Session 61: Is Virtual Therapy for Me?

Published Jun 13, 2018, 7:00 AM
For this episode I’m joined by Melissa Douglass, LCSW who has an entirely virtual practice in St Louis. Melissa and I discussed some of the differences between traditional and virtual therapy, how you can decide if it’s right for you, how to find a virtual therapist, and she shared all of her favorite apps for mental wellness.

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Welcome to the Therapy for Black Girls Podcasts, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr Joy Hard and Bradford, a licensed psychologist in Atlanta, Georgia. To get more information, visit the website at Therapy for Black Girls dot com. And while I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey, y'all, welcome to session sixty one of the Therapy for Black Girls Podcasts. Many of you have probably heard about virtual therapy as another way to work with the therapist, so I wanted to make sure you had all the details you needed to decide whether this might be something that works for you. Today, I'm joined by Melissa Douglas, who has an entirely virtual practice in St. Louis. Melissa is the sole distance counselor and owner of Gold Driven Counseling, LLLC, a private tele mental health counseling practice where she supports teens and millennials through challenging educational, career and life transitions through secure video conferencing. She is a native of Chicago, Illinois, who has called St. Louis, Missouri, home for almost a decade. She is a proud Triton who received a Bachelor's of Social Work degree, Master of Social Work degree, and also a certificate and Nonprofit Management and Leadership from the University of Missouri St. Louis. She is a licensed clinical social worker and a distance credential counselor who has diverse volunteer and work experience with youth and juvenile detention, community based and educational settings. In addition to private practice, she also works on the clinical team serving adults in a psychiatric hospital setting. Melissa and I discuss some of the differences between traditional and virtual therapy, how you can decide if it's right for you, how to find a virtual therapist, and she shared all of her favorite apps for mental wellness. If you hear information that you think others also need to know, please make sure to share it on social media using the hashtag TBG in session. Here's our conversation. Thank you so much for joining us today, Melissa, Thank you for having me. Dr Joy. I'm very happy you were able to join us today. Because I know there have been a lot of questions about people look looking for virtual therapy or if they live like in a town that's further from a big city and they're not like a lot of therapists there. People are wanting to know, Um, you know, do therapists offer virtual options? So I know that you have a completely online practice at this point, correct, Yes, so you are the perfect person to talk with us about some of these concerns. So first, can you tell us a little bit about what virtual therapy is and how it might be different from traditional therapy. Yes, so it's very basic, and so we're gonna talk about just basically tele mental health and virtual therapy because there's a whole other section of just tele medicine that covers a lot of different professionals. But tell mental health is really when the clinician and the client are in different physical locations using technology to communicate pretty much, and so it's referred to as etherrapy, virtual therapy, online therapy, and distance counseling. And what I tell my clients is during our virtual counseling or virtual therapy sessions, we can do almost everything other than I can't handle a tissue. If you start to cry that UM time and I can't be a physical support UM in a crisis. But because I use all video and an actual platform design for telehealth UM, it helps me to have the same relationship and report to be developed and resources to be used. Because I can share my screen with people so we can work through resources and things together and actually see worksheets and stuff like that, I can have more than one person in a session with me. So couples counseling or family counseling can be just the same as as traditional therapy UM. But when you talk about tele mental health, there are other options other than video, So you have phone counseling as well as a synchronous methods such as email and text based counseling. And so all that means is that you and the therapists are not live communicating. So you may send a message and you have to wait until the counseling therapists can respond to that and then you go back and forth that way UM. And so with those method it is there has to be a confort with communicating feelings and thoughts in a in a written format. But the largest difference is that the responsibility of ensuring privacy of the session is a little bit more shifted to the client because they're in their own space. But I always share that tele mental health isn't better or superior methods to traditional counseling. It's really all about appropriateness and preference. So it sounds like it's very similar to coming into the office for therapy, except that you might be in your home, like in pajama bottoms. Absolutely, So what kind of feedback have you gotten from your clients, Melissa about whether it be um, you know, like like it better or worse than traditional therapy? Like, what kind of feedback have you gotten? Yeah, and so again, like I said, it's all about preference. But I received a lot of great feedback from my clients because again, because I use the video base, we really are able to establish the same relationship and report because we can still see and feel each other's personality, we can hear the tonality, and we can see affects from each other, and so it's a little bit more than just communicating in a written format, and so we're able to really build that relationship. They also enjoy the flexibility it allows in their schedules, as well as the convenance of just having to log on and I'm right there. They don't have to travel or really fitted into their schedule in addition to travel and things like that. But I always