Pros and Cons of Teletherapy (from a therapist’s perspective)

It’s been just over 6 months since I’ve been conducting teletherapy sessions, and as a therapist I love that this is a service I can provide! During a time of Covid and social unrest in our county, I’ve seen a huge spike in demand for mental health services across populations. As I reflect on both the good (and not so good) aspects of teletherapy, I wanted to share some insights for other therapists that are considering the online therapy route.

Pro: Minimal overhead costs

Private practice can involve a lot of overhead costs: rent for office space, utility bills, subscription to an electronic health record keeping service, etc. We also have to pay fees to maintain our license, take continuing education courses to remain licensed, and (ideally) have liability insurance.

With telehealth, my overhead costs include my Internet, cell phone, and electric bills (which I already pay for since I practice from home). My “rent space” is the Internet! Much cheaper to maintain than renting an actual office space. :)

Con: Technical difficulties

On a few occasions, I’ve had a session abruptly interrupted due to a poor internet connection, a client’s laptop/phone suddenly dying, or technical issues related to the platform I am using. So far, my clients and I have taken this in stride with quick troubleshooting. My workstation also uses a wired internet connection and I regularly restart my computer. With that said, it can be challenging when this happens during a critical session (such as processing trauma). It’s an added layer of worry that doesn’t exist when doing regular face-to-face sessions.

Pro: I get to work from home!

My commute is a walk to my office desk in my apartment. My lunches and breaks are at home with easy access to my kitchen and balcony. I have control over the lighting, the thermostat, and how I structure my time.

Con: I work from home...

With all the benefits of practicing from home, it can be challenging to transition between work and home life. I sometimes check work messages during meals (still trying to minimize that!). Without a commute, it’s easy for me to ruminate on difficult sessions during my evenings. Seeing the temptations of home life from my desk -- even as small as a good library book waiting for me at my favorite chair -- can be distracting from my work.

Pro: Working with clients I might not otherwise get to serve

I’ve been pleasantly surprised at how many clients I’ve been able to work with because of telehealth. I have clients who might not otherwise access “regular” face-to-face therapy due to a variety of reasons: the costs of traveling to a therapy office, lack of access to therapy in their immediate area, or even unique issues like agoraphobia or being housebound.

Pro: Easier to set and maintain boundaries through telehealth

This is one that I had not anticipated until growing more comfortable with telehealth. I started out on an online telehealth platform. This platform makes it quite clear to both providers and clients that higher level services, such as full psychological assessments and crisis services, cannot be made available due to the limitations of online therapy. I initially viewed this limitation as, well, a limitation! But I’ve been pleasantly surprised at how much it has helped in maintaining boundaries on what I give as a provider. If a client indicates that they need a higher level of care, we coordinate to see what is immediately available in their area. Unless you’re a provider willing to travel out to the client’s location to provide higher-level services, using the limitations of telehealth as firm boundaries can be helpful.

Con: There are greater limitations with the services we can provide

In line with the previous “pro”, we cannot realistically provide all mental health services that might be readily available with face-to-face sessions. It’s much harder to conduct a full mental status exam without the client literally in your presence. It’s nearly impossible to provide all the aspects of crisis intervention that we rely on, such as proximity support. It’s also harder to provide referral or case management recommendations when your client lives in a part of the state that you are not at all familiar with. It’s important to not only keep these limitations in mind, but to regularly communicate them with clients before and during the teletherapy process.