Telehealth Best Practices: Gunter Swoboda of Swoboda & Associates On How To Best Care For Your Patients When They Are Not Physically In Front Of You
An Interview With Dave Philistin
My concern is that we are quick to jump onto the next shiny innovation without considering the bigger picture. We all too often see technology as the solution to a problem when in reality ‘the cure is often worse than the disease’. We need to take a more ‘devil’s advocacy’ stance in the application of new technologies.
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 Gunter Swoboda.
Gunter Swoboda is a psychologist, author, speaker, mentor, producer and host of the globally syndicated podcast Inspire Change with Gunter. Swoboda is the creator of the Making Good Men Great movement along with his wife, Lorin Josephson. Recently, The New York Times called Gunter’s debut novel Mountains of the Sea released on June 1st of 2021 from Winterwolf Press “Visually enticing, with a very masculine, but fractured lead character trying to find his way that many young men can relate too…the story arc’s strong thematic and through-line keeps you engaged all the way to the last page.” Additionally, he has authored the non-fiction Surfing the New Wave of Masculinity: Making Good Men Great, produced/created the Venice TV Award nominated Masculinity That Inspires Change for Amazon Prime and was Consulting Producer on psychological drama and upcoming feature film Lifelines that will be released this winter.
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 please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My fallback Life Lesson Quote is ‘No pain. No gain.” Every sphere in life rests on this principle. If we don’t experience discomfort and pain then we never learn self-awareness, flexibility and resilience. We don’t improve our skill sets when we don’t stretch ourselves and experience some pain, and ultimately, we stagnate and live a hollow existence. The analogy I often use is that when you learn to surf, you’re for a lot of fear, frustration, and from time-to-time actual pain. These come with the territory even when you’ve become an accomplished surfer.
None of us can 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?
At the beginning of University, I met my wife and soulmate. She and I have shared a lifetime of love and adventures, including sharing our passion for our work in philosophy, gender studies and psychotherapy. Most recently, we have become partners in crime in co-writing fiction. More importantly, my wife is part of the Making Good Men Great faculty. We have focused that our ability is a true measure of practicing what we teach. It is part of our commitment to helping men and women work together in a non-patriarchal way. Recently we finished our first collaborative work that is now with the editors. The amazing thing was how easy it was to do when we stuck to all the principles that support a good relationship and teamwork.
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?
Firstly, we need to distinguish between medical service provision and psychological assessment and therapy in considering the pros and cons of Telehealth. A friend and colleague of mine, Dr Mark Williams, a neuroscientist, and I worked on an article on the use of AI in psychotherapy and counseling. Our position is that we are social beings, and we understand and learn through connection. A large percentage of our brain evolved over millions of years to enable us to connect and socialize. This evolution has been in the context of close proximity and is essential for human beings to thrive.
These multiple brain systems enable us to connect, understand and empathize with others. In that moment of contact, mirror neuron systems activate. For example, when another person smiles, brain cells in your frontal lobes become active, resulting in micro-movements of the same muscles in your face. This also results in the release of neurotransmitters that make us feel as though we are smiling. This process enables us to understand and appreciate how the other person is feeling.
Our neural system allows us to automatically read body language and mimic it to create a sense of connection. We can tell with amazing accuracy how a person is feeling simply by their body language. Via the mirror neuron system, we activate the same neurons that would generate those muscle movements in ourselves, supporting our understanding of how they feel. We also mimic their stance or sitting position to make them feel more comfortable and relaxed if it is a friend or feel threatened if we are in a confrontation or feel attacked.
This automatic exchange of input is critical in establishing rapport and connection towards an excellent therapeutic relationship or any relationship for that matter.
There is a further distinction that is important to consider. In the mental health field, there are some qualitative differences between psychotherapy, counseling, and coaching. These differences are not set in stone but are useful to consider in the context of delivering psychological treatment. Psychotherapy relies on the immediate here-and-now presence of two or human beings close to each other. This is by and large a deep state of contact between the therapist and the client(s) wherein the subtle psychodynamics are critical to the growth process. Counseling, although very similar to psychotherapy, can have a more practical component to it, while coaching is outcomes/skills training focused.
Of course, all of these benefit from having the patient/client in front of me. Ultimately, it is our view that AI cannot be effectively applied to the process of psychotherapy and counseling. If we consider this in relation to Telehealth, then I would argue that Telehealth can work for coaching and mentoring but has a limited application in psychotherapy and counseling.