share with people who are a little bit unsure about telehealth because you know, honestly, it's it's still a fairly new thing. It's been around for about thirty years. And we talked about the telemedicine space, but for tele mental health, I think it's gaining more traction in the last like ten years and more visibility. And so I always tell people that it's been researched for effectiveness. And so in the early two thousands, there were a lot of different studies done, but a couple that I like and that I like to share is that UM in two thousand want to study was conducted by the Department of Psychiatry at Washington University here in St. Louis, and show that that patients quickly adapt an established report because the basis of relationship building UM is there with tell A Health. And then there was another one, another study built in two thousand and five by a psychologist from Northwestern University who conducted trials that showed that clients living with depression tended to stand counseling longer and star a larger reduction and symptoms by participating in phone counseling. And so, you know, I like people to know that there is research um back to the effectiveness of of tle mental health and virtual therapy. Yeah, I mean, and I'm glad you brought that up, right, because that is I think another benefit of virtual therapy is, you know, sometimes one of the more significant symptoms of depression is like not wanting to move and not wanting to leave your house. So if you can talk with your therapist via you know, your laptop or your tablet, then you can still participate in treatment. And you know, made me see some benefits from the treatment that you wouldn't have if you, you know, stay at home. Yeah. Absolutely, as well as the social anxieties as well. And we know that that's the largest mental health illness in the world and so or at least we'll say in the US. And so that's also a great benefit as well. And I think it is important for us to mention that this is not um jumping on face time with your therapist, right, So it's not like your therapist will just FaceTime call you and you just answer these are very um or at least your therapist should be using hip A compliance software and platforms that will increase the security of the session. Correct, absolutely, yes, yeah, so there are precautions that your therapist should be taking. But like you mentioned, um, you know, like if you decide to have your session and you know your partner is like right next to you, then you are compromising your own confidentiality. But your therapist is taking the precautions they need to make sure the session is safe. Yes, absolutely, got you. Okay, So what kinds of consideration should that somebody consider if they're thinking about virtual therapy, Like what kinds of things might they want to think about? Yes, so I definitely always say that the virtual therapy is just the method in which we're doing the actual therapy, But you definitely want to consider the expertise of the clinician and if their focus is what you need um, And so you want to make sure that that the actual option is not the main thing um and that the person if you're experience and depression or anxiety, that that actual clinician that's offering the virtual therapy specializes in those things. Another huge thing because of the the lack of geographical barriers with tell a mental health. UM, you want to make sure that the clinician is licensed in the state that you reside in, because it's legally required UM. And so that's the misconception that a lot of people have is that because we can just use our phones or computers and things like that, that we can work with anybody, and that's not true. UM. Excuse me. Also, all I tell people to do a real self assessment and consider if they would be comfortable seeing someone from a distance UM again, because the comfort and the impact of a separate therapeutic space is really important to some people, and so UM as well as thinking about if you have a support person that is is near and accessible if there is ever an emergency situation. And so that's not something that was mentioned yet, but emergency planning is something that is very important when it comes to TELL mental health because if a client were to experience that sometimes some suicidal thoughts or things like that, there has to be an emergency management plan in place that that usually includes a emergency support person near UM to kind of triage that with the with the therapist, and then UM clients should be to feel free to ask if they're tele mental health UM therapist or counselor has completed any training, and so some states required and some don't even you also share that you know, it's not just jumping on a FaceTime call, UM, and it really speaks to the clinician operating in their areas of competence, which is a safeguard for the client, and the client should be comfortable and aware of talking about that with the clinician. Yeah, like you said, all the states don't require it, but you know, it does feel like most therapists who are doing a significant amount of virtual therapy or tele mental health have completed at least some like trainings and UM maybe even some additional certifications. Yes, yeah, So can you talk a little bit more about the emergency planning because I know that that is something that often comes up and I think something that um, you know, frightens some therapists away from maybe wanting to do tele mental health is like, Okay, what do I do in case of an emergency? So can you talk a little bit about what that process is like with you and your clients. Yes, So, assessment of fit is very important, and so when a client contacts me for a consultation we're having that initial call, I'm usually doing a brief assessment at that time, and so I'm assessing if they are at high risk of currently having suicidal thoughts or have had a plan or intent. I'm I'm also assessing for any homicidal ideation, any active substance use, UM, any delusions around technology. And so that means, UM, some people experience thoughts and things that UM someone is spine on them through their computer or things like that. So that wouldn't be comfortable in a therapeutic