Psychotherapy at Home: Telehealth Makes it Possible
The service is becoming more common, offering a number of benefits
Bri Vieira, a digital strategist in Boston, saw her therapist regularly, and credited the weekly sessions with helping her manage anxiety and depression. But Vieira never met her therapist in person.
She used teletherapy — a method using face-to-face telecommunications technology over the internet for psychotherapy sessions.
Teletherapy sessions work much like the in-person variety. “You make an appointment in advance with a therapist, but instead of traveling to an office, you hop on your computer and receive a HIPAA-secure link to your email to gain access to the video chat,” says Tara Genovese, a psychotherapist based in Chicago. (HIPAA is the Health Insurance Portability and Accountability Act, the federal law requiring health care providers and organizations to ensure patients’ health information is kept private.)
A client can be anywhere to receive teletherapy — at home, at the office during lunch, and regardless of the weather or the lack of transportation options. It can be very helpful to people who live in rural areas, far from mental health professionals.
“It also allows the client to be in a place where they are most comfortable to discuss delicate topics,” Genovese says.
Teletherapy vs. In-Person Therapy
On the positive side for telehealth, Vieira says, “There is definitely more flexibility, which made me more accountable for keeping my appointments … for my in-person therapist, I often cancel because I won’t make it on time if I’m stuck late at work.”
Says Carla Buck, a clinical mental health therapist licensed in Washington state and practicing globally from Dubai, United Arab Emirates: “You don't have the uncomfortable situation of sitting and waiting in a therapy office. And you can join a call with your therapist in the comfort of your own home, in your pajamas and with a cup of tea in hand.”
"It allows the client to be in a place where they are most comfortable to discuss delicate topics."
Of course, teletherapy is not for everybody. After trying it for a while, Vieira went back to in-person sessions. She says she enjoys the feeling of leaving behind the energy from her session at her therapist’s office and that she feels “lighter” for it.
Another negative of teletherapy for some people could be the inability to control the environment. A psychotherapist’s office is typically quite controlled in terms of noise and interruptions. But when you join a video call from your home, the doorbell might ring, the dog might start barking or someone might be able to hear you in the next room.
Despite closing the door and putting on headphones, Vieira says she was uncomfortable thinking others might hear her during her teletherapy sessions.
What’s more, subtleties that may not be caught on a low-resolution camera or sounds that may not be picked up from a microphone could be problematic. “The patient is sometimes missing the subtleties in the therapist's demeanor or expression of empathy,” says Ross Grossman, a psychotherapist at Affinity Therapy Services in Los Angeles.
There’s also the possibility of dropped Wi-Fi connections, causing a break in the flow of a session.
“As technology improves, most of these will become negligible issues,” Ross says.
Is Teletherapy Effective?
Therapy via telehealth has been shown to be equally as effective as in-person therapy, especially when it comes to general anxiety, depression, life transitions and family dynamics.
When comparing virtual visits with office visits, roughly 63% of patients and 59% of clinicians reported no difference in the overall quality of the visit, according to a study published in January 2019 in the American Journal of Managed Care. Cognitive behavioral therapy delivered via telehealth for depression and anxiety disorders is equally effective as in-person, according to a 2018 study by researchers at the University of South Wales in Sydney. One survey by Teledoc Health, a leader in virtual health care delivery, found a 32% decrease in depressive symptoms, a 31% reduction in anxiety, and a 20% drop in stress as a result of patients using teletherapy.
But for those in need of significant support around trauma, eating disorders and addiction, in-person appointments may still be your best bet, therapists say.
Most therapists agree, however, that virtual therapy is better than none at all.
And building on the 27% of employers that already offer apps to support sleep and relaxation, 53% of employers plan to implement programs like mental health teletherapy by 2021 to enhance their employees’ emotional well-being, finds a survey by Willis Towers Watson, a global advisory company.
What Do Psychotherapists Say about Teletherapy?
Teletherapy is still a relatively new way of doing therapy for patients. But Buck says it isn’t new for therapists.
“Some of us have been doing it for years,” she says, adding that she sets solid boundaries about what she needs from her clients (like their address for safety reasons, should she need to send help) as well as what she expects (like no joining a session while driving).
“Personally, what I like the most about providing telehealth psychotherapy is that I can see anyone in my state,” says Genovese. Chicago, as in other parts of the country, has a great disparity in access to mental health care. “Telehealth creates the bridge to close that gap for needed mental health services,” she says.
Will Insurance Pay for Telehealth Appointments?
Many private insurance companies cover telehealth and it's best to check with them to find out about coverage for teletherapy. Medicare covers some telehealth mental health services, but primarily for people in rural areas where there is poor access to mental health professionals. And in those cases, to use teletherapy, the patient must be located at a Medicare “originating site,” meaning a local health care facility or nursing home.
There is legislation making its way through Congress to expand Medicare telehealth access for Medicare beneficiaries seeking mental health services at home.
Just like in-person therapy, costs for teletherapy vary widely, depending on the practitioner or health care organization. Most therapists using telehealth charge anywhere from about $100 to $250 per session, according to a 2011 survey by PsychCentral, an online publisher of mental health information and resources.