I sent out a request for a psychotherapist in the White Plains/Scarsdale zip codes for a spouse of a woman with whom I worked face-to-face in my office in Boca Raton, Florida. The first response delivered almost immediately, came from Samantha who offered up video therapy; she is licensed in New York State and that is the only form of therapy that she does. Next to come in was an email from a psychologist, Claire, in the Midwest; she offered phone time and HIPAA compliant video sessions—she labeled herself a coach. The last two arrivals were from psychologists within a 30 miles radius; they do face-to-face in-office therapy. That was before the current pandemic and novel Coronavirus.


Sans the current decade, the only therapy that I have ever known has been the in-person, drive to get there, on an easy chair or couch (sometimes analyst couch), therapy. And sometimes with their dog or cat. That is because my personal experience with therapy, at least the bulk of it, preceded the digital age. 


Coinciding with the recent release of Lori Gottlieb’s book Maybe You Should Talk to Somebody”, a book listed on the New York Times Bestseller list almost immediately, the frequency of seeking therapy is at an all-time high. No wonder it hit the charts so fast. While she espouses the process through five cases of traditional in-office treatment, with herself as one of the brave and noble patients, at no point does she offer up alternative choices, at least that we know of, with the exception of a last-minute session with a TV producer stuck on the set. With that in mind, I felt it imperative to explore at least some of the options out there.


Options for Psychotherapy


Today there is a myriad of options for growth and transformation. With the advent of technology and the ease of travel, we now get to choose whether or not we want to take our ailing’s into the weekly therapy room in-person or online or on a phone or on-demand via text or in a concentrated in-office accelerated format.  Just as there are 25 varieties of salsa on the supermarket shelves, there is a potpourri, albeit not quite as assorted or salient as the salsa, of therapies.


Note that this text is but part of a larger piece in the works, however, with the advent of Covid-19 I am here only addressing telehealth, that is video and phone platforms, due to their presence in the current environment. I will leave text therapy for the wider spread.


What is Telehealth?


Online counseling and coaching are typically done via a telehealth platform such as zoom, skype or doxy.me, although I have known others to use facetime and/or just plain phone without the video component. Today I learned that Verizon was going to release a  platform . . perhaps a good investment. So . . . video v. phone?


Sam, who lives in a rural town some hundreds of miles from his psychologist, has reached out for advice with a brief history of erectile dysfunction. The resources in his area are limited and with this, he can have access to trained and experienced seasoned people, particularly in the area of sex therapy. With his work, his sessions are more geared towards coping and not uncovering work since the firewall prevents the intimacy needed B to go deeper.


Although I have used all and methods, I resort to phone with in-between session contacts, crises and on the rare occasion, when someone has limited or no access to the internet. I’m not a fan of phone sessions where you lack the option of making that visual engagement with someone, particularly someone with whom you have a relationship and know. The ability to tap into the facial expressions, breathing changes and overall energy, is virtually absent. Further, a video option requires someone to sit and be still whereas the phone does not; distractions are anticipated. 


The firewall with both is exponentially greater.


When is Telehealth Useful?


Diane and Mark are local, down the street yet due to social distance and shelter in place orders are not opting to be seen in the office and although psychologists are considered ‘essential’ services, most are on telehealth, at least 95%. Their couples session on zoom goes well and with their therapist intensely focused on the nuances of their movements, they are able to do a fair bit of ‘co-regulating’ in their cycle.


With the explosion of coaching in recent years, therapists opt to be justify crossing state lines where therapy is not possible in states in which the therapist is not licensed. Yet there are those who coach and these are primarily those with appropriate training and/or experience that is limited to a few. While an option for some, coaching by definition hovers on the surface and does not dig deep as therapy does; they are different in many ways, too many on which to elaborate here. Yet bottom line . . . coaching is directive and works on the surface while therapy is the exploration of the psyche, sometimes advice-giving, a much deeper process. Nevertheless, the use of coaching to advance the loophole may be less grey hat and useful until such time that psy-pact is enacted and up and running, of course depending upon how many days one wishes to work in another state. 


What is important to know though is that working through actual pain is not without its downsides. It is the epitome of the ‘no pain no gain’ in that there exists all too often, an emergence or worsening of symptoms when the core work is being processed. It is for that reason that touching that pain point without a solid relationship and access between patient and therapist can emerge into a virtual nightmare. It is at times a challenge to help someone via online video chat and near impossible to do it with someone in a dyad in which the relationship lacks safety and security, as in texting therapy. 


Telehealth during Covid-19


It is important to note that online therapy and/or coaching and phone therapy should be limited to issues in which there is no ongoing symptomatology such as a mood, psychosis or dissociative disorder, although there are exceptions to that, namely the stability of the patient and the preexisting relationship between patient and therapist. That said, when the relationship supersedes the symptoms and the patient can remain intact, telehealth can be a great holding environment and a transitional object of sorts until contact is re-established, such as during lockdown.


With little advanced warning, the therapeutic community ‘transitioned’ with little planning and preparation. In the current environment, the in-office face-to-face the frame of the therapeutic process is challenged and lessened. That said, to adapt we are forced to be telehealth providers and in that are seeing the mental health community come together with an awareness of the limitations and maximize the strengths to help our clients. Practicing with screens and speakers instead of couches and chairs is within the context in which we are all operating. Telehealth has begun.

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