space if that's UH some concerns as well as some complex traumas. And so those are some things that I that I quickly assessed for in a consultation within also through the assessment phase. And so with the emergency planning, I share with clients that if any UH safety issue were to come up, and we'll just speak about the suicidal thoughts and things like that, if that was to ever be UM a concern, then I definitely openly share with them that is my ethical responsibility to UH call the police to do a wellness check and things like that. But I also wanted to UM a little bit more comfortable for them too, and so we talk about any support people that they have in their life that has quick access to them. And so if it is a spouse, where if it is a parent, that they would give me permission to disclose and contact them and say that I am their therapists and they are having UM a very hard time right now and if they could check on them. I remain on the phone or in a session with my client during that time, but then I also triage with the support person as well. Okay, So it is very similar to what you would do if you were meeting with the person in your office. Absolutely, but unfortunately they have the ability to hang up and disconnect the right thing that they could. You know, they have the options to leave your office too, Like I've had clients that leave, you know, like just abruptly in the session if you know things are not going the way they want or something. So I mean, so there's still that option even in real life. That's true. Yeah, So Melissa, does UM insurance pay for virtual therapy? Yes, there are many insurance companies that pay for pay for virtual therapy and usually equivalent to the cost of traditional but it varies state to state, and it also varies between insurance companies as well, And so I always tell people that the best thing to do is to contact there ensure to ask about the details of their specific plan, okay, okay, And so if that is something that is UM gonna be like a priority, like if using your insurance is a priority, then checking with your insurance company probably is the first place you want to start. Yes. Absolutely. And are there other places that people could go to find therapists who UM offer virtual therapy? Like is there a directory that lists people? Like where would you go to find a therapist who practices virtual therapy? Yeah? So there are there are many directories on one, I mean therapy for Black Girls yours, many of the clinicians specify if they offer virtual counseling. Also on Psychology Today dot com UM, that's something that people specified. There are specific UM directories as well that are coming out that a little bit UM newer for UM clinicians that provide virtual therapy. I'm not a part of any of those UM. But then you also have the open Path collective with when you have people that need discounted options UM. You can also act your primary care physician UM, as well as contact and insurance companies as well. But I think when you're looking for um A therapists who only provides virtual therapy, that's the main route that you want. There are also just a lot of companies that are becoming larger that provides that as a as a basis. So I think now just traditional therapists like they are specifying if they offer teletherapy and addition, but then you have some of those bigger companies as well that that's their main focus online. Okay, so we're definitely gonna talk about it. I'm guessing you're referring to like talk Space and Better Help and seven Cups of Tea, like the kinds of companies. Okay, So before we get there, though, I do want to kind of talk a little bit about um like pricing in terms of virtual therapy, because I think that they're for some people there could be the idea that, oh, it's virtual, so it's likely not going to be the same price as coming into UM your traditional office. And so what are your thoughts about that. Yeah, so, as I mentioned earlier, you're still um tell a tele therapy and virtual therapy is is just the method in which you're um participating in therapy, but you are still, Uh, what you're paying for is the expertise and the skill and the time with your therapists. And so those counsel sessions, and I'll speak for myself, are still an hour session and so I am sectioning off an hour of my time, are dedicating an hour of my time to my client for their for their session. And so telehealth is going to be about the same as traditional therapy UM. And then as we see with with many different therapists, like we have different fees as well, and some you can find a little bit more of a lower rate and some may be higher UM. But it's it's more it's not necessarily going to be lower because you're still paying for the time and the skill of that clinician. Yeah. And that's where I think some of the confusion may come, like with like talk space and better Help UM, because those fees are typically lower, right. But that also I know that they have like different plans sometimes like you can do the text messaging UM, or you could do video, but their fees likely still are not as high as you would if you were just going with a traditional therapist who offers virtual therapy. Yeah. Absolutely, And I think that can be misleading sometimes because some of those lower fees are talking to more of those written formats and it's all the text based therapy based therapy where you don't have to necessarily dedicate that our space UM to that client. UM. It definitely does take time to construct some of those UM written message and responses and things, because again you have to communicate in a written form that expertise and that skill UM to that client. But some of those lower fees that they advertise, I think it's it's more geared towards that tech based therapy because with some like talk Space and Better and Breakthrough UM and Better Health as well, they also offer video and it's about average to what traditional therapists charge. Okay, okay, So while we're talking about that, let's just move into talking about UM and not necessarily about any platform and specific but in general, like all of those platforms offer similar kinds of things. So what are your thoughts