Telehealth Best Practices: Dr. Norman Blumenthal of Ohel Children’s Home and Family Services On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Learn how to articulate emotions from a distance. The vocabulary of emotions and concern become more relevant during a telehealth session. It is often striking to me the abundant nomenclature we have for scientific or technological phenomena and yet, our vocabulary for nuances of emotions is so lacking. Identify ways to decipher a mood or sentiment that would otherwise have been conveyed by your physical presence.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Norman Blumenthal.

Dr. Norman Blumenthal is a licensed clinical psychologist who serves as the Zachter Family Director of Trauma and Crisis Intervention at Ohel Children’s Home and Family Services in New York. In this capacity, Dr. Blumenthal leads a variety of inclusive bereavement counseling and trauma resources, guiding and nurturing families during their time of need. Over the last year, Dr. Blumenthal successfully spearheaded the launch of Ohel’s “TheraZoom” — a real-time telehealth offering to provide mental health and wellness support on a national scale.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

My entry into a specialization in bereavement and trauma began quite innocently and unexpectedly. It was about 25 years ago and a social worker from an organization that helps families with children struck by cancer asked to meet with me. She stopped by my office and told me they had a number of children who died this past year, and wanted to organize a retreat for their parents. I was asked to serve as the “anchor” or main speaker for the retreat. At first, I was flattered they thought of me. Later, I found out that I was the seventh psychologist they asked. No one wanted to touch it. I had much hesitation but told the social worker I would think about it. Later that day, when I had a break, I gave it some thought and said to myself, “If you are a mountain climber you want to tackle Everest. This is Everest.” The rest is history.

Can you share the most interesting story that happened to you since you began your career?

A bedrock of psychology is empathy. Empathy as it differs from sympathy is a capacity to put yourself in that person’s place as if the events were happening to you.

Very early in my career as an intern, I learned a lot about empathy. I was working with a seasoned psychiatrist, Dr. Sylvia Axelrod. We focused on Holocaust survivors and their children who needed psychiatric hospitalization. We presented and wrote up our experiences, which naturally resulted in invitations to consult. One time, a neighboring psychiatric facility asked Dr. Axelrod to visit and I joined as the “sorcerer’s apprentice.” The facility had a patient who was a Holocaust survivor and whenever her past traumatization was mentioned, she minimized the issue and refuse to discuss her experiences. Dr. Axelrod interviewed the patient in front of all of us asking her about her breakdown, hospitalization, medication and the like. At one point, Dr. Axelrod referenced the patient’s history surviving the Nazi concentration camps. The patient shrugged as if to say it was no big deal. Dr. Axelrod, a contemporary of this woman, then said, “I want you to know that as an American who has never lived through anything like that, there is no way I can relate.” The woman started to cry and said, “Finally someone who understands.” At that point, I realized that true empathy is sometimes saying I can’t understand. Earlier in my life, my goal was to be smart. In times like this, I quickly realized it is a lot harder and more important to be kind.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

One of my favorite quotes and guiding lessons is, “Life would be unbearable if it weren’t so hysterical.” Humor with taste and consideration is immeasurably essential to my work and life. The joy of laughter counters pain and potential hopelessness. More importantly, the punch line of a good joke often captures irony and the unpredictability of life events.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

My late parents had challenging lives. My father was a refugee from Nazi Germany who spent four and a half years in the American Army during World War II, ultimately decorated for his service. Less fortunate, my mother was a survivor of seven Nazi concentration camps. I learned much from their enduring drives to live, prosper and acclimate despite traumatic pasts. As important, if not more so, I learned from our relationship that having almost diametrically opposite life experiences and histories does not preclude connecting and growing together. This is so endemic to what I do professionally.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

In my role as a bereavement counselor with a specialty in parental loss of a child, I was asked to address the parent body of an out-of-town school after the tragic death of one of its young students. I was speaking in a very open room partitioned off for my talk. A woman, whom I had assisted previously when her child died, arrived late probably ambivalent about attending what might be a triggering event. Afterwards, she told me that as soon as she entered the room and heard my voice, she already felt more composed. It’s hard to substitute for the impact of one’s immediate presence especially when engaging in psychotherapy or counseling. So much of the impact is rooted in the non-verbal presence of the provider and the patient’s personal connection.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Once I led a group for bereaved parents, one of whom was deaf. A sign language interpreter was hired to assist him. What struck me while watching the interpreter was how much more he had to do than translate. He had to quickly look at the communication source since there were many individuals speaking and the patient could not discern from whom the particular verbalization was coming from. More germane to our discussion, the patient couldn’t hear the emotional tone of the conversation, which had to be conveyed through accentuated facial expressions and motions.

Similarly, the challenge for facilitating therapy remotely is to impart and hear the emotions and passion that are more easily discernable when in one’s immediate presence. Even periods of silence that are not uncommonly a part of therapy need to be supplemented with facial expressions or nods.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You?

