In marketing speak, Rick Mitchell is what we call an “early adopter,” the kind of consumer that is often a pioneer in embracing new technologies. They’re the folks who aren’t afraid to try new products and then let the rest of us know that it’s fine to jump in after them, that the water is just fine.
More than 20 years ago, Rick jumped into the telehealth pool, discovering long before many of his colleagues in mental health services that the convenience and efficiency of talking to patients remotely had remarkable advantages.
For Rick, a behavioral health therapist with Next Steps Services in Bristol, Va., his first steps toward long-distance therapy sessions began simply and intuitively – over the phone. As far back as the 1990s, he recognized that he didn’t need to be sitting in the same room as his patients for every session, so he adopted a hybrid model – an in-person session here, a phone session there – whether it was an onboarding orientation session, follow-up services or even crisis intervention. Given the often-considerable distances between him and his patients, it was a practical solution to a vexing problem, especially when you consider that many of his rural Southwest Virginia patients had trouble securing reliable transportation or were juggling childcare commitments.
As the technology became more sophisticated – allowing Rick to interface with his patients via computer – he nonetheless maintained that hybrid model. He does find it advantageous to connect from time to time to patients in person as he believes it can accelerate the bonds of trust that develop between therapist and patient, but for the most part, he leaves the decision as to whether to meet face to face or via Zoom to his patients. He says that he’s gone years without actually meeting with a client in the same room, and while there was a time pre-COVID when patients were reticent to try a telehealth appointment, now there is no hesitation. “Just send me a link,” they say.
But given the location of many of Rick’s patients, connecting via the internet is not always so easy. Much of rural Virginia still struggles with reliable broadband access, and this lack of internet reliability is one of the chief hurdles to expanding access to care. In pockets of the region where access is more available, there has been a spike in those taking advantage of telehealth, especially group sessions. Where groups were often three or four in number, post-pandemic, it’s not unusual to find nine to 10 people logging into a group session.
Rates of people not showing up for appointments has decreased as well, as people know if they are pressed for the time availability or resources necessary to get to an in-person appointment, they will ask to move the appointment to telehealth and remain connected to their treatment and goals without skipping a beat. This results in more effective outcomes than someone historically just having to miss the appointment, a dynamic that created tension between client and therapist, as discontinuation rates following no show appointments is really high. Often this is because the client thinks the therapist is going to be angry at them or chastise them in some way for missing an appointment, even though the therapist most often would have claimed that to not be the case.
In addition to accessibility, Rick and his colleagues have also discovered other reasons that many patients prefer sessions from home. They can attend to child care needs, manage their households, walk around while talking, go in and out of doors, practice mindfulness in their own environments, implement theories and strategies while being discussed where it matters most and incorporate the input of others in their support systems in more effective person-centered care. For some, being able to move around and participate in a coping skill while still in a session without taking a physical break from the session is a tremendous benefit. More broadly, it reflects the added comfort level that many people feel when receiving counseling services in their homes. While many therapists had feared that remote sessions would lose a sense of intimacy with their patients, there is evidence to suggest now that the opposite has happened. Some people still prefer to talk in person, yet those are the people who tend to have better resources available. Talking with some clients from the comforts and security of their own homes, sometimes those most in need, and sometimes not, allows them to open up all the more.
Optimistic by nature, Rick is hopeful that the promise of expanded access to broadband in rural Virginia is close at hand. Once that pool gets bigger, he’s expecting even more folks to jump in.