For clinical psychologist Alison McGrath Howard, Psy.D., the decision to stop practicing face-to-face and begin using teletherapy to counsel patients was a no-brainer.
On March 13 – the Friday of the week that COVID-19 turned America upside down — she woke up with a fever and a cough and felt “horrific.”
The week before, she’d traveled from her Washington, D.C., home to a conference in New York City. On her return she learned some participants had tested positive for coronavirus. When she became symptomatic, she had herself tested.
She had COVID-19.
“I was in a panic,” said Howard, 54, a psychologist for 19 years. “I saw 50 people that week and I didn’t know I was sick.”
To her knowledge, none of her patients got sick. Howard wasn’t hospitalized, but by late May still hadn’t fully recovered.
Despite her illness, she continued to practice, and despite never having used teletherapy, she was seeing patients within a week after what she calls “a steep learning curve” as she switched to online counseling exclusively, first from her home and eventually from her office.
Across the country, psychologists interviewed by The National Psychologist in late May told similar stories about their abrupt pivot to teletherapy and shared insights in the hopes that other psychologists would benefit.
Early-career psychologist Teresa Young, Ph.D., had some experience with teletherapy but mostly saw patients face to face in her private practice in Columbus, Ohio. That made it easier for her to switch to teletherapy but not necessarily easier for her patients, particularly those in their 70s and 80s. She’s been doing telephone sessions with some patients, hoping she’ll be reimbursed.
“I think, to some extent, we might have to eat some of these costs,” said Young, 33, who’s been practicing for three years. “It’s kind of the cost of doing business during a pandemic.”
Sheldon Kramer, Ph.D., had an entirely face-to-face private psychology practice in Encinitas, Calif., just north of San Diego, when he had to close his office March 17 and begin teletherapy at home.
In the past, he had taken classes with friend Marlene M. Maheu, Ph.D., who founded the Telebehavioral Health Institute, so he found the switch to online therapy fairly easy.
Like all the psychologists interviewed, Kramer, 69, misses seeing his clients in person.
“Online can’t duplicate the human energetic exchange between a psychologist and their patient,” he said. But he’s found multiple advantages to teletherapy, so much so that he’s considering ditching his rented office space and using his home full time, possibly with a mix of in-person and online therapy.
Kramer has found that his patients are more relaxed talking to him from their homes, leading to more intimate conversations as well as the bonding experience of showing each other their homes. He’s been able to lead meditation and incorporate music into his sessions and feels he has closer contact with patients in some ways because he’s looking at them intently on the screen.
New York City psychologist Yasmine Saad, Ph.D., also has found her therapy has deepened because her patients are talking to her from their homes.
“It’s much more personal, more like talking with a friend,” she said. “There’s an ease about it because you don’t have to commute. I had one of my most productive sessions with one patient because she felt so safe when she was talking to me from her bed.”
Saad, 44, who has a group practice with more than 10 other psychologists, has managed to keep seeing patients, despite having COVID-19 in mid-March and watching her 6-year-old daughter during work hours. She had occasionally used teletherapy before the pandemic for clients who were traveling, but many of her patients had never tried it. Some initially balked but finally gave it a try when it became clear that in-person sessions weren’t a possibility anytime soon, Saad said.
As of late May, she had no plans to return to in-person sessions anytime soon. New York City has been hit hard by the virus and many people continue to work from home. To travel to her office, most would have to take public transportation and face possible exposure to COVID-19. And Saad doesn’t believe she could effectively counsel clients wearing masks, a hurdle she doesn’t face with teletherapy.
Psychologist Jim Broyles, Ph.D., director of professional affairs for the Ohio Psychological Association (OPA), said his private practice was all face-to-face before COVID-19. Since then he’s transitioned to a mixture of in-person and online therapy, all from his office in Grove City, Ohio, just south of Columbus. Patients coming to the office wait in the parking lot until it’s time for their session, have the option of wearing a mask and socially distance themselves during sessions, Broyles said.
Through his job with OPA, Broyles has heard from many psychologists about the chaotic switch to teletherapy.
“It wound up not being as challenging as they thought, but the biggest hurdles were working through all the laws and rules and insurance company policies so that we were in compliance with all the regulations we had to follow,” he said.
Also, in early March, Medicare switched its policy on teletherapy so patients could use it from their homes. Previously, psychologists couldn’t get paid for a teletherapy session unless the patient accessed it from a designated area, such as a doctor’s office. Broyles said he’s heard about “surprisingly few” psychologists having problems being reimbursed for teletherapy.
Mary Alvord, Ph.D., who heads a large group practice with offices in Rockville and Chevy Chase, Md., had to switch not only individuals to teletherapy in March but also the resilience-building group therapy sessions she runs for children and adolescents. Between 10 to 15 percent of her practice already was online and she’d used video meetings to link her two offices since 2005.
Privacy for patients can be a problem, she said, as well as technology glitches. But the advantages are many, including reduced barriers to treatment such as travel time, bad weather and mobility issues.
Alvord has no plans to reopen her offices for in-person appointments anytime this summer. She and her colleagues continue to discuss that option but have reached no conclusions about how to overcome issues such as having enough personal protection equipment and keeping surfaces clean.
“I’d rather err on the side of continuing telehealth rather than take chances,” she said.
Marlene Maheu of the Telebehavioral Health Institute in California, said her company sold more training and consultation during the first two months of the pandemic than in all of 2019.
“We’ve had a constant flow of individuals and now, larger institutions, that want training,” she said, including universities and community health centers. Maheu also is in heavy demand to do webinars for associations and other organizations, including the American Psychological Association.
As for Howard, the Washington, D.C., psychologist who’s still recovering from COVID-19, she’s back to a full schedule of therapy, all online, and is leery of face-to-face sessions anytime soon. Her office is in a busy apartment building with people coming and going constantly.
“I know it’s really unlikely someone would get COVID from coming into my office, but until I can know that with 100 percent certainty, I don’t want to do it,” she said. “Until I have a lot of assurance that I can’t get sick again and my patients can’t get sick again, I don’t think it’s ethically OK.”