The curious evolution of telehealth in private practice psychotherapy

Exploring the practice of being a psychotherapist and the fast pace of technological change in the last decade.

Though I have been a therapist since graduation in 2005, I started my private practice in 2018. At that time, it was unusual for therapists to see clients via telehealth. Since I work with trans and queer clients, and at the time teenagers as well, I would often be working with people who had to drive 3 hours one way to see me because there were no local clinicians specializing in this work. I eventually suggested that we meet via telehealth to save them time and gas money, which many of my clients immediately agreed to. I also had a policy where if a client was too sick to make it in, might be stuck in traffic and be late, or had child care issues, they could message me and I could send them a telehealth link. Many of my clients have chronic illness and this ensured that they got the care they needed.

I am a part of several online therapist communities where clinicians refer to each other to ensure the names they gave out were a good fit. At that time, I remember there was one small group practice in particular that was online only, ran by a therapist with connections to the area I lived in, not a private equity firm or other online company. When they would suggest their name as a potential referral, I recall some therapists expressing skepticism at the quality of therapy that could be offered via video, and that it was difficult for some people to see this kind of therapy as legit and real treatment.

I think about that group practice now and wonder if they think back to that time, because they were one of the few groups who was able to pivot seamlessly when 2020 and the beginning of the Covid pandemic hit. I was similarly grateful that I had the structures in place so my clients were familiar with telehealth, knew how to access the links, and how to set up their computer and phone so they could continue to get care.

Now most therapists offer telehealth. Many therapists have completely closed their in person offices and only offer therapy online. Some therapists I know who graduated during the pandemic have never seen a client in person. It is wild to think how much has changed in the last 10 years for this profession, and how quickly. Among the changes has been in the influx of corporations who have begun offering counseling apps and commodifying therapy in a way that is peculiar to watch, and from my perspective, with dubious ethics and outcomes.

Therapists now have the equivalent of a health clinic run out of their home. Not only do they need to know how to do the work of a therapist, they are also IT for themselves (and often their clients). As a group, therapists are not known for being particularly tech-interested or savvy, so the learning curve for many has been steep. Fortunately plenty of companies have recognized this need and have created new services that are user friendly on both ends. With the sudden shift in 2020 in health care, regulations were temporarily eased to allow telehealth on a variety of video mediums, emphasizing the need for people to get the care they need immediately. Some states briefly shifted who could see clients and from where. The country is still in flux with the laws in each state being significantly different, and the country-wide counseling compacts starting the roll out slowly. It can be difficult to keep track of even if you are highly tech literate.

Beyond the regulations around who can see whom where, the technical aspects of how can be a challenge. This is more than a remote worker participating in an occasional video conference call, this is sometimes 8 hours a day in front of a screen conducting video telehealth. The change in work can’t be understated. Ensuring the video, the audio, and the internet connection are working on both ends and uninterrupted is a particular challenge unique to this new way of offering healthcare. Beyond working consistently is the need to have it be connecting safely

The curiosity I hold and my goal in future blog posts and trainings that I will be offering is this: in what ways are therapists prepared to offer safe and effective therapy from their homes, and where are the gaps. Technology in all fields is moving forward at light speed, so it can be impossible to stay ahead of the curve in all areas, and also learning something once and calling it good is no longer sufficient. I plan on creating trainings that will help therapists know what questions to ask, when to revisit their security structures and settings, and how to recognize what best practices are while they are changing so quickly.

Be watching this blog for more updates, and a date for the first training.