We are all experiencing change. Whether we are coaches, therapists or clinical supervisors we are all working differently since the onset of the pandemic.
Some of us were in full-time in-person practices with never a thought to working online. Some of us were already practicing in-person and online. Some of us only agreed to online work with clients we have already seen in-person. Many work constellations exist and even more so now. An omnichanneled approach is essential but strict regulation and outdated pedagogy may further restrict our ability to care for our clients.
Restrictive Telemental Health Policy
The writing of this post was actually influenced by a recent rule I read in the Louisiana Rules, Standards and Procedures Chapter 5 § 505: Teletherapy Guidelines for Licensees.
Teletherapy shall be delivered in real-time (synchronous) using technology-assisted media such as telephonic and video conferencing through computers and mobile devices. The use of asynchronous modalities (e-mail, chatting, texting, and fax) is not appropriate and shall not be used for teletherapy, except in a crisis to ensure the client’s safety and stability.
The rule also restricts telemental health training:
Professional Training with a minimum of nine synchronous clock hours in teletherapy.
And clinical supervision?
Up to 25 percent of total supervision hours may be used within a telesupervision format
Similar rules are in effect in various states. For instance, Georgia requires 6 hours of telemental health training and 3 hours of online supervision training to practice online supervision. But only a portion of continuing education credits can be obtained online (favoring as does Louisiana, live, in person training).
Restrictive Telemental Health Training
While states and countries attempt to place an expectation of professional development regarding telemental health, these restrictive rules often interfere with equal access for clients and in many ways, can be disruptive to the client’s continuum of care. Restricting methods of delivery such as email and chat (both are backed by research with demonstrated efficacy) seems more an agenda of the policy makers than protecting the client.
To put this in perspective, many policy makers and university professors who advocate for these strict rules and regulations, received their accredited doctoral degrees online, engaging in chats, discussion boards, video conferencing and email, encompassing an omnichanneled approach. This is the pedagogy of distance learning. Yet those same approaches are deemed inappropriate for the delivery of online therapy and supervision. It can be concluded that it is not the quality or the quantity of training that seems important, but that we continue old-school ways of learning.
Why an omnichanneled approach?
When I taught about online therapy as an adjunct to private practice in 2002 at the American Mental Health Counselors Association and again in 2005 at the American Psychiatric Association- and discussed online supervision that same year at the American Psychological Association- I was speaking about email, chat and phone. Videotherapy was not as accessible at that time. I brought many points to these discussions including the idea that adding email and chat can offer a richness to the therapy or supervision process that does not exist in an in-person exchange. In many respects, the dialogue deepens through the written word and the therapist or supervisor can view the therapeutic dialogue through a different lens.
Now with video conferencing at the ready, chat and email has fallen off the online therapy radar for many. But not here at Online Therapy Institute. In fact, we teach an 80-hour course, Certified Cyber Therapist (available across the globe) that meets the educational standards put forth by the Association for Counselling & Therapy Online. The training covers all methods of delivery- synchronous and asynchronous. Keep in mind, that Georgia and Lousiana pale in comparison with 6 hours and 9 hours respectively, or even the 15-hour Board Certified Telemental Health provider credential through the Center for Credentialing and Education (CCE) in the United States.
In summary, email and chat are viable delivery options for telemental health but a specialist approach is required gained through appropriate training.
Zoom Fatigue is Real
Another reason to include an omnichanneled approach is the phenomenon known as “Zoom fatigue.” It is real and it occurs for a few reasons. The first and most obvious is that we are not used to being online via video all day. We are not used to seeing expressions zig zag or play catch up with words. We are not used to the tech glitches or sound difficulties or fuzzy screens. And we may never get used to that. For this reason, self-care is important. Taking more breaks may be necessary to carry forth your work with clients.
Zoom fatigue also happens because we simply are not used to seeing ourselves when we are talking to someone else. Witnessing ourselves all the time is stressful. We were not biologically or neurologically wired to see ourselves in every conversation. This also requires us to take longer breaks.
With that said, doesn’t it make sense to back off the video for a while and add in elements to the therapy process that can be enhancing for the clinician and client and create better outcomes? Including email and chat with audio and video strategies creates a much more fluid experience and represents the current social fabric that embraces mixed media. These are the times we live in, with or without a pandemic.