eNewsletter - July 2020

10 Lessons Learned About Virtual Programming and Treatment
Heather Treat, Psy.D.


Can you hear me?

This is the question I have been asking the most lately.

COVID-19 has made it necessary to figure out how to provide behavioral health-care in a safe and physically distant way. Virtual treatment has become a necessity. In just a few days, our entire mode of treatment was completely upended. Everything changed.

At the beginning of the pandemic, patients took a few weeks away from treatment, thinking this would blow over. As the quarantine continued, patients began to schedule virtual appointments, but these appointments came with a lot of anxiety for both staff and patients. Learning how to make this work was an interesting process.

We’ve asked ourselves many questions over the last several months:

  • How do we get patient paperwork signed?
  • Many patients don’t have access to a printer for paperwork or treatment. What do we do about that?
  • What is the best and most effective way to teach my patient treatment skills virtually?
  • How do we maintain confidentiality through emails?
  • What are HIPPA requirements with virtual sessions?
  • Did I confirm my patient’s email address? Is it accurate?
  • How do I thoroughly check my patient for safety risks?
  • What about my high-risk patients? Do we need a different process to check these patients?
  • What if we are in the middle of a critical emotional moment and we have technical difficulties? What if the technical issues become a consistent problem?
  • Do I have enough bandwidth? What is bandwidth?
  • What about my non-technologically savvy patients?
  • What are the CDC requirements?
  • What about my COVID-19 exposed or positive patients?

The answers to these questions and others have led me to the following 10 lessons learned about providing treatment virtually:\

  1. Work with colleagues to problem solve situations that don’t easily translate to the virtual environment. In the beginning when I started to panic, I would ask myself how I would handle this if the patient were in person. If any part of the process could not be adapted to virtual, I would then problem solve those issues with a colleague. Consult, consult, consult! Do not forget that you are not alone in this.
  2. Practice using the virtual platform. Call your co-workers, friends, or family members and become an expert on the technical aspects and troubleshooting techniques.
  3. Time is critical. Give yourself extra time to get set up for virtual sessions.
  4. Establish and double check account settings. Make sure your virtual platform accounts have the correct settings. No one should be able to come into your personal virtual room without being allowed in by you. For virtual groups, the chat feature should be disabled to keep patients from talking with each other privately.
  5. Give clients a chance to practice, too. Reach out to clients beforehand to orient them to the virtual platform and the way virtual sessions will work.
  6. Maintain your workspace. Have your desk set up. Keep your area clean and have all the supplies you need at your fingertips.
  7. Set the boundaries and rules with your clients. In our groups, we talk about the requirement that patients are alone in a room while participating. We make it clear that no one other than themselves should be able to hear the group or see the computer screen to maintain everyone’s confidentiality.
  8. Have the right tools.
    • Get a stand or few thick books to prop your computer up to eye level. This is very helpful with posture and helps with eye strain and neck/shoulder pain.
    • For hybrid groups (when clients are in person and online in the same group) have a webcam and microphone so that online people can see and hear the entire room.
    • Have multiple webcam/microphone-enabled computers or phones available when possible. This helps account for technical issues. One computer is bound to not work at some point, and you want to have a backup plan.
  9. Virtual fatigue is real. Self-care is somehow even more important now. Not only do you have to stare at a computer all day, but you have the emotional toll of COVID-19 on your own psyche. This is emotionally and physically exhausting. If you are asking yourself why you are so tired, you know your answer: the global shared experience that is the COVID-19 pandemic. To help combat this fatigue:
    • Take breaks. Give yourself a couple of longer breaks in between your sessions. 10 minutes may not be enough. Plan these breaks.
    • Watch your posture and adjust your chair appropriately. Your feet should be flat on the floor. Your knees should be level with your hips. Your hands/arms should be supported -do not let them hang off your desk. Have your computer at eye level.
    • Stretch between sessions.
    • Drink water (especially if you are wearing a mask).
    • Eat. Have your snacks/meals prepared beforehand.
    • Increase positive experiences in your day-to-day life to help you improve your own capabilities to emotionally regulate. We all need down time and balance in our lives.
  10. Lastly, lean into the virtual format. This will help decrease your own suffering. It is difficult to do therapy virtually but there are some benefits. You can see where they live and meet their pets. Family members can join in on sessions more easily when needed. And of course, you and your patients are safer from COVID-19.

Our next challenge is to reintegrate patients back into in-person treatment. What I have discovered is that most of our patients did not want their psychological services virtually. Our patients have been flexible about following CDC guidelines if that means they can come in person.

Be clear about what the guidelines are for your facility and have the supplies you need (i.e. thermometers, hand sanitizer, extra masks, cleaning supplies, etc.). Start the conversation about coming back in-person for a few sessions before you plan to do it. Prepare your patients. Do what feels comfortable foryou and your family. Do not bend to the pressure of coming back in-person if it is not right for you.

If you are a healthcare provider at this time in our history, remember you are not alone. Reach out to your colleagues and lean on them for support.

One of my adolescent patients ends every virtual session we have with this acknowledgement which I extend all fellow behavioral health providers “Thank you for your service. Stay safe and healthy, healthcare hero.”