Overnight the world changed. Public health terms have become common phrases; we hear people talking about flattening the curve and social distancing. Scientists have become household names, with Dr. Anthony Fauci not only appearing in press briefings but chatting with Stephen Curry. And people are staying home. Millions of people’s homes have suddenly become their workplaces. For many, that brings new challenges like learning how to join videoconference calls and not disturb family members. But for mental health professionals, that has meant quickly coming up to speed with best practices and regulation regarding tele-mental health. 

I’d like to first off apologize. Apologize for the disruptions in your lives – in the balance between your profession and your family, and in the challenges in holding the stresses, anxieties, fears, and loss of others as all of these things greatly rise in the population. Apologize for the professional challenges of learning new skills on the spot, not based on your interest, but on the necessity of a world that changed so abruptly. Second, I’d like to offer some practical tips to hopefully help in this transition you are experiencing in your practice.

I want to focus on two things – some important considerations when providing tele-mental health, and some information on innovative tools, like apps, which can be integrated into services during this time.

Choosing the platform where you will host sessions with clients

One important consideration for tele-mental health is the platform through which services will be provided. Various video-conferencing solutions such as Doxy.me, thera-LINK, and Zoom are available for mental health providers to use and it is worth determining if one of these might work best for your practice. Many of our clients may not have reliable technologies – broadband Internet access, webcams, or microphones to facilitate successful video-conferences. It is worth noting that although video-conference sessions are billable to Medicare, phone only sessions are not. Audio-only phone sessions have been demonstrated to be efficacious for many treatments, however providers need to also consider payment issues around such services.

Creating a comfortable and professional environment

Another consideration is how one might build and maintain rapport, recognizing that this is likely new for both you and your client. The environment is a key factor here. Make sure you have an environment that conveys the same feelings of safety and security you would aim to provide in your typical therapy office. Discuss with clients how they might find spaces to feel comfortable while discussing therapeutic issues. This might be extremely challenging right now for some clients, as kids might be home all day or back from college, and partners might be working from home as well. This may also mean that a client’s typical time slot may still work for them. Some people might have new constraints that limit their schedules, while others have new flexibility that might facilitate changes.

Exploring and integrating new technologies

A host of innovative tools are available to help facilitate treatment. While you might be used to using handouts to provide homework assignments, now is the time to adopt technology tools into your practice. The Veteran’s Administration, for example, offers a variety of apps intended to support the delivery of evidence-based practices such as prolonged exposure, cognitive-processing therapy, mindfulness, and cognitive-behavioral therapy for insomnia. You can view these apps the VA app store at https://www.mobile.va.gov/appstore/veterans. Other apps might be helpful adjuncts to evidence-based, for example cognitive-behavioral therapy apps such as Sanvello (with the premium version available for free during COVID-19) and mindfulness apps including Headspace and Calm. To find other apps that might be helpful for you and your clients, PsyberGuide.org has an app guide with reviews of over 200 apps.

If you are going to recommend an app to a client, it is useful to consider the following:

1. if the app is available on both Android and iOS and therefore available for any client with a smartphone
2. whether the app supports the treatment you are providing, which might require downloading and using the app yourself for a few days
3. how you will integrate the app into your treatment including assigning activities, checking in during sessions, and completing necessary documentation in your notes.

Mobile apps provide a useful way to extend lessons from therapy sessions into real-world settings and might be especially useful in this time when the therapy office is now virtual spaces rather than your traditional set-up.

Providing treatment at a distance offers new challenges yet also provides new opportunities. This might be a chance to build new competencies as the number of resources available – blog posts, webinars, practice tips – right now are expanding the meet the need of those providing mental health services. Continue to look at ADAA for further advice and resources and thank you for all the work you’re doing now to support those in need.