Client Attitudes Towards Telemental Health and What We Can Do to Address Them
Hannah Brockstein, B.S.
Alvord, Baker & Associates, LLC
The COVID-19 global pandemic has increased the need for telemental health services worldwide as offices are closed due to state and local guidelines. Clients are feeling isolated and lonely while quarantined to their homes, they are lacking in social interaction and support, and are feeling anxious about the uncertainties that have come along with a global pandemic. We know based on previous research that telemental health is effective across ages for a variety of disorders including anxiety (Berryhill et al., 2019), depression (Osenbach et al., 2013), PTSD (Frueh et al., 2007), and ADHD (Myers et al., 2015). There has been minimal research conducted on how clients perceive these services. As employees and clinicians of a private psychology practice, we sought a better understanding of the attitudes of clients and potential clients towards telemental health services before and during COVID-19 in order to help clients feel more comfortable with this technology.
We devised a survey asking a variety of questions related to the demographic information of the respondents, their comfort and experience with technology and video conferencing, their experience with mental health services, and their greatest concerns and potential benefits of telemental health services. This survey was then disseminated during the month of June using social media, word of mouth from the clinicians in our practice, listservs, and neighborhood groups. In total, we had 185 survey respondents. Unfortunately, our participants were not very diverse. Due to limitations of COVID-19, the survey could only be distributed through online platforms and word of mouth. Of the 185 participants, 76.2% identified as female, 88.6% were White, 90.8% had a Bachelor’s degree or higher levels or education, and 77.8% live in suburban areas. The average age of participants was 42.6 years ± 15.4. We only collected data from consented adults ages 18 or older.
What did participants say?
What is appealing about telemental health?
The majority of responses focused on the convenience of telemental health including reduced travel, optimal hours, ability to continue therapy when sick or unable to leave home, and the opportunity to continue therapy from a remote location.
What are your biggest concerns about telemental health?
The two most common concerns that participants had were less in person interaction and worries about their ability to build a relationship with their therapist. Some other concerns included worries about their ability to communicate virtually, the confidentiality of virtual platforms, worries about dealing with change and unfamiliar modes of therapy, and feeling socially uncomfortable with virtual communication. Most of our participants were not concerned about access or ability to use the technology needed as the vast majority had some video conferencing experience and were relatively comfortable with using technology. Additionally, our participants were highly educated and reside in suburban areas and as a result have greater access to the technology needed (high speed Internet and computer access). In populations with limited financial resources and/or in rural areas, this could be a concern that needs to be addressed with clients.
How has COVID-19 influenced attitudes towards telemental health?
Would you be interested in therapy via (video) telemental health if you wanted/needed therapy?
Overall, 87.5% of people surveyed were interested. Two-thirds of respondents stated that COVID-19 had made them more open to using telemental health.
Please explain how/why COVID-19 influenced or changed your perspective on the use of (video) telemental health?
The overall themes of these comments show that people have begun to see the place for telemental health and how it can be advantageous to access necessary services. People who were previously reluctant have now tried it themselves and agreed that it is very useful for when they are unable to make their appointment or see their clinician in person. Many who had experienced telemental health in the past noted that they still prefer their in-person sessions to virtual sessions.
It is promising that the conditions of COVID-19 have made clients more open to telemental health services. With increasing willingness to try virtual sessions, we have the ability to reach more individuals, especially in communities that have less access to mental health services. It is also important to understand how important access to and comfort with technology are to the willingness to try telemental health. These factors may be important prerequisites for positive attitudes towards telemental health, so it is important for clinicians to advocate for better access for their clients. We can also take this information about client concerns and work to better address them with our own clients.
With input from licensed clinical psychologists at Alvord, Baker, & Associates, LLC, I have eight tips to share about what we can do to address these concerns with clients.
1. Be careful with your assumptions regarding technology comfort.
It is easy to assume, especially now, that clients are experienced and comfortable using technology. However, there are still many people who are not ready to jump into virtual sessions because they do not feel comfortable with the platforms or devices that they need. Offer to practice with your client. You can walk through the steps together (over the phone or in person after COVID-19) until they feel ready to get online themselves.
2. Make sure you have informed consent for telehealth use.
In our practice, we have a specific telehealth agreement form that states the risks of telemental health as well as outlines an emergency plan if you are disconnected or need immediate care.
3. Have a conversation about how telemental health may or may not be different.
Have an open discussion about doing virtual sessions and what might feel different to your client. You can also discuss what might feel the same in order to ease your client’s transition to a virtual platform.
4. Invite clients to bring up their concerns.
Make sure to allow your client to voice their own concerns about transitioning to telemental health. If you can directly address their worries, it may be easier to gain their willingness to try it.
5. Share some of the benefits.
Speak with your client about some of the positive aspects of telemental health. You can use some of the benefits discussed above or come up with some of your own that you have seen with your own clients. Help them see it in a positive light!
6. Ensure privacy.
It is important to discuss confidentiality with clients as well as the parents of a client if they are a child. For example, our clinicians discussed clients having their session in the car with others present or parents who want to eavesdrop on their child’s session now that it is happening in their home. You can address these concerns before they become an issue.
7. Have a backup plan!
We all know that technology sometimes fails, and have probably experienced our fair share of it during this pandemic. Talk to your client about what you will do if something goes wrong. You can make sure you have a phone number to reach each other at if one of you loses internet service or the platform that you use stops working. Having a plan in advance with a client can help ease worries that clients may have about their virtual sessions and can help you think on the spot when something goes wrong!
8. Spend time on the relationship.
One of the main concerns that many of our survey participants had was building or keeping a relationship with their therapist. If you are working with a child, it may be hard to do this so our clinicians suggested having the child screen, draw on the virtual whiteboard, or show you things in their room that they like. There are many virtual games and activities you can find online, or you can get creative and make them yourself!
Never in history has there been such a great need for telemental health. It is positive that most of our participants were willing to try this format for therapy sessions. We believe with the right precautions and collaboration amongst clinicians, telemental health can be an effective way to deliver therapy services to clients in need.
Berryhill, M.B., Halli-Tierney, A., Culmer, N., Williams, N., Betancourt, A., King, M., & Ruggles, H. (2019). Videoconferncing psychological therapy and anxiety: a systematic review. Family Practice, 36(1), 53-63. https://doi.org/10.1093/fampra/cmy072
Frueh, B.C., Monnier, J., Yim, E., Grabaugh, A.L., Hamner, M.B., & Knapp, R.G. (2007). A randomized trial of telepsychiatry for post-traumatic stress disorder. Journal of Telemedicine and Telecare. 13(3), 142-147. http://dx.doi.org.proxygw.wrlc.org/10.1258/135763307780677604
Myers, K., Vander Stoep, A., Zhou, C., McCarty, C.A., & Katon, W. (2015). Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 54(4), 263-274. http://dx.doi.org.proxygw.wrlc.org/10.1016/j.jaac.2015.01.009
Osenbach, J.E., O’Brien, K.M., Mishkind, M., & Smolenski, D.J. (2013). Synchronous telehealth technologies in psychotherapy for depression: a meta-analysis. Depression and Anxiety, 30(11), 1058-1067. https://doi-org.proxygw.wrlc.org/10.1002/da.22165
About the Author
Hannah is a clinical research coordinator at Alvord, Baker & Associates, LLC, a large group private practice located in Rockville, MD. She graduated from the University of Maryland, College Park in 2019 with a double degree in psychology and family science. Hannah is applying to clinical psychology doctoral programs and is interested in studying the development, implementation, and outcomes of accessible, evidence-based interventions for children and adolescents with ADHD and anxiety disorders.