, ‘right’ ‘uhum’. They reflect back to you using paraphrases and summaries. Very basic stuff. If your therapist doesn’t do these things, it might be time to find a new one.
3. Your therapist laughs and jokes inappropriately.
If your therapist laughs at you or makes a joke, and you don’t find it funny, then tell them. ‘I feel hurt when you laugh at me or make jokes about me.’ If they apologize and recognize their mistake, forgive them, let it go. Sometimes therapists get relaxed in their client/counselor relationships, sometimes they’re a little sleep deprived, and in an effort to increase rapport they may overstep the line. This is a sign that the therapist is able to be themselves around you, and that they see your relationship as having a good level of trust. But, if your therapist makes a mistake and offends you, then that mistake should never happen again and the therapist should try to correct the error. If the therapist doesn’t seem to care, it might be time to move onto someone else.
4. Your therapist looks at the time. A lot!
It’s your therapist’s job to keep track of their time schedule. It’s okay if a therapist checks the time once or twice in a session; they need to. But if they’re checking their watch every five minutes, you might want to bring it up. Sometimes, people do things without realizing it. And it might be that your therapist has some emergency happening, or that they’re late for something and it’s distracting them. Regardless, as a client it isn’t your job to manage your therapist’s behavior. Let your therapist know that their time-checking is annoying you and ask them to stop. If it ever happens again, I suggest finding someone else to be your counselor.
5. Your therapist doesn’t agree to see you if your finances change.
Sometimes, in therapy, a client is going through a difficult time. And on occasion this difficult time results in a loss of finance. Now, sometimes therapy is expensive, but if you have been seeing your therapist for three or four sessions and then suddenly find yourself unemployed and without an income, your therapist should continue to see you. If they say that they require payment to continue and refuse to see you, then it’s time to move on. Your therapist needs to make some sort of agreement with you. Perhaps you can delay payment until you’ve found a new job, or see your therapist at a reduced fee. I don’t necessarily think it’s right for clients to have free therapy. I think when clients invest money in sessions they perceive their sessions as having more value. But a therapist should certainly support you through a rough financial spot. After all, that’s their job. If they’re unwilling, find someone else.
6. Your therapist doesn’t ask you to set goals or work towards goals.
The only way we know therapy has worked is by something changing. And we go to therapy because we want something to change. If your therapist doesn’t identify goals to work towards, how will you know when therapy has worked? Or has finished? If you set the goal of ‘I want to manage my stress better’, you have something specific to aim for.
Most clients have about 3 – 10 goals on their lists. These goals should be set at the very beginning of therapy. At least within the first 1 – 2 sessions. And these goals should be revisited, often. There should also be sub-goals that you are working towards each week to achieve the larger goals. For example, if your goal is to cut back on stress levels. A sub-goal might be “Do 30 minutes of exercise a day”. Goals are important. If your therapist isn’t encouraging you to set any, then it might be time to find someone else.
7. There’s no positive encouragement whatsoever.
If your therapist isn’t encouraging you and doesn’t verbalize how well you’ve done in achieving your therapy goals and homework. Then find someone else. You worked hard, you are showing up to therapy, you’re opening yourself up and being honest about all the things you’re struggling with. Your therapist should praise you for that because it’s worth praising. What an amazing thing it is that you have the courage to visit a stranger, tell them the truth about who you are and then work towards improving yourself. Well done! If your therapist can’t share in that, or show you how wonderful that is. Then give them the boot.
8. Your therapist makes you uncomfortable.
Now, we need to be careful here. There’s a difference between a therapist being the source of your discomfort, or therapy itself being the source. If you find your therapist creepy, unrelateable, too stoic or too expressive that you don’t like sessions. Then you might need to find someone else. If therapy itself is making you uncomfortable, that might just be you adjusting to the process, which can be confronting. The therapists jobs is to join with you, and you need to let them know if you don’t feel ‘joined with’. If the therapist doesn’t work to change this, or you keep putting in effort to relate to your therapist, but it doesn’t work, then tell your therapist and ask them to refer you to someone else.
9. Your details are disclosed without your knowledge.
This isn’t just a personality fit. This is a legal and ethical issue. If your therapist discloses your personal information without your written consent, to anyone (without being subpoenaed by a court of law and without suspicion of self-harm or child abuse) then you should find someone else, immediately. You might even want to report them.
