Safety. Safety is always number one in mental health care whether sessions are in person or virtual. With in-person sessions, it is easy to call 911 and reach the local police or mental health deputies for assistance. Obviously calling 911 when your patient is in another county or state is unhelpful in an emergency. Virtual safety planning is doable with just a little bit of planning. For all patients I require the names and phone numbers of at least two emergency contacts, contact information for their primary care physician, and the name of their local hospital or mental health receiving unit. I also research the resources in the patient’s local area. I conduct safety checks at every visit regarding self-harming behaviors, suicidality, and homicidality. Additionally, each state has different procedures for emergency situations, thus it behooves providers to be aware of these differences.
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 interviewingAlicia Rozycki, PhD.
Alicia Rozycki, PhD, is a Licensed Psychologist and Founder of AROSE eTherapy & Life Design, an online psychotherapy practice helping professional women navigate life’s challenges. With 14+ years of experience as a clinician Dr. Rozycki launched this practice to promote the ease and convenience of tele-healthcare to her clientele. Prior to founding AROSE, Dr. Rozycki primarily worked for the US Military as well as in the civilian sector providing psychotherapy and psychological testing services in health care settings, teaching college courses, and conducting and coordinating psychological research projects. Dr. Rozycki earned her Doctor of Philosophy in Counseling Psychology and Master of Arts in Psychology from Texas Tech University; Bachelor of Science Cum Laude with Honors in Psychology and Bachelor of Art in Studio Art from University of Maryland, College Park; and Certificate in Residential Interior Design from Florida State College at Jacksonville. Interior
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?
I am first generation American born and raised in New York. My parents and grandparents were Polish immigrants. Looking back, I now see that my draw towards psychology may have come from my close relationship with my grandmother. She and my grandfather were prisoners of war in Soviet gulags during WWII, and she frequently told stories about working and starving in Siberia, being released to find her own way to the Middle East where she could enlist in the Polish Army, serving in the Italian Campaign, and then being shipped to England before settling in New York. Listening to people’s life stories fascinates me to this day. No matter what a person’s backstory is, I feel honored when it is shared with me. Between being fascinated by her life stories and then falling for psychology three days into taking the Introduction to Psychology class offered by my high school, I felt this was the path for me. I believed psychology had all the answers to life and provided a guidebook for living. Now, through my own experiences, I feel a strong pull to work specifically with professional women. I have enjoyed working with a range of patients over the years but have come to realize I feel a great connection to professional women working through life changes — relationship shifts, career shifts, loss, relocation. I identify with these challenges and have also been very inspired by the perseverance I see in women who battle through these situations. I have watched women come in the door depressed, anxious, and overwhelmed only to find their voice and strength. Being a part of the transformation is exceptional. I also feel it is extremely important for women to support women. Too many times women get cut down, by other men and women alike; I want to be a part of the solution.
Can you share the most interesting story that happened to you since you began your career?
During my final semester of graduate school, I was furiously completing my dissertation — doing a final clean-up of data, running statistical analyses, writing the last few chapters, preparing for my defense — and working a part-time job for a company that provided psychological services to nursing home residents while juggling family obligations. It was a stressful time, but I was glad to have a job and one that I could continue with post-graduation that would provide supervision hours towards my licensure. This company was rather large and essentially had franchises throughout their region, and so I was working for one of their offshoots in a small, rural city. I have since learned that many large health care companies set aside significant savings in case of business emergencies; this company did not. I will never forget the sequence: I graduated with my PhD on Friday; I went to work on Monday and learned the company was filing for bankruptcy due to a Medicaid audit from several years prior — I was asked to stay on for 6 dollars/hour (this is 2007); and so, I filed for unemployment on Tuesday. It was surreal. This left me unlicensed in a rural community where finding a job, let alone one that would provide supervision for licensure, was no easy feat, and poof, the opportunity I had for that was gone. It was a powerful lesson to learn only a few days into my career about the harsh realities of our health care system and the importance of careful business management and planning. From this I have learned the importance of careful documentation, the need to always place ethical and legal practices first, the need to be financially prepared for business emergencies, and the advantages of working outside of managed care.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“If you are going through hell, keep going.” –Winston Churchill. I saw this on a plaque in a discount store and had to have it! I am sure it spoke to my fascination with WWII history, but it is clever and true. Stopping in the middle of your “hell,” or an incredibly stressful time, is the absolute worst place to stop for a rest — it is hot; you will get burned! If we can hang in and hold on sometimes for just for a few minutes, our circumstances or perspectives shift again, and we are no longer in that acute place of “hell.” This is such an important point for us all to remember at those low times. This is a key point mental health professionals make when working with suicidal individuals and why we may hospitalize people who are in the frame of mind that they should stop or give up during the toughest times; keeping someone safe for a few days or a week can give someone a little time and perspective to make a lifesaving difference. I also love that this quote comes from a man who was a prominent world leader. He brought nations out of one of the darkest periods in world history, and he himself suffered from depression. I believe he was speaking from experience as a world leader and as a human at the individual level.
