Benefits & Drawbacks of Telehealth

In this transcribed episode of The Shrink Think Podcast, Aaron and Nathan dive into the pros and cons of telehealth when it comes to therapy.

Aaron Potratz:
Hey everyone, welcome to the Shrink Think podcast. We are excited here today. You guys dunno if you're listening from somewhere else, but it's no longer summer here, so it's like dark and dreary. We

Nathan Hawkins:
Said this was coming.

Aaron Potratz:
Yeah, we knew it was coming. So we're going to be recording a whole lot more podcasts because we're never going to go outside and ever again for 10 more months.

Nathan Hawkins:
We're recording our summer stuff now.

Aaron Potratz:
Yeah, right now. We're excited to be here today. We were in Las Vegas over the weekend with some of our brothers from across the country, some of our buddies that own their own practices. If you recall, earlier this year we were in Vegas and there's a group of us guys and we had this round table discussion. It was really cool, really awesome. We, however, have a larger group now and we did not get to do that. So you just get to hear us tell you how awesome it was and then you'll all just have to take our word for it. So thanks for coming along for that boring ride. It was a whole lot more fun last time.

Nathan Hawkins:
And then our host next year will all of a sudden have 25 people, so we’ll

Aaron Potratz:
Probably. Yeah, and who's that? It's not unusual to be loved by is that Vegas guy?

Nathan Hawkins:
Maybe you'll be our next host. Hopefully it's not. Let's get ready to run. It'll be so the ball comes out of the ceiling.

Aaron Potratz:
It'll be like in an arena somewhere.

Nathan Hawkins:
That will not be good.

Aaron Potratz:
No. Although the exposure will be great. If we have that big of an audience, it'd be sweet.

Nathan Hawkins:
Yeah.

Aaron Potratz:
Anyway, today we are starting like a two-part series. I guess they're connected, but we decided that we're going to do this in two parts. If you just do them, I think in one we just would pack them into one. It would be a little bit too much for an episode. So we're going to be talking about telehealth or virtual counseling, video counseling versus in-person counseling. That'll be our next episode. So today we're going to be talking about telehealth and when we use the term telehealth, I mean that's the kind of common language that I think clinicians use. You can call it anything you want. Video sessions or video counseling. Video therapy. I dunno. There's probably a number of

Nathan Hawkins:
Phone therapy.

Aaron Potratz:
Sure.

Nathan Hawkins:
Yes.

Aaron Potratz:
That one

Nathan Hawkins:
Will work Also, people talk on what? It's a corded phone. That's what you thought? It's a spiral cord. Yes.

Aaron Potratz:
So first of all, what is telehealth? I mean, it's basically you're sitting in front of your laptop or your computer. Some people are on their phone in their car and your therapist is in their office or their home office and they've got their laptop up. There's a camera, maybe there's a mic or headphones or whatever. And you're doing counseling virtually. You don't have to come into their office, you are doing it from your car on a walk wherever. Some people, this is great, they can do it while they're traveling. Maybe they're in a different state or a different part of the state, but they want to keep their counseling appointment. They can do that. So this is very different from in-person. And by the way, it's not really new, although I think the pandemic really changed a lot of this because everyone was staying home. And so how do you go to counseling and stay six feet apart or avoid potentially transmitting disease to somebody else? Well, virtual therapy, that became a much bigger way of doing counseling and in a lot of ways it's continued on, but it's become a little bit more purposeful. It's used for specific purposes now and it's not, I think as broad as it was during that pandemic.

Nathan Hawkins:
One thing I would say about that is interesting just as a difference between pre pandemic and post. So those folks working on licensure, at least in Oregon, it used to be pre pandemic that you could only count 10% of your hours that were considered telehealth or by phone or whatever. So if you were seeing a client, your clients that you have during the week, say you have 10 of them, you could only actually talk to one of them on the phone. Now imagine if they kept that rule. Now clinicians would revolt. Clients would revolt, but somewhere over the pandemic in the beginning they just dismissed. They just got rid of all the rules for us on the clinical side and said, do whatever you want. I mean kind of. Kind of

Aaron Potratz:
Was like that. If everybody needs to be virtual, then go for it because that's safer. All the health regulations were like don't be in person as much as possible. So it was like, okay, let's do that.

Nathan Hawkins:
Well, and they also suspended the state line stuff for a little while there. It didn't matter where you lived. They wanted people getting help. So it was like if you're in Oregon, you could counsel somebody in Nevada. Everybody's looking the other way, bro. We're suspending everything. So of course the pandemic ends and people start coming back together and they're like, it just was a whole new world. Now you are not shutting the door on virtual. 