10. Your therapist tells you what to believe.
I’m a pretty independent thinker. I know my morals and beliefs. So I’d be able to tell instantly if a therapist was using their own personal agenda with me. But not everyone can pick up on this. In therapy a therapist is the expert. They are guiding their clients towards healthy thinking, and we want to trust them. Your therapist should not tell you what morals to abide by. If you are having an affair and you’ve lied about it to your partner/spouse it is not your therapists place to tell you that’s wrong. If you believe in god, or have religious beliefs, your therapist should not tell you your religious beliefs are wrong, either. If you lied to your mother/neighbor/local police officer, it is not your therapists place to tell you that your behavior is immoral. They may, however, ask you how you intend to develop trusting healthy relationships with other people, if you yourself aren’t acting trustworthy. But they should never cast judgement on your behavior. If your therapist does this, then find someone else.
If you ever have any problem with your therapist. If you do not like something they said or did. Please tell them. Try to correct the issue first. If it continues, then please move on and invest your time with someone who you feel really cares and listens to you and wants you to achieve your therapeutic goals.
In a similar vein to a previous post, the following discusses ways to make therapy a meaningful and fulfilling avenue for self-help.
Psychotherapy can be a beneficial part of many people’s lives.
Working with a therapist can promote growth and healing, as well as decrease symptoms such as anxiety and depression.
Therapy is also an investment. People spend money, time and energy hoping to make themselves and their relationships healthier and happier.
Each person comes in to therapy with different hopes and expectations, as well as different problems and concerns. Just as every person and therapist is unique, every therapy experience is one of a kind.
Although there is no way to guarantee the exact road that your therapy will take, there are some things that you can do to make the most of your therapy.
Keep communication with your therapist open. If things seem to be going too fast or slow, tell them. If you feel overwhelmed, mention it. Your therapist will not know what is going on unless you speak up about it.
Work on your problems outside of the therapy hour. This might mean completing homework if your therapist assigns it, or practicing new behaviors. You may be asked to pay attention to your thoughts, dreams and feelings. Therapy is only one small portion of your time; many changes happen in the other hours.
Reach out when things get worse. Tell your therapist if you begin to feel more depressed, anxious, or suicidal. There are things that can be done to help you and keep you safe.
Be honest. Your therapist is not there to judge or critique you. Don’t give the answer you think is correct, or that you believe your therapist wants to hear. State the truth. There is nothing that can’t be discussed in therapy.
Use words rather than actions in session. If you feel like running out of the room, say it rather than getting up and doing it. If you’re so angry that you want to scream at your therapist, using words instead of actions allows you and your therapist to better understand what is going on. When you act out, the therapy session becomes focused on the behavior, rather than on the emotions behind it.
If you decide you want to quit, tell your therapist. A skilled therapist will not get mad and convince you to stay in therapy. They will help identify what is going on, and what the various options are. Simply cancelling an appointment and not returning phone calls or letters can be quite concerning for a therapist.
Therapy can be extremely beneficial. Do what you can and to make the most of it.
When looking for therapeutic forms of support, it is not enough to just merely show up at someone’s door and expect the therapist will be the answer to all of life’s problems. In the following, here is a series of recommended questions to consider if choosing a therapist.
One of the challenges of being a counselor, therapist, social worker, chaplain, etc. is losing the ability to be with the humanity of the people we visit. We all go through lulls in our support, where there is almost a mechanical aspect to what we do. Those that are attuned to knowing what takes them away from being with someone are often quite successful, for they will know when to take a break and not let “work” become the goal. The article below discusses these challenges in some more detail.
I have been working in mental health for about 12 years. I listen to clients in crisis for many hours a day, providing support, empathy, interpretation and direction.
Therapists can easily lose track of their own issues, ignore their own problems, and at times have difficulty shutting off the therapeutic process.
In order to be a good therapist, it is necessary to take care of ourselves — our clients depend on it. Just because we know everything there is to know about stress management doesn’t mean that therapists can’t become mentally exhausted. If you are feeling “depersonalization” toward your clients or possibly yourself, you could be experiencing emotional fatigue.
Here are some ways that I like to keep balanced.
I use my colleagues’ expertise regularly. We go to lunch and consult each other on difficult cases. We bounce around different techniques and approaches that could heighten the therapeutic process.
