Effectiveness of telehealth therapy

While I'm sure your mileage may vary, I find telehealth therapy to be a very poor substitute for in-person therapy. In fact, I've stopped therapy altogether since things have been locked-down again. I know telehealth exists out of necessity, & I'd probably turn to telehealth therapy if things got really, really bad, but there's something about removing myself physically from a space that allows me to extract myself from emotional spaces more readily. I can't seem to do that through telehealth. If "talk therapy" is just about talking, however, I don't fully understand why I have such a hard time doing telehealth therapy. There's a part of me that feels I'm just being excessively needy, or something. Does anyone else stuggle with this as mightily as I have?

First, I assume you're talking about meeting with a therapist over video (like Zoom, Facetime, or one of the doctor-specific ones). So, seeing them on a video and talking to them virtually vs. in person. Rather than something like Betterhelp, where I think it's all just texting, if I understand it correctly? If you mean the texting thing, then ignore my answer!

So, the first time I had a Zoom session with my therapist (nearly a year ago--mid-March 2020), I was ready to just say "No, this isn't going to work, forget it." It felt too painful, sort of seeing him, but not really? I had considered trying just the phone instead of video. But then I opted to give video another shot. And it felt better the next time. And then I just gradually got used to it.

It helps that my T is pretty good at communicating over video. He's had some experience with it pre-pandemic because he sees teens and young adults, so he'll sometimes keep meeting with clients after they've gone away to college. But he's very good at looking at the camera (which feels like eye contact), staying engaged, still talking with his hands. So I think that helps. It also helped when I asked to be the one to end the session (like click on "leave" or "exit") so it would feel less like he was on screen then just went away.

And I've grown rather comfortable with it, though it took some time. It helps that I'd been seeing my T in person for a couple years before the pandemic started (I imagine it would be difficult to connect to a brand-new T this way). As much as I miss seeing him in his office, at this point, if the options are "see me in person, but we're both masked and 6 feet away" or keep seeing him on Zoom, I might try the office once, but think I'd be more likely to opt for Zoom.

So I'm curious as to how much of a chance you gave it. And also what your specific concerns were. Did you not feel connected? You could talk to the T about ways to connect better, even if it's something that seems silly like touching your hands to the screen or having a starting and ending ritual. Did your T seem distracted? I'd mention it. If it was earlier in the pandemic, maybe they were still adapting to video therapy and would be better at it now? Do you lack privacy in your home? Fans and white noise can help. If you had a bad internet connection, that's another issue. Just a few thoughts...

Thanks for your thoughtful response, LonesomeTonight. The telehealth I was referencing is of the Zoom type. I could see my therapist on the screen...if I could look her in the eyes. When I'm in tough spots I have a hard time making eye contact; I always have, for some reason. Even when I'm in a better space I sometimes have an easier time reflecting if I'm not looking at her. It's kind of a disembodied voice approach.

None of the potential problems you cite really apply in my case. It's not privacy, or anything tactile. I think it's just a matter of removing myself from the scene of my "suffering" (woe is me, right?), taking a 15 minute drive to her office, & sitting on the couch in her office. It seems to be more spatial than anything else. Removing myself "from the scene of the crime," so to speak. Does this sound familiar to anyone else?

I struggled a lot with telehealth therapy in the beginning (and for quite some time). There was something about the drive time (20 minutes) that allowed me to transition into a therapy frame of mind and then transition back out of it in order to go about my daily life. The transitions felt abrupt and jarring with telehealth. It almost felt like being teleported from one place to another, with no advance notice, and I hated it.

I also felt like he was "not real" over videoconference. I have some dissociative tendencies due to trauma, and every week, if felt like he became less real to me, like he was fading and getting further and further away. This went on for a few months and it was really, really hard. We talked about it quite extensively and that helped. We talked about how the "therapy space" had been really important to me, how it was a safe place, and now we didn't have that anymore. We had my space and his space and they were not connected. So we talked about ways to create a shared therapy space, even remotely and via telehealth, and we worked on that. He pivoted his computer around the room so I could see his space, but that turned out not to be enough, and I asked him the next week if he could do it again, but slower. He picked up his laptop and walked me around the room, showing me the art on his walls, the books on his bookshelf, the rug, the chair he was sitting on, his view when he was sitting at his desk, the door to the room. He even walked me to the window and we looked out together. He commented that it was garbage day, and he told me how many kids live on the block. In this way, he shared his space with me, and I did the same with the room I was in.

I also started clearing space/time around my sessions, allowing myself at least 15 minutes on either side to mentally transition. My family knows to stay out of the upstairs when I'm in therapy, because if I can hear them, I can't get into the therapy frame of mind. I created a little ritual for getting ready for therapy, and I had some props that I set up around me (two of them things he let me bring home from his office when we knew we were switching to telehealth). We also talked about having an ending ritual, so the ending didn't seem as abrupt.