Aaron Potratz:
That might be a song also.

Nathan Hawkins:
Oh, it might be

Aaron Potratz:
A whole new

Nathan Hawkins:
World. It's a whole new, okay. I was on video doing that this night. You want to see that? No, you don’t.

Aaron Potratz:
I like how you moved into the soprano up there.

Nathan Hawkins:
That was falsetto.

Aaron Potratz:
Yeah, but it's true. It created a new environment. And the other thing too about the whole pandemic thing is I think it really clarified a lot of things in a certain sense. You're describing how the barn doors were thrown wide open into this wild, wild west of video counseling and we got a new soundboard. That was it. But through open the barn doors for the wild, wild west of video therapy. So now all betts were off. You can do all kinds of things, but then through the process it's like, okay, we learned things. We honed our knowledge and awareness, our experience of what works or what doesn't work. And so one of the things now that has come out of this, I think that has been really good for video therapy or telehealth, is the ability to see clients who are in remote parts of your state.
So for example, we are in the Portland metro area, so the, we're in an area that is accessible everywhere around the Portland metro. You can come from east, west, north, south and get to us fairly easily. However, if you drive a little ways, let's say a little bit south and then a little bit east into the middle of the state, you're going to get into nothing land. There are places in Oregon where it's so rural or there aren't very many counselors or if there are therapists that are there, everybody knows them. So if you were to go to this person, everybody might know. You might be in the waiting room and like, oh hey Bill, I actually didn't want you to know that I was here. So seeing a therapist in the Portland area that's an hour or two away, or even three or four hours away is actually a huge benefit for confidentiality or maybe for a specific specialty. Maybe there's nobody in your town that works with eating disorders or nobody in your town that's got some specialty in gambling addictions, but you have to see somebody in the metro area farther away. But you can do that now via telehealth.

Nathan Hawkins:
I was thinking of the therapist in the small communities. They could be named, not named. There was a movie. It doesn't really matter. Anyways, I was thinking of calling them the chamber of secrets because you imagine me, that’s

Aaron Potratz:
Harry Potter.

Nathan Hawkins:
Yeah, Harry Potter. Because all that stuff that you'd be holding everywhere, it would kind of be hard as a therapist in that community. I mean everybody would be like, Hey man, you see Bill? And then you're like, you mean on my way here? Right.

Aaron Potratz:
His new,

Nathan Hawkins:
I can't tell you if I saw him in therapy, but I could tell you if I saw him on my way here,

Aaron Potratz:
Man,

Nathan Hawkins:
That'd be lame anyways.

Aaron Potratz:
Why'd you get awkward all of a sudden?

Nathan Hawkins:
No reason. No reason. I can't confirm it and I why I got offered. Wait, you’re a therapist. Is he coming to see you for therapy?

Aaron Potratz:
I can't tell you that.
Nathan Hawkins:
Call me on the phone though and we'll do therapy. What? Anyway,

Aaron Potratz:
Yeah, telehealth is one of those things that has broadened access, I think. So you're no longer limited to what's directly around you. And the other thing too is that this will get into the time and convenience factor of telehealth is that no longer are you confined to the location that you're at within a certain radius, maybe 10 miles or 30 minutes or something like that for your therapy. But the other thing is because you can see people four hours away without driving anywhere, that's pretty awesome. But the other thing too is that for a lot of people, they've got really busy schedules and maybe all they have is a lunch break at work and they don't have time to leave the office, drive somewhere 20 minutes even, and then do the counseling appointment and then drive 20 minutes back. Now you're looking at an hour 40. In this example when they only have an hour lunch break, that wouldn't work. But with virtual therapy or telehealth, you can just pop out from your office, get into your car or close your door to your office and pull your blinds so nobody can look in and see what's going on and do your counseling appointment from the convenience of your mobile device and then go right back to work.

Nathan Hawkins:
Or you could multitask, you could go to the grocery store, you can go to different places that you have to go anyway. Or

Aaron Potratz:
You could drive to pick up your children while you've got your phone hanging up. And if you do do that, your phone's going on video Zoom, for example, then make sure you plug it in and turn your AC on because your phone will overheat and shut down and we will lose connection with you.

Nathan Hawkins:
Oh yeah. And everything we just talked about our lies from the pit, don't freaking go to the grocery store. Do not do those things. That’s

Aaron Potratz:
Right.