about, you know, like people reaching out or working to working with therapists through any of those platforms. Do you feel like those are good choices for people to explore? Yes, I think they can be good choices as long as you're knowledgeable about what you're participated in UM and so full disclosure, I per I was a therapist through one of the online platform arms before and and a very good experience. But some concerns that arise is that with some of them they do random matches to a therapist, which means that they have like a little bit of a virtual assistant that takes some of the background and assessment information and then they randomly match them to a therapist. And so what I was seeing that was happening often was that I was being assigned clients that were not in state with me. And as I mentioned earlier, UM, that's something that I'm legally required to UM be bound to with the exception of international clients and so and tell the mental health there are no international regulations and so you can't have clients in other countries and things like that, but other states you cannot. And so I think they can be good choices as long as UM clients are able to do a little bit of that background research on the clinician and still see what their expertise is, still see where they are located UM and make sure that they are getting the service and things that they that they wanted, that they need and that is important to pay attention to. I mean probably more of a concern for the therapist providing the services right that they're making sure they're practicing ethnically. Um. But you as the client also want to be aware of like any kinds of things that could come up, you know, like if somebody realizes like you're not in their state and you've been working with them for a while, and then there may need to be like an abrupt termination or something like that. That those are the kinds of things you would want to think about. Yes, absolutely, got you. Okay, So Melissa, you mentioned um you know, like you have a system that allows you to do screen sharing um, which sounds really cool, right, Like that's just like when we are in our offices using like a white board or something to work through an issue with the client. UM. So that I think does add another layer of comfort and like ability to work with a client by sharing your screen. UM. So what kinds of things are you typically working with on your clients, Like what is the specialty that you use in your practice? Yes, so I work a lot with clients to experience and anxiety UM as well as depression. I'm seeing a lot of chronic stress and and overwhelmed. So stresses is a huge one as well as some trauma. And so my background is cognitive behavioral therapy as well as very hugely strength focused as well as solution UM brief solution focus therapy, and so I'm using all of those same skills and interventions and things just at a distance. And so it's it's better and easier when I can walk a client through a particular intervention in using worksheets or UM. There's an option on there where they can share journals and things with me, and so I'm able to read some things that they're doing some homework on that they can share with me even in between sessions UM. So that's helpful as well. So I'm doing all the same work as I would in a traditional office UM, but just providing it at a distance. Okay, and you kind of touched on this a little bit, but can you go in more detailer at anything that you didn't say before. Are there certain concerns that would not be appropriate for virtual therapy? Yes, definitely, UM higher risks and when I say higher risk for suicidal UM thoughts, I would say like currently actively UM having suicidal thoughts, and definitely if there is any type of a plan UM that would probably not be appropriate for distance council again because that safety is what's important and so UM, Yes, there are clients who have had passed UM thoughts UM of suicide before UM, but they have worked through those and don't and they may be more passive and not very developed or they're able to control them and things like that. And so definitely active suicidal thoughts, Definitely active thoughts of homicidal ideation UM, any active substance use and that's UH with any therapy UM. And again delusions around technology and any real complex trauma that that in person UM, just physical space would be more important to have. And what what's the issue with the active substance abuse, Melissa, So what the active substance abuse? Well, again it's it's safety. And so when we're looking at at mental health and having talk therapy and things, when there's any type of substance abuse so high alcoholism or any UM substance abuse like pills and things of that nature, UM, we want to make sure that detox um happens first and that a person is working towards recovery before we can talk about UM can actually engage in really good talk therapy because um, we know that substances and things alter our thoughts and things of that nature. And again because of safety at a distance, if someone is actively um using substances, they can actively be doing that, you know, during our session or right before the session and things like that. And so being able to have a cent of alcohol or um anything else and having that real good assessment that we can see through video, but it's even um more prominent in person. UM is important. But again just with the the safety and the altering of the mind, we we don't want to engage in that if there's active substitutes. Got you? So an active you mean, like like you just said, like may have a drink or something right before session? Yes, got you? Okay, Okay, So my listen, do you have any upcoming events or anything going on that you'd like to share more information about. I'm in the midst of developing what I'm calling the Goal Driven Students College Tour, and so again higher education and students in that um age rant is something that's really important to me. And so with the Goal Driven Students College Tour UM, the mission is really to visit as many institutions of higher education within Illinois and Missouri to educate about mental health and tele mental health as an option. And