Limit distractions: This might seem intuitive but be sure to turn off all other devices and alerts — this goes for you as well as your clients. Close all tabs and emails, and make sure alert sounds are off. It can be tempting to check a quick email here or there, but it’s important to be in the moment for your client just as you would in your office. I’ve had clients pick up a phone call in the middle of their session. Ironically, it’s usually a call from their boss while we’re discussing establishing boundaries at work! It gave us room to talk about the situation, but also breaks up the stream of conversation and can divert from the work you’re doing to get better.
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 interviewingAlyssa Mairanz.
Alyssa Mairanz is the Founder and Clinical Director of Empower Your Mind Therapy based in New York City. Alyssa saw a unique opportunity to create a group practice providing a supportive and validating environment for clients, while fostering the education and development of tomorrow’s therapy leaders. Utilizing the core principles of Dialectical Behavior Therapy (DBT) and Psychodynamic Therapy to improve mental health, Alyssa encourages clients to think differently, worry less, and feel better. Alyssa attended the Ferkauf School of Psychology Yeshiva University where she attained an MA in Mental Health Counseling. She is certified in advanced DBT treating self-harm, suicide, personality disorders, trauma, and eating disorders. To learn more please visit www.eymtherapy.com.
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 became a therapist because I find the human mind fascinating! Growing up, I was always the friend people turned to for advice or a shoulder to lean on. I enjoyed being the person my friends turned to and felt good about helping them talk through their issues.
Understanding more about human nature and why we do what we do has always intrigued me. Learning how I can take this interest and knowledge in Psychology to help others live their best life solidified my passion for becoming a therapist.
Can you share the most interesting story that happened to you since you began your career?
What’s interesting in terms of telehealth is that I’ve had experience with it for quite a while before the pandemic began. I regularly hosted Dialectical Behavior Therapy (DBT) phone coaching for select clients and worked with some of the popular third party online/mobile therapy providers. These experiences taught me how (and how not!) to best structure the teletherapy services for my group practice as we entered COVID-19 quarantine.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite life lesson quote is by philosopher Soren Kierkegaard: “Life can only be understood backwards; but it must be lived forwards.”
This quote applies well for approaching therapy as a whole, but also when thinking about working in this emotionally challenging career. Specifically, when COVID-19 hit and I was restructuring our business model to offer telehealth, I needed to completely reconfigure our business model in a way that helped me cater to people in the community. Taking a look back at our successes and missteps while growing the business forward allowed me to hire more therapists, so I had more time to focus on patients who really relied on therapy support during this transition.
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?
I’m very grateful for my therapist who has helped me significantly over the years. Being a client has helped me understand and empathize from this vantage point when dealing with my own clients. I practice what I preach!
In addition, therapy has built my confidence as a business owner and therapist, while also strengthening relationships with family and friends. This helped me become a calmer person, open up more to those around me and build a strong support system while growing my business.
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?
Specifically, with clients who are dealing with suicidal ideation and self-harm, there are many benefits of having an in-person session. Most importantly, the therapist is able to pick up on non-verbal cues more easily in person, which helps the therapist get a feel for where the client currently is in their journey. Recognizing small changes in hand and eye movements, posture, expressions and more can signify there might be more to what your client is saying verbally.
In person therapy is also a bit more intimate — being in the same room with your client helps you grasp their strong emotions and can build rapport a bit faster and stronger than over a Zoom call.
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?
One big challenge is distraction on both ends of the computer screen. If a phone rings or an alarm goes off during a session, particularly during an important or emotionally intense conversation, it can throw off progress. Similarly, it’s hard to catch non-verbal cues that would otherwise be obvious in person. These distractions can sometimes slow down developing a strong client-therapist relationship.
Technical glitches such as the internet not working properly or a microphone cutting out is bound to happen and can be quite frustrating.
Some teen clients, particularly those who are resistant to therapy, don’t take it as seriously. They tend to look down at their phones or refuse to log on video so they can do other things. When we schedule in person appointments, they are bound by our physical time together and their parents are usually bringing them into the office. Over Zoom, the accountability isn’t as strong.
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? (Please share a story or example for each.)
- Limit distractions: This might seem intuitive but be sure to turn off all other devices and alerts — this goes for you as well as your clients. Close all tabs and emails, and make sure alert sounds are off. It can be tempting to check a quick email here or there, but it’s important to be in the moment for your client just as you would in your office. I’ve had clients pick up a phone call in the middle of their session. Ironically, it’s usually a call from their boss while we’re discussing establishing boundaries at work! It gave us room to talk about the situation, but also breaks up the stream of conversation and can divert from the work you’re doing to get better.