I belong to many professional organizations and am very involved in my community. I feel that if I have the support of my community, then I am not alone in my journey. I enjoy volunteering and giving back to my community whenever possible. It makes me feel good to see that I have helped others with a small donation of my time.
I enjoy spending time with my family. Going to the beach and reading or walking is especially refreshing. I have two Labrador retrievers who demand a lot of attention. I find a great escape just going out into the backyard and throwing the Frisbee for an hour.
My family enjoys going on vacation. I take two trips a year with the family and then one with just my husband.
My practice is in my hometown. I have developed many friendships over the years. I enjoy spending time with many different groups of people. I am very thankful for the friendships that I have made.
In college, I had different goals. I could do and wanted to do everything that came to my mind. I achieved more things in one day than most people did in a week. My priorities have changed. I have a family now and I find it necessary to relax. Now, I want to balance giving and getting – attention to my family, friends, spouse, community, and solitude.
As a mental health professional, self-care is a minimum standard of professional practice. Your clients deserve to be served by a healthy, well-balanced health care professional. Every mental health professional has vulnerabilities, weaknesses, and needs. Take time today to identify yours.
For many, face to face encounters can be difficult to engage in. This has led to an increase in phone or other forms of therapy. According to the below article, it seems that the face to face aspect of care is not an absolute need and for many, this method of communication might work better for improving one’s well- being. Would the same hold true for supporting other mental and emotional ailments?
Talking to a psychologist on the phone as therapy for depression may work as well as meeting face-to-face, according to a new study.
Depression is common in the general population and psychotherapy is considered an effective treatment that some patients prefer to antidepressant medications.
The convenience of phones could make psychotherapy more readily available. (Charles Rex Arbogast/Associated Press)But about 75 per cent of patients with depression in previous studies said barriers like time constraints, lack of available and accessible services, transportation problems and cost stop them from going for treatment.
In Wednesday’s issue of the Journal of the American Medical Association, researchers compared treatments by randomly assigning 325 patients at community clinics in Chicago to face-to-face therapy or telephone therapy for 18 weeks.
“Our study found psychotherapy conveniently provided by telephone to patients wherever they are is effective and reduces dropout,” the study’s lead author, David Mohr, a professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, said in a release.
The results showed 20.9 per cent of the people who had therapy over the phone dropped out compared with 32.7 per cent for face-to-face therapy.
But those in the telephone group scored three points higher on a depression scale than those who met in person.
“The three point difference is of questionable clinical significance but it raises the question whether some individuals are at risk of worsening after treatment with telephone therapy compared to face-to-face,” Mohr said.
The slight worsening could’ve been because those receiving phone treatment had more mental health difficulties and would’ve dropped out of in-person sessions altogether.
The possibility that face-to-face treatments creates better results for some can’t be ruled out, Mohr said. Physical presence could increase resilience or help people maintain their skills after treatment ends.
“The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individuals who otherwise have barriers to treatment,” the study’s authors concluded.
The researchers couldn’t think of any reasons why the findings wouldn’t apply to psychotherapy for other illnesses such as a anxiety disorders but that wasn’t specifically tested.
They were unable to mask the patients to the treatment, which could affect bias the results.
The research was funded by the U.S. National Institute of Mental Health of the National Institutes of Health.
Much of therapy today is person-centered, which the author in the below piece attributes to Carl Rogers. Chaplaincy owes much to this therapeutic approach, as we are trained to be agenda-less when we visit, allowing the patient or client to guide the conversation. Of course, there are times when chaplains do have somewhat of an agenda, as well they should, because there is a professional aspect of needing to be supportive of the people for whom we are to care. In the piece below, the author discusses how person-centered therapy is really about trusting ourselves to resolve difficult situations.
So do you trust yourself?
A gentleman born in the early 1900’s trusted you, even though you’ve never met. His name was Carl Rogers, and he was a psychologist. And he believed that you – that all of us – have the innate power to understand and heal ourselves. He believed that somewhere inside, you have the solution, the answer, the salve for your life’s struggles. And that trust will help unlock them.
Well, maybe you can take a leaf out of therapy’s book and sort of see if it might apply to you in your life, and the way you might treat yourself (or not).
In therapy, if you and your therapist follow Rogers’ approach, it’ll be called “person-centred therapy.” And the person it’s centred on will be you. So you’ll set the pace of things – your therapist will take your lead, as they have faith in your mind, your emotions, your entire being to know the right pace to go.
