Some therapists say virtual visits should last beyond the pandemic

Sheldon Krause
Capitol News Service

Lansing — As countless Americans face pandemic-related mental health struggles, many Michigan therapists and psychologists say the practice of “teletherapy,” or virtual counseling, is  an adequate substitute that greatly expands accessibility.

Some experts also say that while many people may experience no lasting negative mental health effects once the pandemic is over, insurance companies may not continue to support the expansion of teletherapy.

Dr. Umar Latif of the Dallas VA Medical Center, which has been offering psychiatric sessions over video for more than a year, talks with patient Anthony Presciano via teleconference from Denton, Texas, Thursday, Aug. 3, 2006.

Teletherapy as a practice is just what it sounds like — therapy conducted virtually, often over the phone, FaceTime or Zoom. 

As with many traditional activities, COVID-19 made most in-person counseling either unsafe or legally restricted.

Michelle Byrd, a psychology professor at Eastern Michigan University, works in private practice for McCaskill Family Services in Plymouth and Brighton.

“I had never done a telehealth visit prior to the pandemic, and then my practice switched to 95% telehealth,” she said.

The results were unexpected, Byrd said. 

“My experience has been surprisingly good. I can’t compare it because I have new clients I’ve seen through telehealth who I didn’t previously treat in-person, but I’ve been kind of astonished by how authentic the interactions feel and how successful the interventions seem,” she said.

Professor Mary Bower Russa of Grand Valley State University discussed a project one of her former students had conducted examining the effectiveness of teletherapy.

Bower Russa talked about the “therapeutic relationship,” the relationship between patients and their counselors. Part of what makes mental health treatment effective is the quality of this relationship. 

Bower Russa described a pre-pandemic study where patients were assigned randomly to in-person or virtual therapy. 

“The treatment outcomes were comparable,” she said. “They were able to form a relationship in telehealth.”

The American Psychological Association also found in pre-pandemic studies that teletherapy seems to serve as an equivalent alternative to in-person counseling.

Bower Russa discussed a possible caveat of teletherapy, affecting both patients and counselors.

“The major thing that I have seen and heard is that people don’t like it as much,” she said. 

“I think that the patient doesn’t like it as much, they don’t feel as connected even if they’re able to still get good outcomes from it, and I know the therapists I’ve talked to have told me they don’t like it as much,” she said.

Experts also noted the increased need for mental health assistance as a result of the pandemic. 

Katie Holden, a clinical therapist with the Well Counseling in Milford, said that the pandemic has both brought out new mental health problems and exacerbated previously existing conditions.

“Some people who maybe were managing either anxiety or depression, or had other support (systems in place) — it feels like that kind of was stripped away,” she said. “Relationship issues then began to increase, or other mental health issues needed to be addressed because you just didn’t have the same kind of support you had before.”

Byrd agreed.

“One hundred percent, absolutely. Across the board, from children all the way to elder adults, there has been a tremendous amount of stress on people all over the world,” she said.

Jessica Harrell, a licensed clinical psychologist who runs a private practice in Farmington Hills, noted the increased demand for her services since the pandemic began.

“It is very difficult to keep up with the demand. In fact, many of us have either absurdly long waiting lists, or we have closed out waiting lists because we’re not able to accommodate people in any kind of reasonable amount of time,” she said.

Harrell added, “We’re sort of running out of people to send others to, and it’s been difficult and heartbreaking to not be able to help everybody that needs it.”

The data support these assertions. 

A study from the Kaiser Family Foundation published in February found that about four out of 10 U.S. adults reported symptoms of anxiety or depression during the pandemic. That’s up from one out of 10 in mid-2019. 

A survey by the Healthy Minds Network and the American College Health Association found that a similar number of students, 41%, reported seeking mental health assistance during the pandemic.

These numbers are particularly worrying, as many experts agree that long-term exposure to stressful situations, such as the pandemic and subsequent crises, can complicate the mental healing process. 

Harrell said, “That anxiety tends to persist and might have become just habitual enough for a lot of us that we’re going to have to gradually expose ourselves to things that came very naturally before the pandemic.”

Byrd added that teletherapy increases access to mental health professionals for clients who might be unable to receive adequate care under normal circumstances:

“For a lot of people, the pandemic has had some small silver linings, and I feel like for people for whom otherwise therapy was too inconvenient, or if there were logistic difficulties to engaging in therapy – things like getting a ride, or making time within your day, finding parking — all of those things are costly in terms of time and money, and so for some people this has really allowed them to engage effectively in their health care.”

Byrd  also said eletherapy has helped individuals in rural communities overcome geographic barriers.

“The other great hidden benefit of that is that when people live in rural areas where there isn’t a lot of professional mental health care available, this has been a tremendous resource,” she said. “Even though I’m here in southeastern Michigan, I have clients that I’m treating in the UP.”

Byrd added that she sees this change as a “social justice component,” allowing counselors to “provide more equitable services to people who otherwise wouldn’t be able to access care.”

Discussing the future of therapy and telehealth, experts were split.

Harrell, who works with many patients dealing with obsessive compulsive disorder, a practice which is often best conducted in-person, said she doesn’t believe teletherapy will completely overtake in-person counseling after the pandemic.

“I believe there are certain aspects of in-person contact that just can’t be replicated through screens, and while it is a wonderful alternative and certainly something we are grateful for during this time when we’re so limited, I do not believe it will be a total replacement,” she said.

Holden said she is optimistic about the future of teletherapy.

From their Hilliard living room, Jennifer Kirkland and her Cavalier King Charles Spaniel Peachez take their turn on a Zoom animal therapy session with memory care patients in Arizona.

“I think it’s going to become the new wave,” she said. “There’s definitely those who do not want that, but I think there’s a lot of convenience to it for people, and the ability to actually transition in life and keep the same therapist, like move some place, I think is pretty helpful.”

While she said she is hopeful overall about the increased accessibility of teletherapy, Bower Russa said health insurance companies will largely determine the return to in-person counseling.

“When they go back to providing live sessions will probably be significantly influenced by the insurance companies’ decisions about how long they’re going to pay for them,” she said.

During the pandemic, virtually all insurance plans that previously covered in-person therapy have covered telehealth equivalently, including Medicare and Medicaid.