Telehealth for Addiction and Mental Health
As with most therapists, about 10 months ago I switched my therapy practice to telehealth in order to help reduce the spread of COVID-19. While there certainly are technical bumps at times, I was pleasantly surprised at how effective it was – I’d seen the data supporting telehealth in the past, but lack of insurance coverage and lack of interest in the public kept telehealth from really taking off.
Now, everything has changed – we’ve adopted telehealth out of necessity, and what was effectively a fringe practice in the past is now mainstream. It’s completely changed the game in terms of mental health access: now you can see your therapist on a lunch break, hop into a session at a moment’s notice if you’d forgotten about it prior, or work with a specialist who lives hours away from your home. And for Psychologists like myself, there’s been a forward-leaning legislation (PsyPACT) enacted that allows us to practice telehealth across 14 states. I am, right now, not just working with patients from Illinois, but also from Georgia and Utah.
If you don’t know much about therapy over telehealth, here’s a recent Q&A I completed that will give you a great overview!
How would you define telehealth or telemedicine?
Telehealth is providing healthcare through either audio or video channels, and serves as an alternative modality to face-to-face.
What are the advantages of therapy over telehealth?
Easier access for patients - no delays related to traffic, and you can also make appointments that otherwise wouldn't be possible due to transit times.
If a patient forgets an appointment, they can still join a session if they are contacted to remind them (for in-person they would have to travel, which would be prohibitive).
As a provider, I can work with patients who otherwise would be too far away.
You can add in others in the family system more easily and on-demand, if they are home with the patient as well. Family sessions are often harder to organize if multiple people need to be at an office at the same time.
As a therapist, it can be helpful to see a patient's home environment, as it provides some indications about how the environment might impact their presenting problem.
What are the disadvantages?
Technical difficulties sometimes disrupt sessions.
That’s about it!
Does insurance cover telehealth visits?
Right now, most insurances do still cover telehealth visits for behavioral health. This may change as the pandemic fades later into 2021, but I’m hopeful that this coverage will remain in place. Demand for mental and behavioral healthcare are only going to increase in the coming months and years as COVID continues to take its toll.
Do you think telehealth is here to stay?
I do. Long-term, I think most therapists will have a practice that is part in-person and part telehealth, and that patients may opt to convert some sessions to telehealth if they are unable to make it in-person. The convenience and access to care is crucial, and there is no dropoff in clinical effectiveness.
What mental health conditions is teletherapy not suitable for?
From a logistical standpoint, teletherapy isn't ideal for clients who have concerns related to active psychosis, mania, or safety (e.g., suicidal thoughts) because it's more difficult to keep them safe in an urgent situation. However, from a clinical standpoint, teletherapy has proven to be just as effective as face-to-face therapy repeatedly in clinical trials. My experience has mirrored this - I have not seen any fall-off in effectiveness of therapy since transitioning to teletherapy. If anything, I've found my clients are recovering faster, on average, than they did before.
Do you believe teletherapy is as effective as in-person therapy? Why?
I absolutely think it's as effective. Although there are some body and nonverbal cues that you can't pick up as easily as a therapist, these are not the most important parts of effective therapy. You can still communicate clearly, form a rapport, and deliver interventions - these are the critical elements. There are even some areas where I'd say it's superior - no-show rates are lower, for example, because if someone forgets about a session they can log on immediately. I've also has experiences where we've wanted to involve someone's significant other, so the client has just called out and their partner came in and joined the therapy session. You can't do that kind of thing in an office setting.
Are teletherapy sessions cheaper than in-person sessions?
This depends on who you're working with, but in general they are not. If your therapist is working with insurance, teletherapy is currently billed and reimbursed at the same rate as in-person therapy, although it's possible this may change in the future after COVID-19 recedes. That said, I hope it stays consistent – a reimbursement or price reduction would create the perception that telehealth is inferior, when that is absolutely not the case from a results perspective.
Hopefully this overview has been helpful! More information is available on my website related to working with me for online addiction counseling – in addition to my concierge therapy practice, I also have a small in-network practice with Equipoise Teletherapy in Chicago. For any other questions, please feel free to reach out to me directly!
-Dr. Weiner