As seen in Authority Magazine
An Interview With Jake Frankel
At each session, a client is asked to confirm their name, date of birth and physical location. This is essential as the client must be physically located in the state where the clinician is licensed. Also, in the event of an emergency, the clinician may need to send emergency to the client’s location.
One of the consequences of the pandemic was the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?
In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Melissa Brinson and Kelly Smith of Open Mind Health.
Melissa Brinson is a Licensed Clinical Mental Health Counselor Supervisor with many years’ experiences treating individuals with various mental health and clinical addiction disorders both remotely and in person. She received her master’s degree in 1996 and has been providing counseling and therapy since that time. Melissa is also a Licensed Clinical Addiction Specialist Supervisor, a Certified Sex Addiction Therapist, and awaiting her EMDR Certificate. She is working towards her PhD in Clinical Sexology at the International Institute of Clinical Sexology.
Kelly Smith is a Licensed Clinical Social Worker who is eligible to practice in four states, NY, CA, WA, and VA. Kelly graduated from Syracuse University in 1996 with a Master’s degree in Social Work. They have over thirty years working in the field in many different capacities including as a psychotherapist, clinical supervisor and clinical program administrator both in a remote and in person capacity. Specialty areas are working with couples, trauma, and the LGBTQIA2+ population.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
Kelly: A college sought me out and discussed social work with me. It felt very familiar, having been the ears and place of comfort for friends and family. I pursued the field and it has definitely been my niche.
Melissa: My father got his PHD in Psychology and has worked in the field for his entire career primarily as the Dean of the Psychology Department at a local University. I always found his work fascinating and enjoyed reviewing his educational videos. There was never a time that I can recall not wanting to enter the same line of work.
Can you share the most interesting story that happened to you since you began your career?
Kelly: When you are in the field for so long you have many interesting stories, too many to identify just one. What I can say is that regardless of how much pain and suffering some of my clients have endured, they showed up for therapy and wanted to find their way through it.
Melissa: I am currently in a program to earn my PhD in Clinical Sexology. Almost everything about the journey is interesting!
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Kelly: “He who hesitates is lost.” I have learned my worth over the years. I cannot get back to the time that I hesitated, but I can move forward and conquer what dreams and goals are in front of me.
Melissa: “Still I Rise” (Maya Angelo) represents resilience and perseverance which is essential for emotional healing.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
Kelly: The loss of a child shifted my life perspective. The presence of my children in day-to-day life is my motivation to keep my vision and focus on goal attainment.
Melissa: Definitely my mother and father. My parents made a ton of sacrifices so that my siblings and I did not have to endure the same hardships that they did. They gave us the support and safety to make mistakes while allowing us to experience the natural consequences of our choices.
Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different to working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?
Teletherapy comes with a plethora of benefits. We have been able to provide care in remote areas where access has historically been limited. Remote teletherapy also allows our clients to experience additional safety and privacy they can’t always experience from office-based care. This is particularly important when it comes to the possibility of running into your neighbor while in a mental health clinic or private practice waiting room. Often times clinics and private practice situations can offer confidentiality but not anonymity. Teletherapy can offer both. Teletherapy is also time saving. Clients don’t have to leave work and/ or drive to their appointments, fight traffic or inclement weather.
On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?
Connectivity and privacy issues present a challenge when a client is not physically present. Technology can be unpredictable and challenging to use for some clients that do not live in areas where adequate Internet speed is consistent. We cannot always ensure privacy when we are not in the same room as our clients. There is the possibility that a client, such as those in domestic violent situations, victims of child or elder abuse cases where the perpetrator may attempt to force the clients to allow them to listen in on sessions. Also, we can often assess how well some clients are doing based on hygiene beyond physical appearance and grooming. The smell of alcohol, mind altering substances, or just presenting malodorous in general, may indicate a client who is decompensating or increase in mental health symptoms. In addition, there are some interventions such as biofeedback, that are not yet possible to be performed remotely. Teletherapy is often confused with anywhere therapy. The client must be located in the same state the clinician is licensed as each state has its own duty to warn statutes as well as other reporting protocols regarding elders and children. Clients can become quite disappointed when they learn they cannot meet with their current provider if they move out of the state where their clinician is licensed. Finally, during sessions, we often use workbooks and other visual aids which are not as conveniently accessed when working remotely.
Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ?
Plan for connectivity problems. Inform clients of alternative means of contact should they have problems with unstable Internet. That plan may include using phone data or a phone session if the individual is appropriate. The plan is to be available in writing discussed in the initial session. The clinician should take the initiative to call the client should there be a internet connectivity issue. There are secure calling platforms for this to occur.
Clinicians are also responsible for ensuring clients’ privacy. Both the client and clinician should be in a private quiet location conducive for a therapeutic environment. This includes being free from interruptions and distractions. In the event there is a distraction or if we suspect that a client is not alone, we will ask specifically if they are alone in a private room and request that they let us know if someone enters a room. We also encourage that the client’s camera remains on and the room they are in is well lit. However, we recognize that sometimes the client could encounter video issues in which case we would proceed with audio only.
Clients also must be able to provide consent. To do so, they must be legal adults free from guardianship. They also must be sober. An individual under the influence cannot technically provide consent. If it is suspected that an individual is under the influence, the session is concluded, and the client is asked to refrain from the use of alcohol or other mind-altering substances prior to their follow up session. We, like most agencies, have policies and procedures that guide these practices of providers. If the issue continues, the client would be referred to in person treatment or assessed for a higher level of care.
At each session, a client is asked to confirm their name, date of birth and physical location. This is essential as the client must be physically located in the state where the clinician is licensed. Also, in the event of an emergency, the clinician may need to send emergency to the client’s location.
If a client is recommended to receive an intervention or interventions that are not possible in a remote setting, they are referred to an in-person provider that can execute the intervention. Fortunately advances in technology and improved software have made remote client engagement available. A great example is EMDR where bilateral stimulation techniques can be administered using new devices and interactive software.
Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?
There is more accessibility for individuals with disabilities. Also, teletherapy creates opportunities for individuals that have limited access to transportation and childcare. For individuals caring for elderly parents, teletherapy would allow them to attend sessions and be in proximity to their loved ones. Teletherapy offers both anonymity and confidentiality whereby their in-person counterparts can offer confidentiality only. Many clients follow through with their teletherapy appointments if mildly ill when otherwise they may cancel if they must attend an in-person session.
Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?
NeuroFlow is wonderful and our agency loves it. NeuroFlow is an interactive, measurement based mental health platform that helps individuals build skills towards leading a happier and healthier life. Through the platform, individuals are provided with a fun, personalized, and interactive way to learn new skills and take better care of their mental health. NeuroFlow allows clients to complete mindfulness, relaxation and self-care activities on their own time, track their mood, sleep, steps and pain. Additionally, clients can utilize a journaling component which has helped many of our clients with trauma to open up to their providers through their writings.
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