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?
There are so many people I could name that it seems almost impossible to narrow it down to one with each person shaping a certain facet of my life. Yet who comes to mind are the people who taught me to appreciate, understand, and have respect for people of cultures and races that are different than mine. My high school German teacher, Herr Robert Krebs, who is no longer with us, was one of those people. His reputation preceded him; he was known as a dynamic, fun, warm-hearted teacher, and he gave so much to the students with an annual German dinner dance he hosted. He had high school kids wearing tuxes with tails and gowns while dancing quadrilles and singing German songs, and we wanted to do this! Fair to say then and even now the German people can get lumped into the politics of the Second World War. Herr was someone who taught us there is most definitely a difference between an individual and a culture or more specifically a political party that may be associated with a culture or country. That message was carried on when I got to college and was lucky enough to work with Dr. Janet Helms, who does profound work in the area of racial identity. Her book, A Race is a Nice Thing to Have, completely shifted my personal understanding of race, racial identity, and race relations, which is significant given I was raised in a predominately White suburb on Long Island. I am forever grateful for these lessons in helping me break down prejudices I sometimes did not know I held.
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?
Offering face-to-face services is of course the traditional model to which everyone is accustomed. We can all agree there is a different experience when we are with people in person verses through video, phone, or text. Seeing someone in three-dimensions and having the possibility of human touch — like a patient wanting to shake hands or hug goodbye at the end of our final session together — are bonuses of the traditional model. From a provider’s standpoint, being in the same space with a patient allows for greater ease of assessment, such as observing body language or posture. Yet we can still make the most important observations via telehealth — seeing facial expressions and emotional reactions. We can also hear the emotionality in our client’s voices. We are still present in listening to their stories and experiences. We provide a space for patients to emote. Human connection is still very much possible via telehealth.
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?
Some challenges with distance would include missing out on observations that are natural when in person, like gait analysis, observing body postures or body language, and other assessments related to grooming. There are ways to work around this if needed, but for the clientele I serve this is typically a non-issue. I find clients are extremely comfortable with telehealth. Some feel even more comfortable because they are in their own spaces; this can help people feel more relaxed than they might coming to an office space. Clients can feel more safe and emotionally open when they are curled up in their comfy chair drinking tea from their favorite mug.
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: Safety. Safety is always number one in mental health care whether sessions are in person or virtual. With in-person sessions, it is easy to call 911 and reach the local police or mental health deputies for assistance. Obviously calling 911 when your patient is in another county or state is unhelpful in an emergency. Virtual safety planning is doable with just a little bit of planning. For all patients I require the names and phone numbers of at least two emergency contacts, contact information for their primary care physician, and the name of their local hospital or mental health receiving unit. I also research the resources in the patient’s local area. I conduct safety checks at every visit regarding self-harming behaviors, suicidality, and homicidality. Additionally, each state has different procedures for emergency situations, thus it behooves providers to be aware of these differences.
