What does a psychologist think about online treatment?

“What does a psychologist think about online treatment?”

The following article is an English translation of an interview with a Dutch psychologist working at GGZei, a mental healthcare treatment centre in Eindhoven (December 2018); the original article in Dutch can be found via this web link: https://www.ggzei.nl/innovatie/online-behandelteam/nieuws/hoe-denkt-een-psychologe-over-online-behandelen

Since August 2018 I have been working as a psychologist in our online treatment team. In the past 20 years, I have conducted mostly face-to-face sessions, and online treatment was not very common. During this time, we did start to use more email and also WhatsApp, which resulted in more and faster contacts. I had never worked with online modules before, in our case the modules from Minddistrict. I will summarize my first experiences with online treatment.

The main questions I asked myself before starting with online treatment were:

  1. How will it work effectively? … working with modules to address a specific problem combined with video consultations.
  2. Can you make a treatment report via video? Can you really connect and build a working relationship with your patient?
  3. For my face-to-face consultations I used a Whiteboard; will a ‘wacom’ have the same effect?
  4. Will I have more ‘no shows’ with online treatment?
  5. Will I enjoy it? Will I enjoy the development process of the patient in the same way?

In what follows I will further elaborate on each of the questions.


Ad 1. How will it work effectively? … working with modules to address a specific problem combined with video consultations.

I quickly realised that the combination of video conferencing and working with a module was very powerful. It allows you to jointly focus and work on pre-set targets. Video consultation allows you to deepen and strengthen the working relationship with the patient. In my previous job, I had great face-to-face conversations, but it was difficult for the patient to remember what was discussed during such a session; sometimes it looked like the patient had already forgotten his/her new insights when leaving the therapy room. When they go back to their day-to-day lives there is a high risk of them also going back to old patterns. When returning after about a week or two they have difficulty recollecting what was said during the previous session. Online treatment allows me to better assess in advance if a patient has invested in his/her own treatment; were the assignments carried out, and was there reaction to my feedback? These are all extra topics to discuss. What has been the reason for not working on your module or why was there no follow-up on what was agreed?

With online treatment, you can send reminders, if this fits into the treatment. It also allows you to make a better assessment of someone's understanding of the psycho-education modules. It gives the patient enough time to write down the answers to the questions asked, leading to more and faster insights, for both the patient and therapist. There is more consistent learning, as the patient works more than once a week on an assignment. On the other hand, it forced me to sit on my hands and give the patient enough space for he/she to work at his/her own pace. As a professional, it is important to set your own rules on how to deal with social media. In my private life I reply to all email/WhatsApp and then I let it go; in the beginning, I also did this for online treatment. You have to decide what is healthy for yourself and for the patient. For me, it turned out to be sitting back, taking action and letting it go. Think clearly about if and when you should or should not send a reminder to a patient; and discuss this also with the patient.        


Ad 2. Can you make an effective connection with the patient via video? Can you really build a working relationship?

Yes, it is possible to make this connection, although in the beginning it might be a strange experience. It is therefore important to discuss this first with your patient in order to make sure that you are on the same page. My experience is that I connect with the patients online just as well as I do face-to-face. This was a very special experience, and I was able to achieve this by taking the same approach as in my face-to-face sessions. My role is to connect and to build trust, which stimulates patients to prepare better and look at themselves and invest in their treatment. It is essential in advance to discuss the expectations with the patient in order to make treatment successful; this can be done!


Ad 3. For my face-to-face consultations I used a Whiteboard; will a ‘wacom’ have the same effect?

In the beginning, I had to practise with the ‘wacom’ in order to get readable writing; but after some practice, it is very useful. The panic circle, for example, is easy to describe: you save it and if the patient wants it, you can easily upload it via the messages service from Minddistrict.


Ad 4. Will I have more ‘no shows’ with online treatment?

Patients can do their video consultation from a location where they feel comfortable. They do not have to take into account travel time and if there is bad weather there is a smaller chance that the appointment is cancelled; so far, I have only had a few ‘no shows’. In relation to patients who are fully engaged in online treatment, I cannot remember any cancellations.


Ad 5. Will I enjoy it? Will I enjoy the development process of the patient in the same way? 

This is a definite YES! It is fun to see how patients are working on and getting a better understanding of their own mental health. I am able to develop good contacts with my patients and, at least in my case, e-mental health / online treatment gives me less stress. With the latter, I mean that the investment in treatment is more equally divided between the patient and therapist. The patient is directly working on his/her own mental health and is in charge of this process. Assignments have better results because video consultations and working on a specific module are combined.


What else... cooperation.

Besides online treatment, I have also worked on the development of e-mental health modules, i.e. how to best design and write these; this is still a learning process. Six months ago, I would not have thought that I would be working with this technology, let alone working on the modules themselves and that I would enjoy this. Cooperation with the E-lab, an incubator for social and technological innovations in mental health, is a real gift; I can ask them for help anytime. This cooperation is very inspiring as I can also give them feedback on other applications and modules they are working on.

I cannot imagine not working online at all, and I will continue to work in this ‘blended’ combination. Good luck with your own online experience!

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