Nathan Hawkins:
Those are the things that happen though. Hold on just a second, Johnny. I can't believe he's doing, hold on, Connie.

Aaron Potratz:
Wait. Mary, are you riding a horse? What's going on?

Nathan Hawkins:
Can everybody hear me in the background? Hi, counselor.

Aaron Potratz:
That has literally happened where they're in the car and there's like kids in the backseat. I'm like, so can they hear me?

Nathan Hawkins:
Yes.

Aaron Potratz:
No, they're on their device.

Nathan Hawkins:
And then one of 'em looks up in the back. Actually, they definitely heard me. Yeah.

Aaron Potratz:
Okay. Well anyway, let's jump back into your sex addiction.

Nathan Hawkins:
Yeah, so don't do that. You're still going to have to carve time out. Okay. Some of you guys are getting willy-nilly and wild westy with your virtual counseling and you're like, I don't even know why I'm listening to this episode. I already know all this stuff. Well, yeah, that makes sense. I mean there is a lot that everybody knows at this point. I think one of the reasons to talk about it is to highlight that there are definite benefits to it and also you need to use it appropriately.
I was talking to a colleague in Vegas, he's such a great guy. He does business a totally different way, and he was trying to think through the whole process of virtual counseling and whether or not to even have a lease anymore and that kind of thing. But the comment they made about virtual, he said, people sometimes will, the executive types and different entrepreneurs will be sitting in that situation of virtual, and then they'll literally log on, I think he said one o'clock, and then here they are, they're going to, maybe they'll eat lunch while they're there, which is, that actually is not a big deal.

Aaron Potratz:
Some people even come into the office and bring their food on their lunch break or whatever, that's fine.

Nathan Hawkins:
But then log off the counseling at 1 59 and then immediately go back to work. And part of the problem with that is that there's no time to process what happened. And so you do need to figure out some way to account for that virtually. And the other thing is that he said, the other thing that can happen is you have throughout the session, you're sitting there on your computer device or whatever you're on, excuse me. And it's pinging an email comes in, boom. So there's certain kinds of distractions that you have to manage that I think it's not okay to put up with, I mean, you've got to create some environment where you can focus and then you can spend time afterwards. If you're going to take this seriously, you're going to pay money to do it. You need to give yourself the space to integrate what it is you're learning and going through and processing.

Aaron Potratz:
And I mean, I did this too with my own therapy. During the pandemic, I would have virtual sessions and I would take notes on my computer. I use on my MacBook, I have my notes app, and I would take notes during the session. But the thing is, and I really would do exactly what you're talking about, where I would, I think it was first thing in the morning or maybe end of the day or whatever. So I would log on, do my appointment, and then immediately roll into some other appointment or vice versa, roll out of my last appointment into counseling and then move on with my day or whatever. But the thing is I had to really be intentional about going back to those notes and looking at them like that day of like, okay, I did therapy. Let's reflect on this. Even if I couldn't do it right away, I had to come back to it and see, okay, what were the key things?
What were the takeaways? Let's revisit this. What do I need to learn and know it's spending that time revisiting, rehashing, whatever was talked about in therapy, I think is the way you can make the most use of that time. So it doesn't just happen, check the box, did it, whatever happened inside the session was good and helpful, but then you're done with it. Because then essentially what you're looking at, and I remember saying this to people quite a bit, is you only go to therapy if you are doing it once a week for an hour. And how many days and hours are you in the rest of your life? I mean, it's like hundreds or whatever. And so you're doing one hour a week in the session, and then if you don't think about it or process or do anything with it, then that's a tiny fractional percentage of the rest of your life. But if you're taking time to think about it, process it, maybe talk to somebody else, then that number grows and that's where you're going to have the biggest impact or a lot more change possibility.

Nathan Hawkins:
All of the change process involves a commitment to action. And a lot of that you can have a great commitment, but you might not be reminded because you're not thinking about it in the times that you need to be thinking about it. And you definitely won't if you're counting on us as therapists to just tell you to think about it. And we're only doing that for one hour. I mean, we're telling you during that hour and you probably are actually thinking about it then. And then the hour is done. You have to figure out some ways to integrate, which means you have to figure out, you have to give space yourself space to do so. I mean, the other thing that's happened, I think in the very beginning of the whole pandemic, this was not true. People were very focused and had the space to do it, but somewhere over the course of time in the land of multitasking, there's been this lesser commitment that happens with telehealth. Like, oh, I was going to come in, but I had to go blah, blah. So it's like a last minute. Can we just do virtual? Yeah, we can do virtual. And in my mind, I'm always like, are we now not as committed to this in this

