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August 12, 2020
woman taking notes

By Robert Hindman, PhD
Beck Institute Clinical Psychologist

I recently read a New York Times article that confirmed something I’ve been thinking about throughout the Covid-19 pandemic: maybe telehealth therapy is here to stay. When Beck Institute decided to close our in-person clinic in suburban Philadelphia and move to conducting therapy through telehealth due to Covid-19 precautions, I was somewhat skeptical. On the one hand, I knew that research has demonstrated CBT telehealth outcomes to be equivalent to in-person sessions. These studies provided a measure of comfort. In addition, three quarters of surveyed mental health professionals are taking on this adjustment with me. On the other hand, I just couldn’t imagine having the same impact over a video platform as during an in-person session. But experience soon taught me that there are many benefits to conducting CBT sessions remotely. If you’re treating clients via telehealth, I’ve compiled some tips here.

woman taking notes

One of my first hesitations about virtual CBT sessions concerned therapy notes, which are an integral part of good CBT. Before becoming a CBT clinician, I conducted psychotherapy sessions without taking notes. Though the sessions may have been helpful, clients would come to the next session reporting the same problems, forgetting some of our previous discussions and what we had agreed they’d work on. After implementing note taking, I quickly realized that my clients seemed to improve more quickly, maintain progress between sessions, and remember our plan of action much better. Clients said the notes were extremely helpful, especially for those who had previously done therapy without note taking.

My therapeutic style includes writing out charts, tables, and diagrams, when indicated. I was unsure that this activity would translate well virtually. With the help of a more tech-savvy client – you wouldn’t know I was a millennial based on my tech skills alone – I used our telehealth platform’s “whiteboard” function, allowing me to draw diagrams, such as the cognitive model of a panic attack. After our session, I was able to easily share our notes through encrypted email.

Telehealth has also improved the impact of my therapy sessions when conducting exposure exercises. In-person sessions are inherently limited when conducting exposures, as they may only apply inside the therapy office. Any in-vivo exposures outside of the office would need to be planned during the session and conducted by the client between sessions. During telehealth sessions, I’ve had clients use their phone or tablet, so I was able to guide them through an exposure as they were engaging in it. One client agreed to walk over a high bridge, an activity she had been avoiding. During this exposure, she said, “I can’t do this!” But I was there with her, virtually, and helped her evaluate her thoughts on the spot, so she could complete the exercise. Afterwards, we collaboratively created a coping card for the next exposure.  

Another significant benefit of conducting therapy via telehealth is helping clients who would otherwise not be able to come to in-person sessions due to distance. Since I started conducting CBT over telehealth, I’ve been seeing client from all parts of Pennsylvania.  Additionally, because many states have relaxed their licensing requirements due to Covid-19, I and the other Beck Institute therapists have been able to obtain temporary licenses and virtually treat clients from all over the country. This is especially necessary as we confront a mental health crisis at a time when nearly one in five US adults live with a mental illness, and many have barriers to access care.

My initial hesitancy to try telehealth sessions has disappeared. I often prefer them, in several ways, over standard sessions, and I can see this being part of my ongoing practice even after resuming in-person CBT.

References:

Acierno R, Gros DF, Ruggiero KJ, et al. Behavioral Activation and Therapeutic Exposure for Posttraumatic Stress Disorder: A Noninferiority Trial of Treatment Delivered in Person versus Home-Based Telehealth. Depress Anxiety. 2016;33(5):415-423. doi:10.1002/da.22476

APA Staff. (2020, June 5). Psychologists embrace telehealth to prevent the spread of COVID-19. Retrieved from https://www.apaservices.org/practice/legal/technology/psychologists-embrace-telehealth

DeAngelis, T. (2020, March 18). What the COVID-19 telehealth waiver means for psychology practitioners. Retrieved from https://www.apaservices.org/practice/legal/technology/covid-19-telehealth-waiver

National Institute of Mental Health. (2019, February). Mental Illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Wilser, J. (2020, July 09). Teletherapy, Popular in the Pandemic, May Outlast It. Retrieved from https://www.nytimes.com/2020/07/09/well/mind/teletherapy-mental-health-coronavirus.html