Therapists Face Different Challenges with Telehealth
”In a moment, saving a bird”
The pandemic has forced medical professionals including mental health professionals to rethink how they do their jobs.
I called my client promptly at 10 am for an appointment we had scheduled. No answer. I called a few more times. About 10:10, I got this text. ”In a minute, saving a bird.” Ok, then. I like birds. I wonder what kind of bird? I pictured her putting it back in a nest or in a box in a warm place, or? I waited til about 10:30 then got another text “do you have time later today? Well of course I have time but….
Isn’t it my time? Already designated for relaxing with my husband. Or taking a walk or starting dinner? Or just being quiet and alone?
Boundaries get blurred
The pandemic has forced medical professionals including mental health professionals to rethink how they do their jobs. Since early March, after a scare with a client who had been exposed to the virus, I have been doing therapy from home. Of course, this is safer for me and my family.
I am in my 70s and live with a man in his 70s who has several risk factors as well. The thought of sitting in a small room across from people who may not be as careful as I am, talking and gesturing and laughing and crying, (and how do you do therapy with a mask, for Pete’s sake?) sounded like a set up for catching and spreading the virus. I was freaked out in March.
I went home, set up an office there, and began using the telephone and internet to connect with my clients. My main goal was to keep talking with my people, to console, encourage, and steady them as we all went through this pandemic for a few months.
The few months turned into six with no end in sight. I didn’t want to keep paying rent and utilities for an unused office so decided to give it up. Now I work from home permanently. I set up some office hours but it’s hard to stick to them, because of birds. And other things.
So I tell my client, yes, we could talk at 2:30 this afternoon. That’s within my stated office hours. Even though I had hoped to be finished before then, I can deal with it. That’s what I’m here for.
Some time before 2:30 she calls to cancel, saying she’s too tired and can we talk tomorrow morning. Tomorrow is Friday, my day off. No, I’m not doing that.
My usual policy with people who miss appointments for non-emergency reasons is to have a talk about the value of my time and the need to prioritize their treatment. If this were a client with private insurance I could charge my standard $75 missed appointment fee. This is not possible in this case. So I take the loss of income, because of a bird. But I like birds.
When I worked at the mental health practice of the local hospital system, the staff kept a running list of creative excuses clients gave for missing their appointments. Here is a sampling:
I missed my appointment because:
- My dog just had puppies
- I’m stuck on the rotary and can’t get off
- I’m expecting my period
- I might be getting depressed
- I’m too anxious (the only reasonable one)
- My kids won’t stop whining
To which I could add
- I’m saving a bird
While clients don’t have to drive to see me now, invalidating all the excuses involving flat tires, keys locked in the car, money for gas, and the danger of driving in ice and snow in winter, instead, there are different excuses like this one: I need to get my husband/child breakfast, the internet just went down and Joey has to go online for school, my wife can’t find the car keys, etc.
And there are many more interruptions than in my pleasant, private office. I listen to children fighting and ruining their parent’s train of thought; I tolerate cats swishing grandly past the screen, tails high (and close-ups of cat butts). There are the occasional tantrums of younger children, endless arguments with older ones, requests for help from unknowing, and sometimes undressed, spouses.
On top of that, there are situations like the long-awaited plumber arriving just as we are about to start. Or a virtual meeting with a doctor rearranged for our appointment time. Of course, if my clients were organized and assertive with good time management skills and clear priorities, meeting with me might be unnecessary. But I know they need help with these things.
This is a new age for all of us and most of us are trying our best to stay afloat, help our fellows and figure out creative ways to solve problems.
It is harder to keep my own boundaries
Another problem is that, mixed in with my clients personal lives, now a part of each session, is my own life. And it’s harder to keep them separate..
I have an office but it’s upstairs. Sometimes I inadvertently answer a call from an unknown number, thinking it might be a repairman I’ve called, and there I am in the middle of frying okra trying to sound professional to a potential client. My private life would be interrupted constantly if I didn’t at least try to screen calls. Even so, I am often caught apologizing to someone I’ve never met for my frustrated or too-familiar tone, and attempting to explain. I am not quite the same person as I was in the office. Maybe this is a good thing, I’m not sure yet.
I find myself talking to people during their commute to work and wanting to send them a summary of our session so they remember the important points. This is probably a useful change. I am sending links to relevant online articles to clients instead of giving them handouts, saving a lot of paper, I guess. If people don’t use the internet, not always a ’given’ with my clients, I snail mail things to them. That’s ok, in fact, I think we have all been exercising unused brain cells to solve some of the new problems we face.
I’ve noticed that I tend to think about clients more often during the day, sending them useful links to things I read or pictures I’ve taken. I occasionally call them at odd hours to check on them if they were having a hard time. When I was a therapist in an office I rarely thought of clients when I went home. I know my work is wheedling it’s way into the very core of my personal life. Is this a “boundary issue” or just how it is in a pandemic. Who knows?
To sum up
- I am not quite the same person at home as I was in the office
- My clients and I know more about each other’s private lives than we did before
- It is harder to keep my personal life separate from work
- During sessions, it is harder to avoid distractions on both sides
- The pandemic has become a routine part of our check-in, sometimes part of our goals
- I feel kinder, softened toward my clients facing the same pandemic restrictions and challenges as I do. I break “the rules” more often.
I would like to hear how doctors and nurses and other caregivers perceive the difference created by the pandemic in their relationships to patients or clients. Though these people may not be working from home, there must be changes in how they perceive and accomplish their work.
I know one thing. This is a new age for all of us and most of us are trying our best to stay afloat, help our fellows and figure out creative ways to solve problems.
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Jean Anne Feldeisen is a writer, cook. and cookbook reader. She writes about cooking, food, books and aging well. Jean has been reading and writing poetry since age 5. The memoir Dear Milly is her first book. She is seventy plus years old and just getting started.