Back in the 1970s, my father was the Director of Health Education, Research, and Development at the University of Wichita, School of Allied Health. He created a program with his colleagues to provide medical information and articles "over the telephone," a brand new idea at the time! This was in the days not only before cell phones, but before personal computers! The university acquired a phone number any citizen could call, and simply by pressing a number of your choice, it would connect you to recorded information on everything from A to Z. I remember it was the first place I ever learned about a disease called "epilepsy." I listened to almost all of these recordings (many of them in my dad's own voice), precocious child that I was, and who knows if that contributed to my focus on behavioral health today.
Telehealth today, of course, is a way of linking health providers with patients who may not be able to make it to an office. Surgery second opinions from experts in other states, folks who are bed-ridden, people who live in rural areas too far too drive... all of these are amazing uses for telehealth.
Of course, psychotherapists have been asking the question over the last few years: Can you do THERAPY via telehealth?
See, most of us were trained using time-tested skills of therapy that also involve seeing a person's facial expression, body language, demeanor, eye contact. Really good and experienced therapists have a heightened awareness and sensitivity to "non-verbal" cues in therapy when someone is speaking... do these get lost in "telehealth" translation? What about the comfort level of therapy in front of a monitor instead of therapy in a recliner or comforting chair? Does the patient "connect" to a therapist as deeply, if they aren't in person... after all, therapy is nothing if it isn't personal. These and other questions are still being considered.
In my practice, I use telehealth under very specific conditions, because not all of these questions have been answered. Firstly, I meet with clients in person to start... until we have that connection, I don't use telehealth. I have to have a pretty good sense of my client's subtle expressions before I trust this. Second, I use telehealth when sessions are less "didactic" (meaning, free-flowing talk oriented) and more in a skills building use, or when someone just needs a check-in. Third, I only do this with clients who I can see at least on occasion, in person. Telehealth is a great tool for keeping up with clients, but I don't feel it will ever fully replace the benefits of in-person therapy.
Here is an article I have abbreviated published by Reuters today talking about this issue, and specifically a study done by Dr. Leonard Egede, at University of South Carolina. It is great food for thought:
Reference:
Telemedicine can widen access to depression therapy for seniors
REUTERS, July 29, 2015
*Many seniors face obstacles to getting help for depression, including mobility issues and fear of social stigma, researchers say, so telemedicine might expand their access to treatment.
*Depression is a particular problem among veterans, whose risk is two to five times that of the general population, the researchers note. Another barrier for this group is disability, with many veterans home-bound and unable to go to a clinic for care, Egede said.
*Past studies have found telemedicine to be as effective as in-person talk therapy for treating post-traumatic stress disorder, but there has been less research on depression.
*Comparing in -person therapy with telehealth therapy, after four weeks, questionnaires showed that only a small proportion of patients in either group had reduced their symptoms by that much, and only half as many in the telemedicine group (5 percent to 7 percent) as in the in-person therapy group (15 percent). But by the three-month point, 15 percent of telemedicine patients and 19 percent of in-person therapy patients were responding. At the one-year mark, the groups were about even, with 19 percent to 22 percent of the telemedicine patients and 19 percent to 21 percent of in-person patients meeting the treatment-response definition based on the questionnaires.
*The researchers also assessed improvement using a structured clinical interview, in which a clinician determined if the veterans would still be diagnosed with major depressive disorder. 39 percent of telemedicine patients and 46 percent of in-person therapy patients were no longer depressed. The small percentage-point difference between the groups is not statistically significant, meaning it could have been due to chance.
*Dr. Charles Hoge, a psychiatrist and senior scientist at the Walter Reed Army Institute of Research wrote a commentary and noted that in-home therapy raises the question of safety, because there are no professionals present if an emergency arises..., such as if a patient reports intent to commit suicide or homicide,” Hoge said in an email.
The Lancet Psychiatry, online July 16, 2015.
Telehealth today, of course, is a way of linking health providers with patients who may not be able to make it to an office. Surgery second opinions from experts in other states, folks who are bed-ridden, people who live in rural areas too far too drive... all of these are amazing uses for telehealth.
Of course, psychotherapists have been asking the question over the last few years: Can you do THERAPY via telehealth?
See, most of us were trained using time-tested skills of therapy that also involve seeing a person's facial expression, body language, demeanor, eye contact. Really good and experienced therapists have a heightened awareness and sensitivity to "non-verbal" cues in therapy when someone is speaking... do these get lost in "telehealth" translation? What about the comfort level of therapy in front of a monitor instead of therapy in a recliner or comforting chair? Does the patient "connect" to a therapist as deeply, if they aren't in person... after all, therapy is nothing if it isn't personal. These and other questions are still being considered.
In my practice, I use telehealth under very specific conditions, because not all of these questions have been answered. Firstly, I meet with clients in person to start... until we have that connection, I don't use telehealth. I have to have a pretty good sense of my client's subtle expressions before I trust this. Second, I use telehealth when sessions are less "didactic" (meaning, free-flowing talk oriented) and more in a skills building use, or when someone just needs a check-in. Third, I only do this with clients who I can see at least on occasion, in person. Telehealth is a great tool for keeping up with clients, but I don't feel it will ever fully replace the benefits of in-person therapy.
Here is an article I have abbreviated published by Reuters today talking about this issue, and specifically a study done by Dr. Leonard Egede, at University of South Carolina. It is great food for thought:
Reference:
Telemedicine can widen access to depression therapy for seniors
REUTERS, July 29, 2015
*Many seniors face obstacles to getting help for depression, including mobility issues and fear of social stigma, researchers say, so telemedicine might expand their access to treatment.
*Depression is a particular problem among veterans, whose risk is two to five times that of the general population, the researchers note. Another barrier for this group is disability, with many veterans home-bound and unable to go to a clinic for care, Egede said.
*Past studies have found telemedicine to be as effective as in-person talk therapy for treating post-traumatic stress disorder, but there has been less research on depression.
*Comparing in -person therapy with telehealth therapy, after four weeks, questionnaires showed that only a small proportion of patients in either group had reduced their symptoms by that much, and only half as many in the telemedicine group (5 percent to 7 percent) as in the in-person therapy group (15 percent). But by the three-month point, 15 percent of telemedicine patients and 19 percent of in-person therapy patients were responding. At the one-year mark, the groups were about even, with 19 percent to 22 percent of the telemedicine patients and 19 percent to 21 percent of in-person patients meeting the treatment-response definition based on the questionnaires.
*The researchers also assessed improvement using a structured clinical interview, in which a clinician determined if the veterans would still be diagnosed with major depressive disorder. 39 percent of telemedicine patients and 46 percent of in-person therapy patients were no longer depressed. The small percentage-point difference between the groups is not statistically significant, meaning it could have been due to chance.
*Dr. Charles Hoge, a psychiatrist and senior scientist at the Walter Reed Army Institute of Research wrote a commentary and noted that in-home therapy raises the question of safety, because there are no professionals present if an emergency arises..., such as if a patient reports intent to commit suicide or homicide,” Hoge said in an email.
The Lancet Psychiatry, online July 16, 2015.
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