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Counselors and Clients Adjust as Therapy Moves Online

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DREAMSTIME.COM | VLADIMIR KONONOK
  • Dreamstime.com | Vladimir Kononok

My latest quarantine routine is a FaceTime with my therapist every other week. I sit on my bed or couch with my phone propped on my knees, and she sits in her house wearing earbuds. We talk about how I'm going to get through this pandemic without losing my mind.

I describe the maddening nature of spending 24-7 with my partner in a one-bedroom apartment; she tells me to set aside quality time to spend together, as well as designated time apart. I tell her how I'm compulsively scrolling Twitter; she advises me to take more walks or try some gentle yoga. I tell her how recently I got so stir-crazy that I spent an evening looking at Zillow properties in Arkansas. She says it's normal that I'm using this time of uncertainty to contemplate future plans.

I'm used to meeting her in a downtown office in Burlington. I've memorized the art on her walls. There's a certain rhythm to those appointments, when I walk from work and spend a few minutes sitting quietly in the waiting room. Meeting virtually is a completely different experience. For one thing, I'm often in sweatpants. The encounter feels much more casual, and I answer the call with "What's up?" It feels like catching up with a friend, albeit one with unusually good advice whom I pay to listen to me.

"There's certainly a formality about the office," said counselor Mark Nash, who lives in Charlotte and has an office in Burlington. With virtual sessions, he said, "We are visiting with each other in each other's homes, essentially. And it's also the case that we're both going through the same thing. We are both being affected by the pandemic."

Nash said he always tries to appear on the same power level as his clients, but the pandemic has also spurred a new level of camaraderie.

"Sometimes a client will ask me, 'How are you?' at the beginning of a session. It's common practice for a therapist to say something relatively innocuous and brief," Nash said. "But under these circumstances, if they ask, I'm going to give them a little more ... just to let them know that I am managing this challenging situation just as they are."

Therapy is built on ritual. It takes time to build a rapport with a therapist and get comfortable in a new setting. Equally important is the time between appointments in which you can reflect and, ideally, make progress toward better habits and ways of thinking.

Therapy is just one of many aspects of life that's been forced to adapt to a virtual setting. For those of us fortunate enough to be social distancing, our computers and phones are lifelines not only to schools, jobs and friends but to health services.

Teletherapy, like other telehealth services, isn't new. The American Psychological Association offers guidelines for it, including practical and ethical considerations. Some therapists had established it as an option for their clients well before the pandemic arrived. Online services such as Talkspace and BetterHelp were created to connect people to licensed therapists via video and even text messaging.

For some people, telehealth was a part of their routine before social distancing became a necessity. Keilani Lime of South Burlington has a health issue that kept her from regularly attending appointments outside of the house.

"It's kind of been this weird 'welcome to my world' situation," Lime said of the collective move to virtual interactions. Being stuck at home with no choice can be stressful, she said, even for people who've experienced it before.

"You can feel boxed in," Lime said. "Being able to talk to a therapist who is frequently reminding me to make contact with the outside world via Zoom right now is helpful."

In fact, Lime wonders whether computer-based options might make it easier for people who've never been to therapy to try it out.

"Talking to a stranger about your feelings is not an easy thing to do. With the virtual world that we're in right now, that kind of barrier is helpful," she said. "You can just close your computer if you're feeling awkward."

For Burlington's Sarah Quintal, video-chatting with her therapist took some getting used to. And it wasn't easy to find space in her house to talk openly so that her roommate couldn't hear her. "It was definitely a lot of low, hushed words and whispering at first," she said. But after three sessions, Quintal adjusted to the new platform.

"I think it's a really positive appointment to have. It's definitely helped me with my routine a little bit," Quintal observed. "If anything, it's nice to see a familiar face that I've connected with for a while."

Of course, not all therapy is just talk, and not all types translate easily to a screen. Social worker Tanya Vyhovsky works with children and teens in Charlotte and Essex. With kids, therapy often looks a lot like play — and that's hard to replicate virtually. But Vyhovsky has found websites that allow her to play board games online with clients. Sometimes she'll do a scavenger hunt, asking a child to find items at home with prompts such as, "Can you find me something in your house that makes you feel really safe?"

"In that sense, we're digging into a deeper place. I get to meet cats and siblings," Vyhovsky said. "In that home space, kids can actually translate out the stuff that we're doing in my office."

The coronavirus pandemic has reduced some of the normal legal hurdles for telehealth. The U.S. Office for Civil Rights, which enforces the Health Insurance Portability and Accountability Act, has said it won't penalize health care providers for using non-HIPAA-compliant technologies, including the standard version of Zoom and Apple's FaceTime. (My therapist has a HIPAA-compliant platform, but it's glitchy, so we've resorted to FaceTime.)

Most insurers, including Blue Cross Blue Shield and Medicaid, have been billing telehealth appointments like standard in-person appointments, according to Nash.

Lisa Carton, a Bennington-based social worker and therapist, said she'd been thinking about moving her practice entirely online for a while, and the pandemic has forced a trial by fire. But she said clients have been contacting her far less often since the pandemic hit. She thinks that when people are facing immediate stressors, they don't feel like they have the energy to work though their feelings in therapy.

"They get overwhelmed," Carton said, "and they think about going [to therapy], and sometimes they think that they should. But that shame doesn't help."

Carton believes undergoing a difficult time actually presents a good opportunity to delve into one's emotional reactions to struggle. Her clients, she said, "are feeling traumatized. So then we have the opportunity to look at what that actually means."

I can understand the impulse to think a pandemic is not the time to dive into the psyche. When has someone treading water ever thought that was a perfect time to examine their fear of drowning? For me right now, it's just nice to have someone to talk to — someone whose job is never to get bored of my fretting.

My therapist holds me accountable for taking better care of myself, in big ways and small. During times of uncertainty, that's something I think we can all use. Some days, I go for a walk so I can tell my therapist I took a walk. And then I've gone for a walk, which does make me feel better. Sometimes it's that simple.

Correction, April 29, 2020: A previous version of this story misstated where Tanya Vyhovsky is based. She works in Charlotte and Essex.

The original print version of this article was headlined "Staying Connected | As therapy moves online, counselors and clients adjust"