July 9, 2020; New York Times
Amidst the seemingly unending series of bad news related to the COVID-19 pandemic, growing acceptance of the idea of teletherapy and its benefits is emerging as one positive outcome. According to Jeff Wilser of the New York Times, the idea of telehealth is gaining acceptance by an increasing number of therapists. And the lessons might go far beyond mental health, as amid COVID-19, a number of nonprofits are learning how to deliver services online in ways not considered fully legitimate before.
Teletherapy is the use of electronic communications tools like Zoom to connect patients and therapists. According to Wilser, amid the pandemic more than three-quarters of clinicians are using telehealth only, and another 16 percent are using a combination of telehealth and in-person sessions. These days, it seems obvious that many of the benefits of therapy can be delivered remotely. But it was not long ago that many therapists were reluctant to engage in the practice. After all, how do you sit with a patient in mutual silence when you’re in separate, distant rooms?
Tamara Greenberg, a San Francisco-based psychologist, dreaded the pivot, for example, because she worried it “wasn’t as real a form of therapy.” And now? “I would say it’s really been one of the most surprising, and in many ways pleasurable, experiences of my professional career,” she said. Interviews with more than 20 therapists reveal similarly positive experiences, even as they also acknowledged some downsides, and that they missed seeing patients in person.
Indeed, according to the therapists interviewed in the article, teletherapy has much to recommend it. One benefit is that it allows the therapist to see into the home and so provides context for what the patient is experiencing. A veteran experiencing post-traumatic stress disorder remarked that teletherapy makes it much easier to access help because there is no longer any need to travel, which can be stress-inducing.
Downsides include a potential lack of privacy. In addition to concerns about digital security, people can also unknowingly interrupt a therapy session, or, in some cases, the patient may have to answer sensitive questions when they are in earshot of other people who make it uncomfortable to speak openly, like parents.
Teletherapy and broader use of telehealth beyond mental health services seems to have the potential to reach even more hard-to-access people. For example, one survey indicates that more than half of American seniors are willing to use telehealth. The main driver for this is the ability to access help quickly. It is also reported that the Federal Communications Commission (FCC) has committed $100 million in new funding through the Connected Care Pilot Program to bring telehealth to rural and low-income parts of the country, in addition to a $200 million program as part of the CARES Act.
Of course, telehealth is not new, but what the pandemic has brought is an acceptance that it is valid as a treatment tool, and that it should be covered and paid for by insurance companies, including Medicaid. An infographic at MedCity News demonstrates that all but eight states have enacted laws that require private insurers to cover the same services in teletherapy as in-person treatment. Many states also require equal payment for the two types of service delivery.
What is also new is that the therapists themselves are accepting teletherapy as a legitimate method of providing treatment. According to Wilser, peer-reviewed studies demonstrate that teletherapy can be just as effective as in-person care in many cases. Interviews Wilser conducted with therapists suggest that many may continue this “teletherapy” trend even after the pandemic.
Making this possible, of course, requires insurance coverage. Early on in the pandemic Medicare and Medicaid relaxed key requirements so patients could receive help with fewer restrictions. There is new legislation pending that would extend this beyond the end of the current health emergency.
There are lessons to be learned here for the nonprofit sector. We are certain that many nonprofits have already turned to videoconferencing and similar tools to deliver services that used to be in-person only. As the country begins to reopen, we should not forget there are many potential clients that cannot or are not comfortable traveling to get the help they need. The philanthropic community also needs to recognize this, and support nonprofits as they continue to invest in and use these tools to deliver therapy, counseling, health, and education.— Rob Meiksins