#2: Communication. This is relevant for both face-to-face sessions and telehealth but may have a bit more importance via telehealth given there may never be the option for a face-to-face visit. I state how best to reach me in my informed consent paperwork and social media policy and review this verbally. I emphasize the best ways for patients to reach me securely and safely and explain why certain forms of communication are ill-advised (e.g., making an Instagram post would be a poor way to reach me). I want to be sure my patients have a convenient and secure way of contacting me, whether it is for scheduling changes or life situations that come up. We review how to be in contact in between sessions, such as by phone or secure messages through the electronic health record. I also address what they should do if they cannot get a hold of me right away and what to do in the meantime. I want them to have good access to care so if I need to add an extra session, I can schedule that for them. I see the communication piece as being important not only from a clinical perspective but from a business / customer service perspective. I approach my practice with the mentality that I am offering a boutique service.
#3 Attention. Again, this is relevant in both modalities, but I think giving undivided attention is of the utmost importance. I want telehealth patients to know they have my full attention and engagement particularly given we are not in the same room. I have received feedback from my patients that they appreciate that I take notes in session; this really lets them know I am engaged and attending to the important pieces of information they are sharing with me. It lets them know I take our work seriously. I also demonstrate my engagement through positioning the video and camera to promote good eye contact. Verbal feedback is also especially important to make up for any losses of a three-dimensional experience.
#4 Lighting and Sound. It might seem strange to mention lighting and sound when talking about therapy, versus the theater or an Academy Awards ceremony, but these two components are key in telehealth. Those who have worked with me over the years from patients to colleagues know that I am very sensitive to lighting in my office. I despise fluorescent lights and like to use natural lighting and or lamps to create a soft and inviting atmosphere. I am sure this has something to do with my background in art. With telehealth lighting and sound are extremely important since we are losing some of the physical cues we would have during in-person sessions. Not only do I need to see my patients well, but they need to see me appropriately. Anyone who has ever taken a picture into the sun or tried to film a video clip knows the importance of good lighting. You need to position your light source in front of you to avoid casting shadows, which can really harm your presentation and be a source of distraction. Good sound quality is just as important. The speakers and microphone on your computer may be enough. I know some providers prefer earphones to block anyone else who may be within earshot of the provider from hearing the patient; the downside of this for some is this can pick up every gulp of your coffee for your patient to hear. For years I have used nature sounds in the background of my sessions for an extra element of relaxation and for extra privacy. I continue to incorporate that with telehealth. The greatest challenge I face with sound in my telehealth practice are my dogs who can unpredictably bark at the wind. I do my best to try to control for that, but sometimes life happens.
#5 Connectivity and Security. Technology is obviously uber important with a telehealth practice. Not only do we as providers need to be sure our equipment is functioning well and the internet connection is strong and secure, but the patient needs to have a proper set up too. Having a strong internet connection will be important for both parties. Sometimes a little education can go a long way; I provide a tip sheet in my welcome packet to address telehealth technical concerns, privacy, and etiquette. It can be very distracting to lose video or audio even for a few seconds depending on the timing, such as if a patient is relaying a sensitive story. Suggesting patients close tabs to improve connectivity would be one example of a tip. Internet security is another important and mandated aspect of telehealth. At the start of the pandemic things were lax from a regulatory standpoint, but now one year into the situation, there is no excuse to use unapproved platforms. Most platforms are HIPAA compliant so this should not be an issue. The electronic health record I use is partnered with Zoom for Healthcare, which in my opinion is the best platform in the business, so I am incredibly happy to use this option.
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?