- Insist clients keep their video on. Clients need to see you to know they are being heard, and you need to see them to check for non-verbal cues and ensure they are fully engaging in the work. We’ve seen this a lot with group therapy participants at the start of teletherapy. Clients felt as though it was easy to get by with no video, which meant they didn’t have to do the work. This was especially an issue with DBT group sessions at first, which are based on practicing skills, so if you’re not on video you’re missing the important aspects of the session.
- Set alarms for session reminders. Be sure to set an alarm on your phone five minutes before a session. Being at home engrossed in work, it’s easy to get lost in another project or meeting. In the beginning of quarantine, I came close to being late for a few meetings and sessions after being so used to commuting and physically being with someone in my office. Once I started setting reminders, I was always on track.
- Think like a social media influencer. Not exactly like an influencer but do try to remember a few tips before getting on Zoom. Find a quiet space and make sure you have good lighting so your clients can see you clearly. I’ve found that if there’s a bit too much background noise due to busy streets or kids, a white noise machine can really help. And if you’re wearing sweatpants, try not to stand up!
- Make sure you take time for yourself. Being a therapist or any healthcare provider is a very emotionally taxing job, so it’s important to take time for your own mental health and self-care. Try to get some fresh air every day and don’t forget to eat between meetings. Like many people who now work from home, it took me a bit of time to get into a healthy routine.
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?
Telehealth offers more flexibility with scheduling and timing. With teletherapy, we’ve seen less cancellations and more punctuality. With no commute to worry about and no obligation to venture to someone’s office when you’re feeling a little under the weather, it’s easier to keep appointments.
I’ve also noticed in some clients that they feel more comfortable opening up while in the safety of their own space. The ‘protection of the screen’ allows them to talk with a bit more ease than if we were in an office setting.
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?
The ability to have continuation of care for both individual and group therapy has been instrumental in the work and progress I’ve seen with my clients. Especially when we are trying to cope with the stress and depression surrounding a global pandemic, having a support system at your fingertips has been very helpful for many during this time.
Video conferencing has been incredibly helpful in that we’re able to actually see our clients while talking to them instead of just being over the phone. Zoom is now a way of life for many working people, so it’s made therapy a bit more effortless.
With all technology we sometimes experience glitches, and for many clients who have both phones and computers with the ability to video chat, it offers a backup in case one does not work.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I would love to create a client portal that provides everything you need in one seamless app. To be able to schedule sessions, ask questions, access handouts and fill out worksheets in one place would be helpful for many. The ability to revert back to handouts for helpful tips when dealing with an issue in real-time with a click of a button would be fantastic. Having the opportunity to write things down and review your previous work to see how far you’ve come in your mental health journey is a great motivator to keep going. There is so much power in seeing your progress.
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?
Don’t be afraid of seeking mental health support! Any treatment is better than no treatment at all, and you can always try a session to see if it works for you before committing to anything more. Having support in your life is important, and many people shift their mindset and realize this once they actually take the leap and start therapy.
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?
There are many pros to telehealth, and since the demand is constantly increasing the technology is improving quickly. Google Meet has been very useful as it allows you to create private chats, which is great for group therapy sessions. We typically have two leaders in each session, one moderating and another monitoring to pull clients aside in order to work on specific skills individually. We’re still able to do this within Google Meet. Meet is also integrated with other Google apps, so we’re able to take advantage of Google Whiteboard, Pages, and other tools.
Screen sharing also makes it easier when working hand in hand with other therapists and has actually given me ideas for other ways I can work with my therapy team in person that will help support clients in ways we haven’t discussed before.
Is there a part of this future vision that concerns you? Can you explain?
At EYMT, we plan to incorporate a hybrid model for providing therapy services moving forward. Personally, my schedule will continue at 50% teletherapy to adequately service my clients’ needs.
A concern for telehealth would be clients, or anyone in general, feeling that in-person treatment isn’t necessary. For some people with certain concerns or struggles, such as self-harm, depression and suicidal ideation, in person therapy should be heavily considered.
There are many services out there promoting virtual therapy quite heavily, but I do have slight concerns about these programs. Speaking from experience having worked with them directly, the programs are not the same as traditional therapy and may not be as effective — especially for higher risk clients.
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. 🙂
We may have heard it before, but the most important movement is better insurance coverage. This would be such a gift to those struggling with mental health issues. Insurance companies need to make it easier for people to obtain coverage and the rates need to improve. Mental health support is important work and we’re seeing a surge in demand now more than ever.
I also believe grants and scholarships for mental health professionals are severely lacking. I would love to create a program and collaborate with schools, bringing DBT to the forefront for high school and college students, who benefit the most from this type of therapy. Even providing support and teaching basic life skills would be so helpful for those about to enter adulthood.
How can our readers further follow your work online?
You can find us on Instagram (@eymtherapy) and Facebook at Empower Your Mind Therapy where we share mental health insights and tips daily. Thank you for having me and be well!
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.