Telehealth in the context of medical service provision has excellent benefits, but there is still a need to see the patient face to face. A large part of primary care is based not on symptoms but hands-on interactions between patients and doctors. Pediatricians, for example, need to assess developmental milestones, growth and development and any potential findings that could be an early sign of future issues. Across primary care, it is difficult for PCPs to effectively counsel patients without seeing their body language or nonverbal feedback, not to mention the challenges in giving immunizations or conducting preventive screenings. While some urgent issues can be addressed via Telehealth, regular check-ups and other annual screenings are best handled in person.
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?
The first thing that comes to mind is that I have a restricted flow of information when my client is not in the same space as me. A good analogy is standard definition TV versus 8K UHD with surround sound technology. This difference may not be that important whilst to others, it is the difference between a good and great experience. As a therapist, I’m trained to pick up on not just what my client says but also to be able to ‘read between the lines.’ Screen-based technology and audio has come a long way but is still not the same as when we sit with each other face to face. So, in Telehealth, I have limitations in my perceptual field. This makes it harder to pick up essential nuances that could facilitate self-awareness, insight and understanding in the client. It also means that I’ might be more fatigued after a series of Telehealth encounters than I might be after face-to-face sessions.
The other issue is the restrictions on the fickleness of the technology. It is not perfect nor consistently stable. For example, I recently spent two weeks getting my high-speed internet connection back online. This meant I was not able to use Telehealth technology. Not only is this frustrating for me, but also for my client.
A further issue is to educate the client on how to maintain confidentiality in their environment. I’ve not had too many problems with adult clients with this, but I also work with teens, and it may not be that easy for some teens to maintain appropriate boundaries.
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 ?
If I must choose five key points, then it would be the following:
- Assessing when and how to set up face to face services as opposed to Telehealth.
- Teaching the client to control their environment.
- Informed consent and Confidentiality
- Commitment to the idea that healing and personal growth is not solely based on a session at a time. It is an ongoing process.
- Reviewing the process and content with the client.
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 main benefits are that Telehealth can provide clients in remote areas access to a wider variety of practitioners to choose from. In addition, as a practitioner, it allows me to expand my client base internationally and in remote rural locations.
Also, homebound clients will have the opportunity to get assistance, Therefore Telehealth provides an excellent alternative.
It also creates more opportunities to schedule with their therapist. If they can’t make it back and forth to the office for a 1-hour appointment with drive time, this is a great alternative to make that appointment happen. Similarly, at a time when many people, like Grey Nomads are choosing a more mobile lifestyle, they can have access with their practitioner providing strong continuity of service.
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?
I look for a stable and secure technology. And there are more and more available. Personally, I tend to use FaceTime and Zoom most. I’m familiar with them and in my experience, they have been stable platforms to work with.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I think the technology is about as good as it gets for a while. I am possibly developing Holographic technology as they depict in Star Trek, where it allows the person to be virtually sitting in my office. Still, I can’t see that happening for a long time. Again, even with the most sophisticated technology where the quality of image and sound is superb, I doubt that it would be as good as face-to-face contact. You can’t beat the sophistication of evolution of human beings with the technology available.
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?
If the issue is that there is no opportunity for face-to-face contact, then my view is that it is important that the client is open and committed to activities between sessions that support the work being done in the Telehealth session.
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?
I think that technologies like VR, AR and Mixed reality will have their place in some way or other. There was some research happening in treating PTSD through VR. I’m not sure how significant or effective the results were and how good the technology in treatment can be.
Is there a part of this future vision that concerns you? Can you explain?
My concern is that we are quick to jump onto the next shiny innovation without considering the bigger picture. We all too often see technology as the solution to a problem when in reality ‘the cure is often worse than the disease’. We need to take a more ‘devil’s advocacy’ stance in the application of new technologies.
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. :-)
I do currently have a global movement that I founded with my wife Lorin Joseph called Making Good Men Great and I would continue improve and spread the word further as it is imperative that we deconstruct patriarchal socialization. It perpetuates cultural and individual toxicity. Through it we can teach and help boys and men to pursue a fuller life away from the crazy hyper-masculine ideas that have led to rights abuses, wars and corporate and political disasters.
How can our readers further follow your work online?
The website for the movement is: www.GoodMenGreat.com, my website as an author/speaker/producer is: www.GunterSwoboda.com, our podcast Inspire Change with Gunter, now in its third season can be found on every major platform and here at spreaker.com/show/inspire-change and you can follow the movement on Facebook at facebook.com/GoodMenGreat
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.
