Future

The Long Road Back: Integrating back into life as the pandemic shifts

 

Written by Dr. Stephanie Unwin-Kuruneri,
a Psychologist and clinical supervisor in Manhattan, NY
[Click here to read more about her]

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It was a long, strange, and scary year

We are quickly approaching the anniversary of COVID 19 in the US and its lasting impact on the American psyche. #themoment is trending. Naturally, a lot of feelings are coming up. Anniversaries are typically a time for reflection, and this is no different. Where were you this time last year?  What were your dreams or plans for 2020? What did you have to give up? A lot? A little? Most of it? All of it?

It has been a full year of seasons, missed graduations, drive by birthdays, canceled trips, Zoom calls and masks. Digesting this reality can feel overwhelming, or even retraumatizing to some. However, it is helpful to mourn what was lost. 

As cases decline, vaccine distribution continues, and the snow begins to melt, the reconstruction of community is on the horizon. While exciting as a return to some form of normality can be, this can be anxiety provoking for many, since we all have our own unique pandemic experience. Some of us have lost loved ones, some have not. Some have escaped sickness and others may still be recovering. Some of us have had a bubble, some have had no one. Maybe you have not been on public transportation or aren’t yet comfortable in stores and still have your groceries delivered. As we attempt to reconnect to each other, to repatriate our lives, it will be helpful to remember that there are myriad stories.

What was your story?

Acknowledging your personal experience over the course of the past year can ease the feelings of anxiety and uncertainty that will surely mark this transition period. What was your story? Perhaps you want to share this with trusted friends or maybe you want to journal it just for yourself. While we think about how to move forward, it is important to consider your personal journey. There was been no blueprint for how to manage life during the pandemic and there isn’t one for how to integrate back into the world. You may want to start slow or dive right in. But it’s important to remember that we are the author of our own stories. Each person has their own threshold for safety and risk. For many of us it has been a balancing act as things have relaxed, restricted, and relaxed again. Exploring and identifying your comfort level with different activities will better help you communicate them to the people in your life (friends, family, your boss).

What did you gain? What did you lose?
Transitioning is important and it starts with you.

As with any transition, there is something to be gained and something that will be lost. This does not mean a net-loss by any means, rather more of a shift from one state of being to another. “What did you gain or lose this past year?” is as valid a question as “What do you anticipate gaining and losing as you move forward?” We may gain more social interaction and connection and yet lose a certain predictability that may have been comforting. There will be a period of adjustment and therefore, we need to give ourselves grace as we adjust.   

It starts with you. As the anniversary approaches, try to check in with yourself and how you are thinking about it. Acknowledging regret, loss, jubilation (you made it a year!) are all valid ways to feel, and not just one, you may feel all of them. It will be this, recognizing the impact that pandemic has had on your well being, that will help you more consciously transition back into the world. Happy anniversary! 

Online Counseling: The Future of Therapy?

https://bit.ly/2OLYksI

https://bit.ly/2OLYksI

Thanks to the internet and its infinite apps, we’re able to gratify almost any need in an instant. So much of our day-to-day has become on-demand and platform-based. Curious about someone? Facebook. Hunting for a job? LinkedIn. Need a ride? Uber. Want a date? Tinder. Hungry? Seamless.

But what if you’re looking for therapy?

Telepsychology aims to make counseling easy to access. It simplifies and speeds up the process of finding a therapist. No more going to an office for a weekly appointment. For most platforms, it comes down to a quick sign-up, survey, live chat evaluation, and then via an algorithm, voila! You’re matched with a counselor. Sounds streamlined enough, but inevitably it’s more complex than that. For starters, which platform to choose?

Telepsychology Options At A Glance

Within the past several years, telemedicine has brought with it a wave of new online counseling platforms. These platforms offer a variety of modality options: video conferencing, live chat, audio, and texting. Some charge per session, others offer monthly subscriptions, with varying eligibility for insurance reimbursement. The table below offers a side by side comparison of the most popular recent online counseling services.

 
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Note: The Wirecutter, a New York Times product review company, recently published several informative articles about online counseling [see below for links]. Their team tried several of these services, ultimately choosing AmWell and DrOnDemand as their top two picks. Preliminary research has indicated that video is the preferred modality, likely because it gets as close to an in-person therapeutic interaction as technology allows.

Benefits and Risks

As with any new tool, online counseling comes with a host of positives and negatives.

Pros

  • Highly flexible

  • Eliminates barriers to treatment - ideal for clients who are highly anxious, homebound, disabled, dealing with PTSD e.g. veterans, or living in rural areas

  • Normalizes mental health treatment and decreases stigma 

  • Serves as a great introduction to therapy on the road to longer-term treatment

Cons

  • Hinges on accessibility to / reliability of technology

  • Introduces legal issues (clinicians are geographically bound by their license to practice in a certain state)

  • Brings up ethical issues (client privacy, limitations with crisis intervention)

  • Limitations of technology with regard to establishing an authentic connection

  • May not be ideal for high-risk cases or clients dealing with serious diagnoses

  • Can be more financially driven than care driven - companies compromise services provided to clients, and fail to support / protect clinicians

  • Are often launched by people who come from a tech background, not a mental health background; without enough clinicians on staff, team might not fully grasp the legalities and ethics of HIPAA compliance, geography-based practice limitations, etc.

Teletherapy has already showcased its potential to normalize mental health treatment and to maximize client access to these services. At the same time, its pitfalls are not insignificant and affect both clients and clinicians. For clients in crisis or dealing with severe diagnoses, the digital interface may not provide sufficient support. Depending on the platform, clients are not always required to provide identifying information, making proper crisis intervention very difficult for a therapist to carry out. In this vein, client privacy is an ongoing concern. Platforms are usually HIPAA compliant, text is SSL encrypted, but therapist access to client records and a client’s right to remain entirely anonymous remain gray areas.

Additionally, technology in general creates a certain barrier that may compromise an authentic therapeutic connection. Imagine being in the middle of an intense, emotional video chat with your therapist and all of a sudden the screen freezes or the WiFi cuts out. It’s a tall order to replace the in-person therapeutic relationship; online counseling is doing its best despite the restraints of technology.

The Takeaway on Teletherapy

Therapy doesn’t need to cling to the couch or fear the smartphone’s influence. Mental health treatment has to be able to evolve with the culture. At the same time, online therapy services shouldn’t compromise quality of care, or legal and ethical standards of the field. Teletherapy companies are a delicate combination of revenue-driven business and nuanced, human service. In online counseling's ideal form, protecting practitioners, supporting clients, and honoring the therapeutic process should always come first.

How do you feel about online therapy?

Would you try it? Have you tried it?

Is it the future or just too strange?

Share your thoughts and experiences with us! We’d love to hear from you. 

Leave a comment below.

More Links About Online Counseling