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There’s No Place Like Home: Three mental health professionals discuss their shift to telehealth

By Benjamin Wexler

Some names in this article are modified in the interest of anonymity.

Photo: mohamed_hassan via Pixabay

“What would this have looked like in 1988?”, wonders Caroline Hanna, a social worker in the public healthcare sector. “Would you call in from a landline?”

Our digital era made the switch to virtual mental health counselling during the COVID-19 pandemic almost seamless, despite pressure on the sector’s capacity from an isolated, anxious population. Anyone with a cell phone can call their social worker. Video-calling, meanwhile, demands specific software, so it didn’t catch on until later. Although both have been used for years in mental health care, their sudden ubiquity raises new problems.

If you don’t have a “Zoom-bomber" story, one of your classmates or teachers probably does. Therapists and social workers, only recently thrown into the world of digital counselling themselves, must clarify with clients the degree of privacy they can ensure on any given platform. Zoom’s Healthcare Plan is secure enough to meet the standards of the public sector, but it still leaves the contacts of patients relatively unprotected. Other platforms, like IIT Reacts, are specifically designed for healthcare and guarantee greater confidentiality.

Video-calling has more tangible problems as well. Social worker, psychotherapist and couple and family therapist Jeremy Wexler lost numerous clients as soon as his practice moved online. People don’t want to be overheard by their kids, or worse, by their abusive partners. Under those circumstances, a phone call from the car or a public park becomes the best option.

Professionals are more optimistic on some counts. Telehealth eliminates some of the stigma and inaccessibility of counselling. In an era of unprecedented openness to mental health treatment, it seems only logical that therapy enter the home. Taking time away from the house is challenging for many young parents; your free time might consist only of a short lunch break; people have mobility issues, particularly in a Montreal winter. Marginalized community members can call in to a therapist who shares their lived experience, despite not living close to one.

Wexler has his reservations. He recalls something a couple once said to him: “It’s the metro ride over to your office where the real work gets done”. The partitioning of spaces is an important part of the work he does.

Jackson Ezra used to do in-person social work, but has had to adapt while training in couple and family therapy at McGill. In class he learns to maintain a familiar office in which clients feel safe, down to keeping the same friendly books on the wall. He and his classmates brainstorm on how to apply old lesson plans to new circumstances. Keep a consistent backdrop for your sessions. Encourage clients to set themselves up comfortably. There can even be an opening and closing ritual, like lighting a candle, to create some sense of spatial connection.

Therapists train to be aware of their physical presence and that of their clients. There’s no digital equivalent to standing up and talking in an authoritative, calming voice to defuse a situation. If couples are on different screens, you can’t evaluate nonverbal cues such as eye contact, seating in relation to one another, or physical affection. Lagging internet interrupts fluid conversation.

Fixing this broken telephone is simple — ask more questions. “And how does that make you feel?”, like a therapist in a New Yorker cartoon.

Sometimes the intimacy of a home environment even improves communication. Those issues that seem trivial in a CLSC office come up naturally sitting on your own bed. Ezra’s client mentioned that his son was upstairs sick, and that segued into a conversation about his concern for the kid.

It’s not always the professionals asking the questions, either. A client was worried for Hanna after seeing on the news that the Health Ministry was suspending vacation for health workers. Normally, clients know a minimal amount about their social worker or therapist’s life, but the pandemic is far from normal. I’m going through it, you’re going through it, and your therapist is going through it. It’s a shared experience, instead of a shared space. “I try to make my calls from a closed-off area, but they know I’m working from my basement, just like they are,” says Wexler.

He was expected to start sessions in-person as of mid-April. Clients were concerned, both for him and for themselves. About 70% chose to stay online, and he suspects that that number won’t drop to zero even after a vaccine is distributed. The growth of online mental health services was accelerated by the pandemic, not manufactured by it, and technology is already catching up to yesterday’s shortcomings. Telehealth offers too many advantages to end with the novel coronavirus.


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