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The empty waiting room of Western’s Counseling Training Clinic. // Courtesy of David Sattler

By Benjamin Leung

Counselors and therapists have moved their practices online and over-the-phone during the “Stay Home, Stay Healthy” order to continue treating and counseling patients while social distancing.

The Health Resources Services Administration website defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”

Practitioners talk to patients over the phone or through videoconferencing services such as Zoom according to the HRSA.

Mary McIntosh was seeing her therapist on a weekly basis in-person when Gov. Inslee issued the “Stay Home, Stay Healthy” order. McIntosh’s therapist called her, asking whether McIntosh would like to continue therapy over the phone and McIntosh agreed.

“I’ve been meeting with her over the phone. It’s good,” McIntosh said. “I do tend to find it’s not as intimate, and I don’t feel that I’m getting the work done that I do when we’re meeting face to face.”

McIntosh said she found herself sharing less over the phone in comparison to in-person.

“We always have these things to discuss that we don’t have time to get to, but when we’re on the phone, like last week I actually got off the phone with her 10 minutes early,” McIntosh said. “And that is just crazy.”

McIntosh said therapy over the phone was still worth doing and better than no therapy.

“On a scale from one to 10, I’d say the in-person counseling is a 10 and the over-the-phone counseling is a seven at most. Not as effective,” McIntosh said.

According to Graham Murtaugh, a therapist at Sea Mar Tacoma Behavioral Health, reception to the telehealth switch has been mixed.

“Most everyone I still see is grateful that we’re offering services,” Murtaguh said. “There have been some folks who have chosen not to continue, who find it disruptive, impersonal and most people want to be back in-person. I haven’t talked to anyone who hopes that this continues.”

Murtaugh said conducting therapy through telehealth has been a challenge, but he’s grateful to still be able to see his clients and check in on their well-being.

“Technical difficulties can get in the way, people’s attention is often diverted if they’re at home, if they’re working, many people are caring for children,” Murtaugh said. “They just don’t have privacy so that makes it really difficult.”

According to Murtatugh, patients with disorders and diagnosis involving psychosis, where it’s difficult to manage reality, may have more difficulty navigating the technological barriers telehealth presents.

Murtaugh said telehealth feels necessary, as it enables Murtaugh to continue working and maintain a sense of stability and routine as he provides care, but he misses the face-to-face interaction.

“Nobody gets into this line of work to sit in front of a screen or phone all day,” Murtaugh said. “The hope is to be with flesh and blood people.”

Brent Mallinckrodt, a professor in the Department of Psychology at Western, supervises Western’s Counseling Training Clinic. The clinic made the switch from in-person services to over-the-phone and Zoom sessions at the start of April, its 12 graduate students serving clients through telehealth.

“I think we are doing remarkably well,” Mallinckrodt said. “I had my concerns when we first made the switch, but I think just judging on how the clients are responding to the counseling they are receiving, I think it's remarkably effective, beyond what I had anticipated.”

Mallinckrodt said patients’ comfort with technology affected their experiences and reception to the switch to telehealth. The clients at the Counseling Training Clinic range from 10 years old to 75 years old, according to Mallinckrodt.

“Kids who are used to Facetime and talking with their grandparents on Facetime, they didn’t have much difficulty,” Mallinckrodt said. “Some of our folks, they don’t have a lot of money, they don’t have a lot of access to technology, they don’t have a lot of computers in their home, so switching over to Zoom or telephone was much more difficult for them.”

Mallinckrodt said some older and elderly clients, though not always, weren’t as comfortable with the technology of telecounseling.

When considering the effectiveness of telecounseling, Mallinckrodt said it was important to note that all of the patients being seen at the moment had switched over to telecounseling from in-person services.

“There are many studies that have been done about the effectiveness of telecounseling,” Mallinckrodt said. “Here’s the issue, most of those studies have been done with people who received telecounseling right from the beginning. In other words, they didn’t have a switch from in-person to telecounseling with the same counselor.”

According to Mallinckrodt, a team of students in the clinic are planning to conduct research on the experience of transitioning from in-person to telehealth counseling.

Mallinckrodt said the biggest issue of telecounseling was one of privacy. In person, clients would come to a private clinic space on the fourth floor of the Academic Instructional Center, Mallinckrodt said. Clients receiving telecounseling from home may be in spaces where they can be overheard or the session isn’t private, Mallinckrodt said.

On the Counseling Training Clinic’s end of communication, Mallinckrodt said time was taken to ensure all telehealth procedures were HIPAA compliant, including encrypting all Zoom and telephone calls.

Mallinckrodt said a disadvantage of telehealth was the loss of body language.

“I think Zoom is much better than telephone counseling where you can’t see the person at all, but in person you have the three-dimensional, full-body view of somebody, so when they learn forward to express concern, when they have hand-gestures, there’s just so much communication that happens through body language that isn’t fully available in Zoom,” Mallinckrodt said.

Mallinckrodt said that an advantage of telehealth was that clients could show counselors personal belongings.

“It’s been surprisingly beneficial for clients to be able to show us something over Zoom from their home and to be proud of the artwork that they’re producing or to show us their favorite toys,” Mallinckrodt said.

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