1. Learn how to articulate emotions from a distance. The vocabulary of emotions and concern become more relevant during a telehealth session. It is often striking to me the abundant nomenclature we have for scientific or technological phenomena and yet, our vocabulary for nuances of emotions is so lacking. Identify ways to decipher a mood or sentiment that would otherwise have been conveyed by your physical presence.
2. Develop a more dramatic and graphic manner to impart facial expressions and voice tones. Both are inevitably diluted when you are communicating via devices and from a distance. It is almost as if acting lessons need to become part of a therapist’s training. Many patients who recall painful ordeals find the attentive absorption of the therapist helpful and validating. Many traumatized patients, including a large part of the population we treated this past year, have expressed enormous relief and gratitude recounting their ordeal while the therapist offered little or no advice but resonated with their pain and injury.
3. Remember (as often the case in psychotherapy) one size does not fit all. It has become evident the variability of patients’ receptivity to telehealth. There were some who found the distance and reliance on devices a facilitation to disclose and discuss very personal matters. At the other extreme were those who could not fathom sharing their most personal matters without the physical presence of the provider. Exploring the receptivity to teletherapy and respecting the patient’s spontaneously expressed preferences is essential.
4. Leverage methods provided by internet communication programs to your advantage. Screen sharing can be used to share resources, especially by patients who want to discuss matters best conveyed by emails they received, photographs, drawings and the like. Much of grief counseling is enhanced by viewing videos, letters and mementos that can be so easily downloaded and viewed jointly.
5. Understand how technology for interpersonal communication is a skill unto itself. It has become imperative that psychotherapists learn the ins and outs of telehealth and how to proficiently manage the procedures. For example, the lighting and background of your telehealth site as well as the clarity of your camera and audio cannot be poorly constructed or something that you are fumbling with as your patient is divulging or sharing some of their most personal and/or painful experiences.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

The breadth of services provided and ease of scheduling are enhanced by telehealth. During the pandemic, our team at Ohel serviced individuals throughout the country and the world, which we obviously would not have been able to do working exclusively in person.

Harry Stack Sullivan is famous for saying, “Patients come to therapy for two reasons: one is to change and the other is to stay the same.” There is understandably an ambivalence about growth or recounting a painful past. The distance of remote treatment allowed patients to put their toes in the water and carefully ease into the therapy process.

Simply being spared the commute to the office supports participation. Several of my patients have described how therapy in the comfort and security of their home lends itself to personal disclosure and risks. While a few patients employ virtual backgrounds to block the appearance of their homes and rooms, most actually appreciate a therapist’s entry into their private domain.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

While often used more for humor or lighthearted communication, emojis can be an effective way to clarify or illustrate a mood or emotion that would be more evident in person. It’s a language unto itself that therapists need to master. Breakout rooms are most effective for professional training but can also be employed during family or group therapy sessions to allow an opportunity for subsets of the participants to communicate or connect.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

Teletherapy is not traditional psychotherapy simply conducted via a computer or tablet. It is its own unique type of therapy that requires research and development. It will continue to take some time and effort to determine how to design better features and offerings as we listen to patients’ needs.

Comedian Steven Wright is famous for saying “I plan to live forever…so, far so good.” We plan to master and perfect telepsychotherapy…so far, so good.

Today, I am working to rapidly master the art of telepsychotherapy along with my colleagues. Within this exploratory phase, the focus is on skillfully comprehending and communicating facial expressions, voice and comparable cues that compensate for the absence of an immediate presence. I have even learned to use hand motions in view of the camera to bring home an important point. Younger patients in particular are screen sharing pictures, performances and screen shots of text exchanges to bring the therapists into their worlds in a manner that mere verbal descriptions would fall far short.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

While this method of providing therapeutic assistance is evolving and changing, the commitment of the provider and field of mental health remains undeterred. Those ingredients can assure that future therapeutic interventions will probably integrate what we are learning about remote care to employ it more effectively.

At the end of the day, the patient is the best judge of whether they are getting the best results of any therapeutic intervention. As little as a physician can tell a patient they are healing if the pain and symptoms are still present, the therapy patient is usually the best judge of whether the treatment is on the right course. Much psychotherapeutic change is painstaking and slow with “two steps forward and one step backwards” but the overall relationship and process should be salutary.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

If you told me ten years ago my practice would be primarily online based, I may have laughed a bit. First, I want to see how current online platforms can further support accessibility to disadvantaged groups, like the disabled or elderly, populations who struggle with isolation. The face-to-face factor with these groups is incredibly important. With that said, the concept of working with a younger adult subset in a virtual world — an exploratory setting where they have an opportunity to find comfort in the environment — has great potential to serve as a supporting tool in therapy.

Is there a part of this future vision that concerns you? Can you explain?

Given the frequency of hacking and unwelcomed encroachments through the internet, I have concerns about the preservation of confidentiality as we rely more on teletherapy. I also have concerns regarding the blurring of boundaries between psychotherapy and social media at large. As it becomes more conventional to share personal matters on social media sites, it may also become less meaningful to share those very private parts of oneself during a therapy session. The former is a means of general connection and socialization. Therapy, in contrast, is a process of painful and laborious disclosure aimed towards growth and change.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

The hockey great, Wayne Gretzky, was famous for saying, “I skate to where the puck is going to be, not to where it has been.” I truly believe that telehealth and telepsychotherapy will be with us even when the pandemic is long gone. I welcome the opportunity to learn new therapeutic techniques ideally suited to remote contact, research the impact of these innovative methods and integrate the enormous contribution psychotherapy has made to the betterment of humankind with this new reality of how we communicate and interact.

This metamorphosis will not take place exclusively in a therapist’s office. The global underpinnings of all relationships must adjust to this new overriding means of communicating and connecting. I do believe all relationships will adjust and change. My dream is not to “throw out the baby with the bathwater.” I hope we can preserve the cherished aspects of communicating and connecting in one’s immediate presence, while being enriched by the vast scope and possibilities of technologically based communication. For example, with the meteoritic growth of social media, there is an erosion of personal privacy. The disadvantage of this change is that different gradations of interpersonal closeness and intimacy is often defined by how much of yourself you share with the other person. If everyone knows everything about everyone, how are more intimate relationships defined? On the other hand, as we become more comfortable being open and honest, age-old stigmas and prejudices will also go by the wayside. We have to find a way to nurture the benefits of this new communication while sidestepping its potentially harmful effects.

How can our readers further follow your work online?

Readers may visit my page Dr. Norman Blumenthal. Feel free to leave comments and suggestions for content. Also, learn more about Ohel and our work here.