so what I've been finding and and I knew, but what's become even more prominent to me is that if you're not in a field of like psychology or social work or counseling when you're in college, you're not really getting much information about mental health. And what the research is showing us is that that population and that age group are more stressed and more anxious than they ever have been. And so it's important UM to me to continue to spread that message about the importance of our mental health. And so if anybody in Missouri, Illinois will want to bring me to their um institution of higher education, like that would be great. And where can we find you online? Melissa? Your website in any social media handles you want to share? Yes, So my website is www dot gol Driven on sling dot com. I'm on Facebook at Gold Driven Counseling, LLC, on Instagram at gold Driven Counseling, and on Twitter at Gold Driven Council Without an eye, got it? And of course all of that information will be included in the show notes. So people can find that really easily. So you mentioned to Melissa the two studies, UM, but I wondered if you had any other resources that you really enjoyed UM, whether about like tele mental health or like your populations that you really enjoy working with, like the adult NG and UM the major transitions, any like books or podcasts or things that you suggest for people wanting to read more about that. Well, I focus a lot on using just what's as our fingertips and so a lot of the resources that I share UM, I use a lot of excerpts and things from different articles and books and things like that. But I also like to use apps really really largely because we have a lot of them that you know, are on our phones and things that are free that are very very helpful. That helps when we're trying to work through interventions and things with our therapists or just in our everyday life. And so UM I have a top five and the first UM just completely contradicted myself because the first is actually not an app, but it goes into the space of of of just the using technology more fully. And so one I suggest a lot of journaling UM with my clients just to to sit down be mindful and work through um some things, and some of them they're like, you know, if they're college students and professionals, they're like, oh my gosh, like I do not want to write another thing, even if it is about my feelings. And so one thing that I suggest is audio journaling. And so what I tell them is we can go through the same processes and things as a journal and really vincing about and working through our feelings and our thoughts and our emotions, but we can do it through audio. And so I share with them to turn their their phone on like they were were going to record a video and then just to sit it down to it only picks up audio. They're not worried about looking at themselves and what it looks like. And so UM, I instruct them to go through the journaling process but just talking it out loud and so it takes that pressure off having to write. But then they can steal process through things and then here it back to themselves. And so that's one UM. But one actual app is called the moment app, and that can track track our cell phone usage. And so with a lot of the clients that I have that are talking to me about being overwhelmed and feeling stress and just not having enough time. UM. Sometimes we have we take a step back and look at how we're using our time, especially when we're exhausted, we're kind of just um, kind of surfing through the internet or social media and things like that. And so that shows them like what they're putting their their time to in an actual, like quantitative way. And so we can look at, Okay, if you spent three hours on social media today, like, how can we use that differently? Another one that I use is called Relaxed Melodies, and that one gives relaxing sounds that can be like mixed with each other, and so you could have like a rain sound mixed with like gusty winds. And so some of my clients who we're practicing that mindfulness and some of that grounding it helps at that time. But then also those who are having trouble sleeping and having trouble fallen asleep, having some of those UM sounds and working through some deep breathing can be very helpful for that. UM. The third one is Pacificum, and it tracks moods and thoughts and it also has some guided meditations, and so that can be very helpful when we're trying to look at patterns. And then the last one is a breathe app and it also helps with the the guided breathing because learning how to to deep breathe can can be very different from just our our normal breathing that we have every day. Those are great, Melissa. I'm sure a lot of people will want to check those out. Thank you all right, well, thank you so much for joining us today, Melissa. I really appreciate it. Thank you again so much for having me Dr Joy and just thank you for this this resource that you've developed, because it is absolutely amazing. You're welcome. Thank you for being a part of it. Thanks. I'm so happy Melissa was able to share her expertise with us this week. Don't forget to check out all of the apps and the information to contact her in the show notes. You can find them at Therapy for Black Girls dot com slash Session sixty one, and be sure to share your thoughts about the episode with us on social media. You can use the hashtag tv G in session and you can also tag our accounts. You can find us on Twitter at Therapy for the Number four be Girls, and you can find us on Instagram and Facebook at Therapy for Black Girls. If you're looking for a therapist in your area, make sure to visit the directory at Therapy for Black Girls dot com slash directory. And if you want to continue this conversation and join a community of other sisters who listen to the podcast, join us over in the Thrive tribe at Therapy for Black Girls dot com slash tribe. Make sure you answer the three questions that are asked to gain injury. Thank you all so much again for joining me this week, and I look forward to continue in this conversation with you all real soon. Take care, fire often,

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