Who Knew? A Crash Course in Telehealth


Six months ago, we didn’t know telehealth. We didn’t intend to learn so much, so fast, but if we wanted to continue to serve our community, we were going to have to. Some of our experience was expected, but I was also surprised by some of it and delighted when I discovered unexpected benefits. I asked my colleagues at CCD to help me share what their experience has been like, for us, for our clients and for our work

At first, we didn’t know what to expect and much of our energy was in researching and test driving various platforms. There were certainly times when the distraction of figuring out the technology prevented us and our clients from being truly present with one another. I noticed, however, that when a client and I had challenges with technology, we also got the experience of working on a problem together and solving it. It felt like the therapist-client team scored the big point when my video finally worked and we both cheered and then laughed about the strange time that is 2020.

Much of what changed was the result of just putting in the time. “If you want to be good at something, you must first be willing to be bad at it.” So that’s how we started the first hundred sessions with clients – badly. But Brittany Zielinski observes that “after some time, it began to feel normal; it was business as usual.” Alex Guerrero says that it was “awkward at first and still is for some of my clients or even specific sessions.”

Many of us were surprised at how quick the new format began to feel normal. Megan Pardy notes, “I was worrying for nothing and I have been able to have just as easy of a time building a relationship with my clients online as I did in the office.” She also observes some of the unexpected benefits: “It is also great to be able to see their homes, rooms, and prized possessions, as this gives me further insight… … I am also grateful that they seem to feel comfortable being on their own turf, as well as being safe from the looming disease in public.” Alex says that some of his clients now prefer telehealth. “Talking via video calls was something they had been doing for years. It felt more familiar and comfortable to them, rather than going to an office. It was easier for them to open up.”

Marcos Gonzalez noted other challenges for him as a therapist, “It’s a bit weird because I can not see all the body language like if they are shaking their legs, keeping the hands together or crossed arms.”

The technology is always a challenge and the digital divide is real. Some therapists and clients have high speed internet, stand alone cameras, and are tech savvy while some are just trying to hold their cell phone in a way that is least distracting for themselves and the other. Alex says “I’d say the main challenge is getting started. Getting paperwork back promptly is rare.” Marcos noted the challenge for his clients of learning how best to place the camera, so it is steady and a helpful distance and angle to their face.

One of the ongoing challenges for some clients is privacy. Megan shared, “I also have clients I used to see in the office that did not want to do virtual due to a lack of privacy from their parents, a privacy they had when seeing me in the office.”

I also have found a difference in how I experience on line counseling. The content seems more compressed, like we didn’t waste any time on side conversations. We’re covering territory more quickly, but still effectively.

In the end, counseling via telehealth is not better or worse than face to face counseling. It’s just different. It brings services to some who might not otherwise receive services. One of Marcos’ clients was receiving services from 550 miles away.

Telehealth makes some feel safer. It interferes with some people’s sense of intimacy. It changes the way we observe and respond to social cues and the way we signal to one another during a conversation. Alex is looking forward to having more face to face because as a therapist, “I feel a missing sense of connection. Some je ne sais quoi thing is missing when you’re not physically with the person, for me at least.”

Our clients are split on the issue, half relishing the opportunity to return to face to face, with the others happy to have the convenience of therapy anywhere anytime. 2020 has forced us to expand our offerings to our clients and probably changed our profession forever.

Contributing Therapists: Marcos Gonzalez, LPC serves Spanish speaking clients of all ages. Alex Guerrero LPC Intern loves play therapy and working with parents of younger children. Brittany Zielinski, LPC, another play therapist, also works with teens and their parents. Megan Pardy LMFT Associate is a provider for our free Family Tree Program.

Jake Jacobson, LCSW practices at CCD