Absolutely. Telehealth provides a great convenience and accessibility that in person sessions simply cannot. People can join the session from the convenience of their home or can attend a session in the middle of the workday on a lunch break without leaving work. Sometimes a parked car can serve as a makeshift office if patients are on the road for work or need a private space. It is a benefit for people in rural areas and cities alike. For rural communities access to care is typically an issue that telehealth solves, and for those in the city, commuting and the cost of gas and parking can be a deterrent. I previously lived in a very sprawling city where it took at least 50 minutes to get across town without traffic. One-hour appointments easily turned into three-hour appointments because of these logistical challenges. In this way, telehealth can make the experience of therapy less stressful and costly for patients. One more benefit of telehealth is the added layer of confidentiality that comes with telehealth sessions. Sometimes people are prominent figures in their communities, and they do not want to be seen walking into a psychotherapy office with obvious signage. Others may be concerned by sitting in a waiting room where they may run into someone they know. Telehealth erases these problems.
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?
Again, Zoom for Healthcare has been my go-to for telehealth sessions. It is an effective tool. The video and audio quality have been particularly good. I have the option of screen sharing when needed. It is also set up for group therapy which not all platforms can do.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I will probably leave this answer to the tech giants, but there are certain features that I would like to see incorporated into sessions or the electronic health record that involve symptom monitoring, whether symptom reports or physiological measures. I use outcome measures routinely, and it would be beneficial to be able to chart and graph this and share the information with patients visually as well as verbally; I have worked with some systems that do this, but it can be a challenge in the marketplace to find every feature you like all in one system.
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?
First, I think it is important for patients to know there is over 20 years of research on telehealth concluding it is as effective as in-person sessions for a range of disorders. A meta-analysis is scheduled for publication in Clinical Psychology & Psychotherapy by Fernandez, Woldgabreal, Day, Pham, Gleich, and Aboujaoude concluding that telehealth sessions are just as effective as in-person sessions particularly when using Cognitive Behavioral Therapy to treat affective disorders like depression, anxiety, and posttraumatic stress disorder. We also know from research as indicated in sources like, The Heart and Soul of Change, by Hubble, Duncan, and Miller that the greatest factor in bringing about change in therapy are the actions the patient takes in the process. Thus, I explain to clients that my approach to therapy includes exercises for them to work on in-between sessions. This may include practicing relaxation or coping skills, readings chapters or articles, completing journaling exercises, and using apps for mood tracking in-between sessions to maximize improvements quickly and effectively.
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 find the research on virtual reality particularly fascinating; it has been growing over the past 5–10 years. Its applications to problems like posttraumatic stress disorder (PTSD) have been an interesting and effective solution to PTSD treatment. It is an inventive way to apply cognitive behavioral treatments in a pseudo three-dimensional way. The findings so far are very promising.
Is there a part of this future vision that concerns you? Can you explain?
I do have concerns for what I see in the marketplace presently. There are several large companies that are taking over the teletherapy world. In researching these companies and how they operate I have my own concerns. There is still much research to be done, for instance, on text therapy. I think consumers need to be wary of findings that are published by the companies that have a stake in the results. I also see my colleagues taking positions with these companies and accepting reimbursement rates that are quite poor. It is a difficult line to walk to try to provide quality care to as many people as possible without undervaluing our profession. I have told patients since I first started working in this field in the late 90s to be careful consumers. If they do not feel like their provider is a good match or they are not getting the care they need, it is OK to move on to a different provider. There are plenty of us out there. I would just hate for people to have a negative therapeutic experience and conclude the entire profession is unhelpful. There are good, bad, and mediocre providers and services out there. I think the consumer must be careful in making their selections just as they would in choosing any other provider or service.
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 want women to support women. We understand each other’s paths, and yet I have seen women cut other women down too many times. There is no reason for it. We face enough challenges. I want to be a part of a movement that supports and inspires women to grow and lift each other up. I would really like to offer a range of services to women in one place. Therapy is not the only one method by which women can foster a healthy lifestyle. I believe having convenient access to a range of quality services and life-enriching activities is important for well-being. I also believe in developing home spaces that promote execution of personal goals like peaceful bedroom retreats for relaxation and sound sleep or energizing spaces for creativity or exercise. AROSE will expand in the future so more to come on these ideas and offerings!
How can our readers further follow your work online?
My website talks about my practice; you will also find my blog posts there as well as links to my social media. You can find this at www.arose-etherapy.com
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.