What is COVID-19 to you? Cumbersome, uncomfortable, lonely, painful or more? To many of your patients, chronic or acute, the general sense of ‘unpleasantness’ can be magnified to debilitating proportions. It takes a lot out of your patients to even do menial tasks; getting out of bed, brush their teeth, taking a shower, putting on clothes, stepping out of the house or doing their job. Throw in media manifested fear of COVID-19 and fear of losing loved ones and you’ve got the recipe of how to induce psychosis. Fortunately, there is a silver lining; Tele-Medicine, or Tele-Psychiatry.
The notion that patients find it awkward or are reluctant to talk to a person on screen is no longer valid. People are more relaxed, willing to open up and try new ideas or coping mechanisms from their own homes’ comfort. They are also more open to new ideas and techniques to alleviate their symptoms. Telepsychiatry helps you assess and understand your patients in an in-vivo setting. In a typical session, you only get one side of the story, your patients, but you get an insightful window into a person’s mental state in a virtual consult.
“I get to meet their pets, their careers, the spouses; I get to see their garden. I get to see what their interests are from looking at the paintings on their walls. I learn more about my patients that way. If you use video to purely see people from the neck up, then that’s fine, but I think you can also use it to your advantage, seeing people at home,” said Dr. Peter Yellowlees, The Chief Wellness Officer at UC Davis Health.1
Integrating in-vivo observations and first-person accounts from patients can help you create a hybrid treatment plan, tailor-made for each patient. While drawing from personal and professional experience is always an excellent way to provide for your patient, virtual sessions may require you to learn new skills or tweak existing ones. Insight of this, we have compiled a set of tips to help you get started.
BEFORE THE SESSION:
- Record yourself doing a session and review it, keeping in mind the local and state laws regarding the taping of tele-mental health sessions. Every session is live, and you won’t get a do-over. Understanding how your patient virtually views you could determine the outcome of a session.
- Dress appropriately. Don’t wear stripes or prints that cause dizziness, avoid bright colors that could be distracting, unless dealing with a child, steer-clear of black as it is associated with funerals, and don’t put on a white coat as it makes it harder for patients to relate to you on a personal level.2
- Screen and group members to foster positive group dynamics. Structure groups around specific issues like depression, borderline personality, life experiences, etc. A virtual environment, where interaction between group members benefit from each other is difficult to build, but not impossible.
- Provide a session ‘syllabus’. Send a pamphlet detailing what the session will entail before the session date, or mention it at the beginning of each session. These ground rules will help you establish structure.
- Use public speaking techniques. What message do you want to get across, how do you want to present it, and what methods are you going to use to engage small and large audiences? Answering these questions and planning your sessions accordingly will ensure a successful session.
- Organize pre-visit events, if possible. Asking children to bring their favorite toys to a session, accommodating for hearing limitations or asking a support person for older clients can improve the level of interaction attained in each session.
- Encourage family members to attend sessions, especially when the patient suffers from significant cognitive impairment. This extra step enhances patient acceptance and provides information that you could not glean from your patient alone. Additionally, families are grateful for the extra time and effort they can offer.
- Ensure emergency protocol at the client location before starting any clinical examination. Some patients may require a more restrictive level of care, so having a back-up plan is always recommended.
- Prepare yourself. Get well acquainted with the session’s main goals, pre-reading chart (if available), knowledge summaries, etc. and set-up your therapy space to feel organized and reduce any stress you might feel.
DURING THE SESSION:
- Amplify voice and other gestures by about 15%. However promising the software you use is, digital changes will affect your voice and gestures will not be as easy to view as in-person.
- Adopt a patient-centric approach. Be respectful, listen actively, express empathy, be culturally sensitive, use non-verbal behavior (like comfortable eye contact and open body position) and replace gestures like handshakes, with a friendly wave or chit-chat.
- Establish your role; consultant versus direct care. Evaluating your scope in the matter will help you identify strategies for dealing with each case.
- Minimize interruptions and reduce the amount of information dispensed just as you would do in-person.
- Don’t rely on informed consent documentation alone. Get informed consent, a green light from your patient on engaging, in general. Chit-chat helps in these situations.
- Add 5 extra minutes to the end of each session. Virtual interviewing takes longer than face-to-face ones and requires more concentration from your end. If the allotted time is not enough, consider subtracting any minor parts.
- Make sure both ends are private and secure during the session. Check lighting and equipment and inform your patient of anyone within the space if they are not already visible.
- Remember to check-in with your client at the end of a session. They might have a problem with the format you’re using or missed something they wanted highlighted.
The transition to virtual doesn’t need to be daunting. Taking these measures and preparation tricks mentioned above will not only help your patients but you as well. Thank you for reading and as always
STAY INFORMED! STAY SAFE!
1Lubell, Jennifer. “Telepsychiatry Poised to Thrive After the Pandemic.” MDedge, Clinical Psychiatry News, 24 Nov. 2020, www.mdedge.com/psychiatry/article/232426/coronavirus-updates/telepsychiatry-poised-thrive-after-pandemic/page/0/1?sso=true.
2Bentley, George. “What Should a Therapist Wear?” Higher Logic, LLC, American Psychological Association, 13 Feb. 2019, community.apa.org/blogs/bentley-george-phd/2019/02/13/what-should-a-therapist-wear.
GoodTherapy Editor Team. “Online Group Therapy: Tips for Therapists.” GoodTherapy, 1 Aug. 2020, www.goodtherapy.org/for-professionals/software-technology/telehealth/article/online-group-therapy-tips-for-therapists.
Yellowlees PM, Shore JH, Roberts L, et al. Practice Guidelines for Videoconferencing-Based Telemental Health. Tel e-Health 2010;16(10):1074-89.
Wootton R, Yellowlees PM: Telepsychiatry and E-Mental Health. United Kingdom, Taylor & Francis Group, 2003.