Interview with an Expert

Amid the current COVID-19 pandemic and related social distancing mandates, ELF magazine spoke with Kate Greenen – she is a local mental health professional who offers individual and couples counseling as well as training and consulting – about telehealth appointments during what has been a difficult time for many in the region. Currently she is offering her services online from Brattleboro but also covers other areas of southern Vermont as well as bordering towns in New Hampshire and Massachusetts.

How have your services changed over the past several months?

Greenen: All of the mental health professionals who have the capability of being online right now are online, almost exclusively. Luckily, video sessions are available and easy to set up, and most clients need no extra software or equipment. I use a service called doxy.me that is HIPAA compliant and secure, and all my clients have to do is click on a link I send them. They are then in my “virtual waiting room” and I join them at our session time.

Has online therapy been difficult?

Greenen: There are pros and cons to online therapy. I’ve used it before the social isolation guidelines as a way to provide services to those with transportation or mobility issues, those with chronic illnesses that find coming into the office to be a barrier to care, and others who need therapy but cannot come in for whatever reason.

Luckily, when the social isolation protocols went into place, most insurance companies waived many of the restrictions based on telehealth to make sure it was covered like an office visit. This has helped many people not have interruptions in their therapy at this critical time for mental health. We have HIPAA-compliant software to use to protect patient privacy.

However, there are some real cons to online therapy. Technical difficulties, poor internet speed, and the lack of in-person connection has been difficult for providers and patients. As a therapist, I feel I miss a lot of the body language and fine facial cues, and there’s nothing more frustrating than having a time delay or a mismatch in a highly emotional or volatile moment. For me, nothing can match the amount of connection and information I get through in-person sessions.

Plus, especially for my parents or those in tight quarters with others, it’s been difficult for the patients to be able to secure their privacy. I’ve had clients sit in their bathtubs and call me, because the bathroom was the only place to assure privacy. Couples have sat in their cars for relationship counseling. Clients with children find there are frequent interruptions and they have difficulty feeling private enough to really drop into the process like they would in a closed office.

What kind of feedback are you getting?

Greenen: The most prominent reaction is gratitude that they will not lose their therapy, that their insurance company will keep covering their therapy, and that they don’t have to lose this support. There are some frustrations with technology, but everyone has been good-natured and understanding, and mostly it has been okay. I recently upgraded my internet speed at my home, and that helped a lot!

Have patients found it difficult, the way you have to provide therapy now?

Greenen: Most clients say they can’t wait to come back into the office. Some clients find it very convenient to be able to not have to travel and expressed a desire to continue online even after social distancing ends.

Has anyone been hesitant or needed extra comfort?

Greenen: It’s easier with clients who know me, as they are already comfortable with me. New clients can find it a difficult way to get to know me and build a therapeutic relationship. I have had to have conversations with clients about how they can protect their privacy and feel safe doing telehealth, because I’m no longer providing the environment for them that is safe and secure.