A Psychologist's Guide to Video and Text Therapy
A Psychologist's Guide to Video and Text Therapy
February 8, 2021 by eMedEvents

Through numerous studies, most researchers genuinely agree that mental healthcare is well-suited for telehealth. Unfortunately, until the COVID-19 pandemic spread across the world, most licensed clinical psychologists have only been educated and trained in traditional in-person therapy.

Are there limits to therapy over video and text messaging, and how is it different from in-person therapy? How can you and your fellow psychologists adapt to the different circumstances? Below are the results of multiple studies, and solutions to what your options are and what might work best for your particular situation/clients.

Therapy over video has become normalized: Overall telehealth was not widely practiced before the pandemic. Insurance companies did not cover telehealth visits, so medical providers could not bill for it. Early in the pandemic, the government loosened numerous medical regulations in an attempt to minimize in-person contact and the spread of the coronavirus. “The preference is to do as close to in-person as we can,” said Dr. Curley Bonds, the chief medical officer of the L.A. County Department of Mental Health. Bonds and many therapists still prefer being in a room with someone, having the connection and intimacy of sitting face-to-face and looking at another person1.

However, most clients and psychologists report that mental healthcare through digital and virtual mediums has been just as effective as in-person care, according to a study published by the Harvard Business Review. Many psychologist credit telehealth as the reason they were able to keep their patients stable through a very difficult year1.

Who might benefit from video therapy: As a psychologist practicing tele-therapy it’s important to understand which of your clients would benefit the most from this form of practice. Below we give two examples of patients where tele-health may be the most suitable:
Patients who cannot travelNot all of your clients have a reliable means to travel, and no one should be denied the privilege of seeking mental health, simply because they can not physically make the appointment.

Patients with social anxietyFor particular psychological struggles, video sessions can be better for severe anxiety that can make in-person sessions overwhelming. Your goal should be to over time have your particular client suffering from severe mental capacity, eventually build tolerance and skills to attend in-person sessions.

In person care to video, how you adapt: Many critics of telehealth claim that there’s a lot of nonverbal communication and body language that is lost over video therapy, also it limits many other important reactions you’ll need to examine from your clients, for example an individual’s leg fidgeting during stressful situations. Psychologists are credited with gathering facts and solving problems clients may not even know they have2.

However, telehealth does provide you with one important advantage over in-person visits, they allow you to evaluate your patient in their natural habitat. You are able to now see what their psychological stressors are, and what their social determinants of health are.

Text therapy: Crisis hotlines are beginning to implement texting options, for those who may not otherwise be able to talk freely. Carly Schwartzman, a doctoral student in clinical psychology at the University of Albany, SUNY, cowrote a 2020 study on the topic of the important factors of text therapy. In conclusion she wrote that text therapy, may not help those with severe psychological problems, but that “it’s human nature to connect, no matter what medium you’re communicating on”, and that any form of support can be beneficial to said individual.

Adapting to message-based care: At first you may struggle with communicating with your patient, mostly via texting. “Online language channels carry fewer messages per instant than face-to face ones, where you can see hand movements and facial expressions,” said Schwartzman. “It takes more exchanges back and forth to get to the same relational understanding.”

However, you will also see there are many potential benefits for evaluating your client through text therapy.“The clinician can get a better feel for a person’s ups and downs,” says Schwartzman “When you hear from them every day, you get more insight to the trajectory they go through during the week.”

You will also have more time to process and react with text therapy. “If a patient shares something with me in the moment, I only have a couple of seconds to respond, But over messaging, you have a chance to sit with it more. It gives you more time to think about how to approach it, put together a more considered treatment plan. And there’s a record of the therapy to review and observe progress”, Schwartzman points out1.

Examples of clients who would benefit from text therapy: Clients with chaotic schedulesWith so many people having chaotic schedules, it’s only natural for people to gravitate toward the most convenient form of communication, texting. Your clients who have travel for work, are working parents or caregivers — people with life situations that make it hard to commit to a regular hourlong session, are the ideal patients you should consider converting to text therapy.

Clients who feel they may be judged for seeking therapyMany people feel ashamed of their mental health problems. Your clients may find it hard to open up about their struggles with their family members and friends, and in some cases try to hide it entirely. Text therapy can be a way to build your client’s comfort, while keeping their privacy as a focal point.

Clients who need therapy quicklyNot only may your client’s schedule be busy, but yours may be as well. There may be times where you go weeks and months without session openings. Text therapy allows you to communicate with your clients every day without interrupting your current work.

Those who can’t afford traditional in-person therapySome of your clients may have have insurance that will cover their therapy, but most will find that their insurance only covers a small portion of their bills or doesn’t cover their therapy all together. Text therapy is generally much cheaper, and provides more flexible payment options.


Works Cited

  1. Ada Tseng; “Tech is making mental healthcare more accessible. What you need to know about video and text therapy” January 29, 2021, Los Angeles Times
  2. Kristi R. Garabrandt; “Pandemic causing changes in mental health care service”, January 19, 2021; The Daily Jeffersonian




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