Aaron Potratz:
Hour? It's fine. It's great when it's a one-off or a, Hey, this thing is happening. I got squeezed out in my schedule, whatever. Can we just do telehealth? It's like, yeah, that's a great way to maintain the consistency of your appointments without losing that week to week. But if that becomes the continual thing that actually can, like you said, it can devalue, devalue the sessions or devalue therapy, looking at it more as like, where can I fit this in and make it as much of a priority in my life versus when you're in person, it's a bigger commitment. And we'll talk about that in the next episode of the commitment that it is to spend that much time, but you're also getting a whole lot more value from it.

Nathan Hawkins:
So there's a lot of benefit to virtual, especially when it comes to treatment with specializations and that kind of thing. And the other thing that the pandemic did with the virtual thing is there are states that are kind of trying to figure out how to group themselves together and respect each other's licensure process so that you can actually practice in another state without having to have a bunch of licenses. I don't think We're not there yet, but that's on the way. It's on

Aaron Potratz:
This way. And the reason for that, if you think about it is, and I've talked with some people around here that they've got some medical issue and they've seen a bunch of doctors around here and literally tapped out the market and nobody knows what to do, but there's a specialist that's up in Washington, maybe towards the Canadian border, for example. Well, that makes sense if you can drive up there and get care. But if we're talking therapy and you've got a specialist in a different state and that person doesn't have a license to treat you or whatever in your state, that person might be the one that you need in order to get help. But because of these stupid regulations, they can't treat you. But if that's changing, then if you have a specialist in a different state that you need to see for your particular issue, those doors could actually open up to be able to get the help that you need. So it's moving in that direction. I think we'll probably get there pretty soon in the next five years or so. The other thing I want to say as we kind of wrap up the end of this telehealth session is that, I don't remember what I was going to say.

Nathan Hawkins:
You lost it.

Aaron Potratz:
I did.

Nathan Hawkins:
That's what happens on telehealth. You're multitasking. You want to change this to virtual.

Aaron Potratz:
Yeah, this is virtual.

Nathan Hawkins:
As virtual as it

Aaron Potratz:
Gets, what are we going to have all of our listeners come in person to a stadium arena?

Nathan Hawkins:
Oh, that's a next level.

Aaron Potratz:
I know a live podcast. I

Nathan Hawkins:
Actually

Aaron Potratz:
Saw that on a comedy show.

Nathan Hawkins:
It's all about the thing I guess that we wanted to try to do is just, yes, telehealth is really cool. It's very convenient, but if you treat it as a convenience, it's a problem. It won't be that helpful. You'll need, it'll be interesting to see the studies coming out because my thought is that telehealth is probably going to be one of those things that there's going to be a bit more of a convenience factor that's going to taint the efficacy of it. I could be wrong, but I just experience it enough to where sometimes I'm like, hello, because I'm doing a phone thing or whatever, and I'm on mute on their side, meaning they're listening to me, but I'm muted. So can't what's going on over there type of a thing because they're doing 15,000 other things that are happening. And so I think, and for us therapists, for those therapists listening, you do need to try to be more intentional with your client and hold those folks more. I'm talking to myself too. Hold those folks more accountable to carving the time out. I also think, depending on your therapist, that you might need to adjust your times in the sense that stopping early to give them space to process if they have to go back to work, just saying like, yeah, we actually should stop now so you have a little bit of time to consider this stuff. And honestly, we wouldn't do that in person. That would be a totally different

Aaron Potratz:
Intervention because you have the commute to getting back in your car to make that transition. Even if you're just down the road, you have a few minutes to make that transition, and you have all those cues leaving the office, getting into your car, getting into new scenery, walking back in the office, all those cues are transitional elements.

Nathan Hawkins:
Right. Well, I think in considering all this, we hope that you've loved this virtual production of the podcast. Have a great day.

Aaron Potratz:
Thanks for listening to our show. Don't forget to head over to Apple Podcasts, Spotify, Stitcher, or wherever you get your podcast, to leave us a review and subscribe to our podcast so you never miss an episode. You can also visit our website at www.shrinkthinkpodcast.com/course and sign up for our free email course, nine Ways to Overcome Fear and Self-Doubt. And you'll get nine weeks worth of customized, practical strategies you can use to get past the fear that's holding you back in your life. Thanks again for listening.