They’ll listen to you. Deeply. Because they’ll believe that everything you say is a clue. That everything you say has value.
And they’ll trust that, much as a plant knows to grow toward the sun, you know how to grow toward your healing, and you’re probably already starting to do that. So they probably won’t plaster you with other people’s opinions or theories, or tell you how you “should” think.
How would it be if you could apply these things to yourself?
To extend a hand of trust to yourself in barren times and know that you will grow again. That you’ve already started. That deep down, something in you knows the way out of pain. And back to being whole. Even if you’ve never grown this particular way before.
To really listen to yourself. To hear every resistance or desire that your gut is trying to communicate to you. To look for the signs that your body – that most intricate sense data collector – is giving you about your world.
And to trust yourself enough to just let yourself grow towards the light in your life. Not to overburden yourself with other people’s “shoulds.” But to just be where you are and going where you’re going. In your own direction, rather than someone else’s.
Sometimes, in really tough times, it can be really helpful to do this in the company of your therapist.
And sometimes, maybe it’s enough to start the healing – the trusting – yourself.
Gabrielle Gawne-Kelnar (Grad Dip Counselling & Psychotherapy) is a writer, blogger and Sydney psychotherapist in private practice at One Life Counselling & Psychotherapy. Gabrielle also facilitates telephone support groups for people who are living with cancer, for their carers, and for people who have been bereaved through a cancer experience. She provides regular therapeutic updates on facebook and Twitter @OneLifeTherapy.
I caution people to be careful about how far to rely on this, but often we can figure out our challenges and problems by taking a good look inside ourselves. If we can begin to parcel out what is truly ailing us, then perhaps we can work to finding the solution. One of the primary elements of therapy is helping a person explore what is innately known.
A lot of therapy is about sort of stepping back and seeing things – seeing yourself – from a different perspective. Getting out of the weave and the warp of the moment and looking more at the whole fabric of the situation you’re in. Seeing if there’s any repeating motifs or themes that might help you unlock some solutions… or even unlock parts of you.
And the wonderful thing is that you can do this without being in formal therapy.
Don’t get me wrong, traditional therapy is a great way to get the hang of this pattern-spotting business. And it’s incredibly powerful to work with someone who’s got your back and can help you see any blindspots you might have. But once you’ve become a pattern watcher, you can use it anytime you like, to find deeper insights and often deeper healing, too.
So what sort of things might you try to notice? What helps spot the patterns?
Is this particular sadness or pain or fear or anger really only related to just this situation at hand (which it may be) – or is this about a repeating pattern you know from some other time in your life? Does it feel familiar? What are the common elements? What does it tell you about what you need or want or hope for?
How have you handled situations like this one before?
Did you run? Or hide? Or fight until there was only you and some scorched earth left? Or maybe you insisted on doing the “proper thing” even though it hurt you in the long run. Did you put others before yourself?
And, in light of all that, how do you want to respond this time?
When there are patterns, it can be hard to break them (even if part of you wants to). You might feel different about yourself if you try it. So, if you’re used to looking after others before yourself, but you don’t this time, you might feel like “the bad guy.” Or if you’re used to unleashing your fury, but you decide to find another way, you might feel like a bit of a “pushover.” But it’s probably only habit speaking. Just be prepared that it might feel a bit strange if you do things differently this time.
Rather than leaping out of some knee-jerk reaction, it’s always worth asking yourself what you actually want here. What do you want in the longer term? What will you have wanted when this thing is resolved. (Not just in the heat of the moment, when all your emotions might be crying out for “justice” or “retribution” or even automatic “peacemaking” before you can intercept with your mind or your heart).
What does the pattern want for you?
It’s a strange question, I know. But it can be so revealing. If you ask this question and really sit with it a moment, what sort of answer arises for you? Does the pattern want the same thing you do? Or would it like you to stay stuck in old habits? Does it want to protect you in some way and keep you so safe that you start to rust? Or is it protecting other people in your life? What does it want?
Stepping back like this and seeing things from a different perspective means that you can use your very life as your guide. You can turn to your history and your habits for insight that only you can give yourself.
who is this ‘I’ who observes?
Photo: the patterns of my skirt and the rug in my therapy room.
Reference: Joko Beck, C, 1989, Everyday Zen, Thorsons, p.49.