To me, psychotherapy is first and foremost about the relationship between you, my patient, and me, your therapist.
Telemental health is a therapeutic modality that is used to facilitate and foster the relationship between a psychotherapist or counselor, and a client – using technology when both are in two different locations.
This can be done for one or more people (a couple, family, or group with similar issues) who are experiencing psychological or emotional difficulties, or who just seek greater self knowledge. Any of these can seek help or support from a mental health professional: to change negative behavior, to improve functioning, or to overcome challenges. The essence of good and effective psychotherapy is always dependent on the therapist and patient’s ability to openly and truthfully communicate with one another on a regular basis.
In the last 40 years, the traditional appointment – meeting in a “bricks and mortar” office has been augmented or even replaced by digital, wireless, or satellite communication.
Previously, bad weather, vacations, or distance or illness might inhibit or even prevent the therapist and patient from meeting. Today, a telemental psychotherapy session can still occur whenever and wherever needed. Psychotherapy is no longer location or even time dependent.
What is telemental health?
Broadly, it is defined as the use of the internet to provide behavioral health services. In September 1997, the National Board for Certified Counselors (NBCC) called telemental health WebCounseling. It was defined as “the practice of professional counseling and information delivery that occurs when client(s) and counselor are in separate or remote locations and utilize electronic means to communicate over the Internet.”
Telemental Health or Web Counseling may be called:
- Online counseling
- Online therapy
- Distance counseling
- Video conferencing
What is needed to participate in telemental health?
- Internet connectivity – wired or wireless
- Means of payment
- Software platform (link to join session will be provided)
- Computer, cell phone, or tablet
- A good headset/microphone combination
Why do I enjoy working as a telemental health therapist?
- My patients are very satisfied, as am I.
- Neither my patient nor myself are limited to one location, so if one or both of us are away, therapy does not need to pause, or even stop (in the case of a move or vacation).
- Scheduling freedom for both of us.
- Patients who might otherwise not have access to psychotherapy, due to distance, location, illness, resources, or personal limitations, can now participate.
- Patients are usually more motivated to do assigned therapeutic “homework.”
How did I prepare and train to work as a telemental health provider?
I graduated from the University of Pennsylvania in 1983 with an MSN in Child/Adolescent Psychiatric Mental Health Nursing, after years of working in adult inpatient psychiatry.
In 1984, I was given a huge, heavy portable computer with the ability to connect to the internet using a (very slow) modem in my home. “Computing” was very primitive, and personal use was almost unheard of. It was nearly impossible for the general public to conceive of being able to “talk” in real time with and get to know complete strangers who were located all over the world and that couldn’t be heard or seen. The only tools available to you were a computer keyboard and the ability to view typed words moving slowly across the screen. There were no audio or video capabilities! Yet, it was possible to make connections worldwide with others who were also using their own computers.
I was fascinated by these realities and the endless possibilities of online relationships at a distance. It didn’t take long before I became a moderator for a site called “Human Sexuality” on CompuServe – maintaining and contributing to my own section, “Cope with Crisis.” In exchange for endless, free computer time (which was otherwise prohibitively costly in those early days), I was required to post a thoughtful message once a week, while posing some open-ended questions. I was to keep the “discourse” going, about some type of crisis that might be universally experienced by others, and to attract new participants. These were usually thinly disguised versions of situations happening in my own life! ;-). This “job” on CompuServe lasted for a few years.
If it was as Al Gore later called it, the “information superhighway,” then I truly felt like an early pioneer in a covered wagon! I actually met my Canadian husband-to-be online in this “meeting place.” He lived in Canada while I was in the U.S. As commonplace as internet dating is now, at that time, no one was able to understand how we were able to “meet” at first, to transcend our respective borders, and then, to actually fall in love this way. Amazingly, with many “leaps of faith,” this evolving electronic technology had made this possible.
As internet use expanded, I was able to network and interact with like-minded professionals with mental health interests similar to mine. I learned from the people I met online. As a psychiatric clinical nurse specialist, I gravitated to these kinds of self-help groups and to my fellow mental health practitioners who were also using their computers in this way.
Using the internet to provide counseling was so novel and new, that there were no formal classes or training programs. My “cybercolleagues” and I really did learn as we went along. We transferred and employed the face-to-face counseling skills we already had. We became each other’s teachers and clinical consultants. In time, our slow “drip by drip” acquisition of newfound abilities became a literal flood of new and valuable capabilities using our computers and the internet. Today, remote communication like this has certainly become ubiquitous! COVID-19 in our lives has awakened many of us to the reality of internet communication.
And as it is said, the rest is history…
Pros of Telemental Health
- Convenience (online scheduling) and portability
- A degree of anonymity
- Access easier for rural, disabled, chronically ill, agoraphobic and for those without transport or child care
- Continuity – relationship with therapist transcends distance and location changes
- Time and money savings (no travel or parking involved, no endless “phone tag”)
- Greater therapeutic relationship earlier and more intense…”walls come down” sooner
Cons of Telemental Health
- Fear of technology
- Privacy concerns and possibility of breaches
- Equipment failure
- Connection difficulties or failure
- Cost and availability of computer and internet connection
- Perception of being more impersonal, less intimate
- Not beneficial or conducive to some severe mental illnesses (like paranoia, dementia).
- Therapists who work well offline in person don’t always work as well online
- Obviously, not always conducive to other modalities (like equine therapy)
It would seem as if the many “pros” of telemental health far outweigh its’ ever fewer “cons.” We have come to understand, use, and integrate electronic personal, social and business communication into our daily lives. It’s hard to imagine that there was a time without it!
Confidentiality and Privacy
All written and verbal communication between a psychotherapist, their client, and others must protected by HIPAA (The Health Insurance Portability and Accountability Act of 1996) legislation. There are exceptions to HIPAA, (explained further elsewhere) which are related to child abuse, and risk of harm to self and/or others.
Will Telemental Health Work for You?
- Are you technologically “savvy?”
- Is your life free enough from chaos that you can function without being able to tolerate some level of distress, if you can’t reach your therapist at times?
- Are you over 18 (or have parental consent)?
- Are you acutely or chronically suicidal? If so, face-to-face, in person therapy may be more advisable.
- Do you have a quiet, private space?
- Are you able to handle “glitches” with equipment or connections? Patience can be a real virtue!
How to Arrange a Telemental Session With Me
It’s easy for us to connect and arrange an initial appointment at a time and day that works for each of us. You can contact me by email at: , or by phone at: 786-633-1300. I will email you a link for forms to complete and return online before our first session.
Please feel free to contact me at any time with any questions or concerns!