Coronavirus outbreak: How therapists stay connected to anxious, isolated clients during an uneasy time
As spread of the coronavirus pandemic shutters businesses and puts more people out of work daily, there is at least one field of work that appears to be thriving right now: psychotherapy.
“I feel like our services are needed now more than ever, especially since a great number of people who work in our area work in the service industry — restaurants, bars, salons… which have all been mandated to shut down,” Natalie Moeller, MSW, a therapist at Moeller, Myers and Associates in Sterling, Ill., the largest private practice in a sprawling area, tells Yahoo Lifestyle. “They are fearful of their financial situation and are reaching out to us for guidance and to help try to calm their anxieties.”
Moeller, whose clientele is made up largely of blue-collar workers and seniors “who take great pride in handling things on their own and stick to the notion of ‘don't air your dirty laundry,’” is seeing a rapid shift in what people need.
“Before this pandemic, we saw people who are moderately to severely traumatized, anxious, depressed, grief stricken. Now we are really ramping up our efforts to reduce anxiety, be the calm in their storm, be the constant steady and rational person for them,” she says, adding hers is “one of the few and perhaps the only counseling office still open in our area, since everyone else has decided to close their doors for a minimum of two weeks.” In the face of the pandemic, Moeller and her associates have been simultaneously sterilizing their waiting room, offering phone sessions and moving gradually onto the virtual platform called Doxy.me.
It’s one of several HIPAA Law compliant platforms available to therapists — meaning that it’s a communication channel that allows only authorized users, is secure and has a specific system of monitoring in place “to prevent accidental or malicious breaches.”
And so, instead of just inviting clients to join a virtual chat as one would to socialize with a friend or have a work-based meeting, practitioners must work through one of many specific, secure platforms — such as Doxy.me, Vsee, Thera-Link and Zoom for Healthcare — either for free or through a subscription plan on which to host private sessions.
How telemedicine works for therapy
“The ethical way is to do telehealth,” explains Mary Alvord, a Maryland-based clinical psychologist who is hosting a webinar for practitioners, “Pragmatics of Telepsychology Practice in the Age of COVID-19,” on Friday through the National Register of Health Service Psychologists. She hosted a similar session last week for the American Psychological Association (APA), for which she co-chaired a committee for telehealth back in 2011. Within a day of the upcoming webinar’s announcement last week, she says, there were 1,000 people signed up. “You can’t use Skype, it’s not HIPAA-secure. And FaceTime is not, either. You have to know that… You need informed consent.”
And then you need guidance in using the platform to its fullest potential, Alvord explains, noting some of the points she’ll stress in her webinar. “You have to do it right. You can’t just say, ‘OK, I’m going to be on my phone.’ You have to know about light and background, the bandwidth capabilities — but mostly you need a [proper] platform and informed consent, which most people don’t have already incorporated into their normal patient agreement… [but] we never know when something might happen.”
While old-fashioned phone sessions can seem a lot easier than what’s required for “telemental health,” Alvord notes, they are often not reimbursable by insurance. There are nuanced sacrifices of human connection, too, she says, adding, “On the phone you don’t have those nonverbals that you can see in video.
“The negative with video is the technology piece, but it has improved,” she says, adding that while it may cause a difficult adjustment period, studies on the effectiveness of telemedicine for therapy have been happening since 2011, all with “really positive” findings.
Another psychotherapist, who has a busy private practice in Rochester, New York (and who requested anonymity in this story), says she’s as slammed as ever with her regular client load, but that the sudden shift — both in anxiety levels and practicalities like getting people set up on telemedicine to eventually make a full switch to virtual sessions — has been more taxing than usual.
“Mostly people are talking about coronavirus, and need help just processing the situation,” she tells Yahoo Lifestyle. “Some are not thinking very clearly and need help with decision making, some are just anxious. I have someone with severe PTSD and this has activated that, so she needs extra sessions because she’s having flashbacks and intrusive memories and she can’t do any of the [activities] that usually keep her glued together. Someone else is in the midst of a divorce. Some are dealing with financial hits. I have mothers trapped at home with acting-out autistic kids.”
And because the area’s biggest employer is its hospital, she adds, “I see a lot of healthcare workers who are super stressed out. That’s been a big thing — talking to them about their worries about their own health, about bringing the virus home to people.”
Beyond the heavier mental load, she’s been hit with extra clerical work, as the area’s Blue Cross provider just announced it would waive mental-health copays and deductibles for anyone doing telemedicine, in an effort to get people to stay at home. “That means I had to notify all my clients, give them the link [for platform Doxy.me], so that’s all really time consuming. I can’t really do a group email, and I’m both emailing and texting everyone to make sure they get the notification. Then I have to reply to everybody. It’s much more stressful now, managing everything.”
That’s something Connecticut-based psychologist Barbara Greenberg can relate to, as she’s moved all clients to video sessions for at least the next two weeks. “All of my patients are dealing with not only anxiety about contagion, but also about the disruption to their daily routines,” she tells Yahoo Lifestyle. “They are feeling helpless and frustrated. I’m working very hard to help them regain some sense of control in their life.”
Adds a Vermont-based psychologist in private practice (who also requested anonymity), “People are feeling a lot of anxiety right now and are also feeling isolated. I’m doing mostly phone calls, but some video, because I don’t have great WiFi.”
Support for people in recovery
In addition to stressed-out moms, healthcare workers, at-risk elderly and so many others, another at-risk population during this transition from in-person to virtual mental support is people who are in recovery from drug or alcohol addictions.
“Recovery, by its very nature, means that people who do well develop a really extensive support group — a sponsor, 12-step meetings. Many go [to meetings] every day for at least 90 days, some go every day for a year, and most who stay continue to go on a fairly regular basis, just maybe not at that level,” Deni Carise, chief science officer at Recovery Centers of America and part of the recovery community for 30 years, tells Yahoo Lifestyle.
“Some of the AAisms — ‘You’re only as sick as your secrets,’ ‘You can’t isolate because up in your head, alone, is a dangerous place’ — they frankly speak to this [pandemic situation] already. The camaraderie, the continued focus, the reminder you get every day that your top priority is not to drink, new people coming in, the people who will nicely challenge you when you say, ‘I wasn’t that bad.’ They all help people maintain recovery, reminding you that you’re here for a reason. And right now, we’re in the midst of a real deadly epidemic of overdoses.”
So, what can people in recovery who depend on in-person support do now that many support-group and 12-step meetings are being canceled? “If you have a sponsor, it’s time to start calling every day. If you are a sponsor, call them to check in,” Carise advises. Luckily, she notes, there are many virtual recovery meetings through AA, NA and other resources (often through the platform Zoom), as well as more Facebook Live meetings with recovery topics. “We’re in the process of putting a number of online resources on our website — recoverycentersofamerica.com and our Facebook page.”
It’s important to find ways to virtually connect she adds, noting, “The ability to go downhill very quickly based on your state of mind and inability to interact with others can be a very steep slope.”
For the latest news on the evolving coronavirus outbreak, follow along here. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC and WHO’s resource guides.
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