Some Lessons from the Rise of Virtual Visits
By Suzanne Dennison DCS., RP, (cert) OAMHP, President, Ontario Association of Mental Health Professionals
As we continue making adjustments to live with COVID-19, we are now well into the learning phase of what it takes to keep things working. In early March mental health professionals had to rapidly pivot their practices to address how to continue offering care – suddenly at a distance. As face-to-face sessions were put on hold, telehealth became synonymous with a solid solution for us and our clients.
It is an understatement to say that this has been a major shift in how most of us work. Yet now that we’ve had some time to transition to virtual visits, a few key lessons are emerging. Teleconferencing platforms are not perfect. Nor are they a perfect replacement for in-person visits. They are, however, a viable way to deliver quality care while keeping everyone safe. Here are some of the takeaways for mental health care professionals as we embrace audio/video conferencing as part of our daily practice:
Stand Up and Move or Take a Walk
It’s hard to find time to get out of the chair when your day is full of back-to-back video calls. As a result, the day can compress into multiple straight hours of sitting at your computer. Before COVID-19, we would get up to greet our clients at the door, bring them in from the waiting room, or walk them out as we finished up. All these small but consistent physical actions provided a brief break and generally some time to reflect or just take a breath.
Having moved to all virtual care, many of us have lost the natural rhythm to our day. Prolonged sitting takes a greater toll on our bodies than before; we must really remind ourselves to get up and move. Video conferencing also requires a subtly different type of active listening than physical appointments do, and this too can add to ergonomic stress (leaning into the screen or struggling to take notes while not missing anything). Many colleagues who had worked virtually before the pandemic tell me that to balance these effects, they limit themselves to only two or three video calls a day and take other appointments by phone – even asynchronous text or email contact changes the overall impact and offers more opportunity to get away from our desks.
Note-taking Becomes an Art with More Detail
Talking to clients and colleagues only remotely can also create a sense that one day blends into the next, and details get lost – something now often referred to as COVID-19 fatigue or fog. With video calls, the visual cues that we are normally well-attuned to are at times more difficult to recognize than when in face-to-face sessions. This fact alone often makes it more work to later recall the specifics of a session.
This effect is even more challenging during couples therapy or any group work where focus and peripheral vision is split, and less visual information is readily available. As a result, practitioners must be more aware of these gaps and perhaps must work a bit harder to clarify, all the while trying to capture more in their notes than before.
Privacy is Essential and Must Be Planned
Virtual calls have also introduced a new dynamic not present before COVID-19 stay-at-home and distancing measures were put in place. Instead of attending a meeting with a mental health professional in a private office, clients are now often reaching out from home. With everyone working in the same place and children underfoot, finding a quiet and private space in which to talk can become a challenge. Making contact from small homes, like apartments and condos, less affluent areas, shared multi-family units, or remote locations can be as difficult as trying to reach out safely from an abusive setting.
As therapists, it is important to remember our clients’ privacy concerns and address their need for a safe space before the session begins. It may be that an unusual location and flexible approach works best, and we hear stories of clients who take phone calls in bathrooms with showers running, text hidden alone in back closets, sit in a friend’s parked car, or connect while out walking – any place and method that creates some privacy and safety. Another solution when more support is helpful and time difficult to find, is a practitioner might offer multiple shorter sessions. For example, it might be easier for some to find privacy if contact is provided as several 20-minute discussions rather than a single 50-minute session.
What is Next as We Find a New Normal?
At this point, it’s fair to say that seeing clients over video, by telephone, using email and/or asynchronous text is likely to continue even after physical distancing restrictions are lifted.
Remote visits are clearly not a substitute for in-person appointments yet virtual care has a place and will likely find its footing as we move forward. Consider a blended model that combines in-person initial appointments followed up by virtual calls, an ongoing mix of physical and virtual sessions, or perhaps, in locales where practitioners or expertise is rare, all sessions are held remotely.
Right now, the challenge is greater than it might otherwise be if only because the pandemic brings with it more than distancing issues. It also carries the high-packed punch of emotional stress for most of us. Navigating the day-to-day in a world without the normal access we are used to has emerged as a major focus in therapy right now, creating issues where none seemed apparent before and exacerbating those that did exist earlier.
When things do start to go back to normal, the COVID-19 curve is flattened and anxiety lessens, I believe we will find there is still a place for virtual care. It is true that it may no longer be a necessity, however it will likely remain an important part of every practitioner’s toolkit.