There is so much about therapy for me that is not about talking, but rather, about a felt sense of something, or something visceral. It's about FEELING seen and heard and connected. Most of that got taken away with telehealth, and we had to find ways to recreate it or substitute it. We've made it work. I still vastly prefer in-person therapy, but I went from thinking telehealth absolutely would not work for me to being able to do some really good and deep work. Sometimes now, when I think back on a session, I can't even remember if it was telehealth or in person, which I think says a lot.

Wow! Thanks for your response! You and your therapist really worked through this to find some solutions. I pretty much just gave up - which is on me. After starting this thread, I wrote my therapist an extremely brief email to take care of some insurance business & mentioned, in a sentence, that telehealth was difficult for me. She emailed me back to inform me that she will be seeing clients in her office again in late-February. Given the space I'm in right now I'm not sure I need an appointment, but it's nice to know that telehealth might be coming to an end .

For me, working remotely has been beneficial and I might even retain remote sessions should face-to-face ever be possible again. I feel much safer and more relaxed. I am less self-conscious and I can be more at ease when I am not in her space (she ordinarily works from home). We don't use the video function on our Zoom sessions (at my request) and this has enabled me to cry more freely and be more vulnerable with her. We met in person once several months ago (at the beach) which was strange and I wasn't relaxed, but it was nice to see her. I miss some aspects of being in her physical presence, but overall, remote sessions work much better for me. We have also had far fewer ruptures working in this way which probably indicates that I am less protective and aggressive.

I was going to stop therapy completely when my T said we had to change to zoom sessions. I have bad experience with online video chats before, but also my internet connection is not reliable and I don’t have enough privacy at home. I had a breakdown after hearing about the transition to zoom, I told T I was quitting and he said he would still see me in person after all. I guess I was lucky. I could never have adapted to zoom, I wouldn’t want to either. I would prefer just a regular phone call.

Yes, my sessions are far from the same and I often wonder the purpose of continuing to see her through the video visits. At the same time, I know I lock people out so easily and that I struggle with object/person permanence so the longer I go without interacting with someone, the more I feel they are not the same person, my guard is up ... and so on. So, I keep seeing her. But yeah, it's not the same and I can't say any real progress has been made for a year.

I used to have a full routine of walking from work to her office, this gave me about 30 mins to let the rest of my world shift aside and me to shed the armor I wear. I don't get that with my 1 min walk from my work set up to my therapy set up zone. (ok more like 3 sec walk, but I do have to wake up and log into a different computer.) Most the time I am home alone when I have therapy. I still feel uncomfortable talking about things that involve my wife or another person via the video visits. I don't feel like I have the protective bubble (frame) that her office creates.

I too, rarely look at her eyes either on video or in person. When I'm in person, I could often look at different things in the space there and different parts of her. I've been seeing her for 5 yrs multiple times a day. By now, she has a pretty good idea of my stress level based on what I end up focusing on in the room. In video, we just don't have that extension of interactions. And because of possible tech issues, silences aren't really allowed to exist for very long before one or the other of us starts to wonder if the call was dropped.

I actually think I would have preferred dealing with the woman on a video screen better. First I would not have to be on her turf and my furniture is a lot more comfortable. Second - I would have been able to stand and walk around which I always find more conducive to talk. Finally I would not have had to be concerned about her going mad and trying to hug me or something

One of the psychiatrists I work with said one of the drawbacks he has found ,from a providers perspective, is that some clients are drinking or smoking Marijuana, or even drugs during appointments. As a provider it makes it hard for him to effectively judge a person's state of mind. With in person appointments l, this would not happen

Good Point.

Certainly drinking and smoking pot would make dealing with those people less horrible -except I always thought it better to have all my faculties at the ready when dealing with them. They are wily and untrustworthy. I never dealt personally with psychiatrists. I have dealt with them professionally and smoking pot would have helped there as well.

I have a personal boundary not to drink any alcohol during a session, even though I could easily just put it in a cup or something. Because I feel like it crosses some line (even if I have a drink immediately before or after). I can imagine it would be difficult for a T talking to a client not just suspecting they're impaired, but seeing them use substances right in front of them.

I have attended one appointment with each T after having a drink (I am pretty light weight). With long term T I felt guilty after and told her at the next appointment. She told me to tell her at the beginning of an appointment of I ever did it again. because depending on where I was emotionally we would either cancel thr appointment or discuss what led me to do that.

With current T it helped me to actually talk about things I had been avoiding. I alsotold her at the next appointment and apologized. We dIscussed yhr pros and cons but of course there were a lot more cons. Again she said if I ever did it again to tell her so we could discuss...especially since I drive so far to our appointments