On March 20, 2020, Ray had an opportunity to catch up with Suzanne Gavin, a Licensed Clinical Social Worker, a Nationally Certified Custody Evaluator, and a Nationally Certified Parenting Coordinator.
What caught Ray’s attention, and the attention of other clinicians is her honest breakdown of her transition (and the related anxieties) to what she referred to as a mandated telemental health practice.
COVID-19 has forced many clinicians into a telemental health practice; this pandemic is not just disruptive to our clients, it is to us as well. Suzanne admits the telehealth changes due to COVID-19 were initially anxiety-provoking to her. She openly shared her concerns with Ray: would telemental health affect her presence and connection with her clients, her effectiveness as a behavioral health provider, or the stability of the therapeutic alliance? Could she be her authentic self over video?
After careful research and attending Telehealth Certification Institute’s training, Suzanne has successfully adjusted and engaged in this “mandated” journey. She found that the research on telepsychotherapy and its advantages are consistent. Suzanne also found she does experience intimacy and connection with her clients, just as she did in person. Clients have never seen the inside of her home and she has never seen the inside of theirs. Sharing this space over video provides an intimacy that can not be done in a traditional office setting, and to Suzanne’s relief, the therapeutic alliance was not disrupted. Just the interaction between Ray and Suzanne in this interview demonstrates this benefit, as they both shared details of the interesting objects in their respective spaces.
Suzanne explains how she discussed the transition to her clients, being open by disclosing that they were “thrown in this together”. This eased the transition for Suzanne and her clients because their expectations were similar - they were learning how to do this together. Suzanne compared this transition to exposure therapy, which focuses on facing fear instead of procrastinating. She admitted that being thrown into the situation actually gave her no opportunity to sit in worry and the what if’s, because the present required her to learn to better serve her clients.
The screen is - as Suzanne puts it - “unflinching”; she is now more present with her clients because of the direct face to face contact teleconferencing provides. In her article The benefits of a Coronavirus-mandated telemental health practice, Suzanne shares tips to help other clinicians find their comfort spot with telemental health. In an easy to follow format, Suzanne walks through the necessities for transition such as screen size, recommended HIPAA compliant video platforms, and of course reminding providers to pay attention to payment methods, as all apps are not HIPAA compliant.
Suzanne also shares how instrumental the Telehealth Certification Institute’s training was for her transition. Telehealth laws are ever-changing, and TCI’s coursework covers legal and ethical considerations specific to telemental health. Suzanne also points out and normalizes the “stage fright” associated with doing video conferencing for the first time, citing some clients have requested audio over video for therapy. She and Ray discuss how normalizing this fear is part of the therapeutic process because it shows clients that providers are human too.
Further, Suzanne invites behavioral health providers to reflect on how they do therapy. If being present and authentic is important to the provider, then a visual component is required. Telemental health may also assist clients struggling with adjusting to remote/telework. Many clients may be trying to balance working from home with being parents, on top of being a spouse or partner. Ray and Suzanne discuss how this is a great opportunity for behavioral health providers to help clients with boundaries, at home and at work. Suzanne also reminds us of confidentiality. Due to her population, many clients used her traditional office as a safe place to work through divorce or separation, as well as forensic and visitation related issues.
Ray recommends sending clients instructions on how to create a private space ahead of time. To identify if the client does have privacy prior to the session, Ray recommends a site audit, where the client shows the behavioral health provider their environment and technology. Encourage clients to download a sound machine app or a white noise app to help blend external sounds in their home into background noise. There are many apps for IOS and Android for download.