Address video, technology, and general IT issues. If the clinician is comfortable using the equipment, this can help the client with proficiency as well. Professionals can teach themselves about the systems and technology available and how to troubleshoot the common issues that arise. We can also normalize glitches and internet outages that are never convenient but are an occasional challenge of providing care via telehealth.
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 interviewing Amanda Turecek, LMFT, LAC of RAFT Consulting.
Amanda Turecek, LMFT, LAC, is the executive director and founder of RAFT Consulting, a group therapy practice that offers mental health counseling for adults, teens, and children. RAFT is based in Parker, CO and offers teletherapy for people throughout Colorado and Oklahoma. Amanda is passionate about offering accessible, culturally competent, and collaborative services. Amanda and her team with RAFT value healthy change, authentic connections, and bold sharing of experiences.
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?
As a rebellious teenager I think I selected psychology as my major because it was not in line with what my family expected from me. However, growing up, I liked to help other kids and was good at listening, making it a natural good fit. My Mom likes to share how I was selected as a “peer counselor” in the fourth grade and trained in playground conflict resolution. I had always valued hearing other people’s stories, and as a young adult I learned that others are not always comfortable sitting in the uncomfortable, painful, messy, and sometimes dark moments of humanity. That connection shifted things for me as I started to build on my experience and training within mental health. For over a decade now I have been building on ways I can connect with others in sifting through the painful stuff that keeps showing up in their lives despite even the best makeup and coping strategy cover ups.
Can you share the most interesting story that happened to you since you began your career?
My clients’ stories of overcoming are absolutely the best and most interesting parts of my career that I am continually invited to witness, and that are also protected by client confidentiality. In my work, I am most interested by the human ability to overcome and witnessing a client’s story start to shift as they feel joy after years of being numb and develop connection with their family after years of despair, is absolutely the most powerful and interesting piece of my career.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“When there’s a gold rush, sell shovels”. I am passionate about finding ways to support others’ success and behavioral and mental healthcare is a way that I can do that. Mental health is now at the forefront of our community challenges and I value offering a way to target that challenge. At RAFT we strive to offer concrete strategies and processing of underlying issues, resulting in people gaining the absolute maximum benefit from counseling with us. Basically, offering the biggest shovel possible to our client and supporting them in reaching their health goals.
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 credit my Mom with modeling strength, adaptability, and an awesome ability to connect. She was a single parent who consistently strived to provide security and support with hard work and a drive to be exceptionally good at whatever she was doing. Early in my story of studying psychology I visited my Mom in Thailand, where she was working at the time. During that trip I shared meals with both high-level diplomats and families living in small towns with no plumbing and dirt floors. She modeled grace and humility with people with all backgrounds, instilling in me a high value of human connection and regard for others.
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?
In office therapy comes with a safe space that clinicians can control and manipulate. In an office we control our environment including furniture, tools, and even our ability to regulate our emotions. We can ensure privacy and confidentiality. Responding to crisis situations and being able to connect a client to immediate higher level of care support is easier and can be safer in office.
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?
On the flip side, we lose that control when clients are in charge of their environment and surroundings for a therapy session. Sometimes, they are not comfortable, or lack certain tools that we might utilize in an office setting. Some families struggle with finding a private space that is free of interruptions. And some clients find it challenging to discuss hard things without that separate space, and physical transition in and out, to do so. If a client is actively suicidal, safety concerns can arise when the client is not in the same space as the therapist.
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.)
I recommend the VIDEO acronym for 5 things you need to know to best care for people when they are not physically in front of you:
Video — Address video, technology, and general IT issues. If the clinician is comfortable using the equipment, this can help the client with proficiency as well. Professionals can teach themselves about the systems and technology available and how to troubleshoot the common issues that arise. We can also normalize glitches and internet outages that are never convenient but are an occasional challenge of providing care via telehealth.
Instructions — Provide instructions for clients that set them up for success! Before our first teletherapy appointment I not only discuss the platform we will be using but also like to talk about what clients can do in their environment to make it as conducive for therapy as possible. For counseling this might include making a cup of tea before session, having tissues close by, and using headphones to ensure as much privacy as possible.
Develop rapport — Sometimes we can be so flustered by the challenges of telehealth that we forget the importance of developing rapport. Developing the therapeutic relationship and establishing trust should all be prioritized when utilizing telehealth. This might include asking genuine questions, modeling transparency, mirroring, and generally being mindful about use of good communication skills.
Evaluate — Evaluate your client’s individual needs and make sure to complete a thorough risk assessment. There are times in therapy when video sessions are not appropriate. This might include active suicidal thoughts or unmanaged symptoms of psychosis. Ensuring that you are assessing risk consistently and appropriately can help make teletherapy a safe option. Also, ensuring that you note the client’s address at the beginning of every session and reviewing a safety plan should crises arise, can ensure the clinician is prepared if a client endorses planning and intent, or other challenges that indicate in person support is required asap.
Outcomes — Talk with clients about their outcomes! I strive to check in with clients about their experience of telehealth and their perception of progress towards their goals. My experience has been that clients meet and exceed therapeutic goals with teletherapy just as often as with in office counseling. But frequent outcome checks can help providers re-assess and make any adjustments that would be helpful.
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 many benefits that in office appointments cannot! Some clients feel more comfortable in their own space and barriers around transportation, childcare, and scheduling are reduced or even removed. One client I worked with for several months started counseling in the office. This client wanted to overcome a significant traumatic event and regain confidence, trust, and general happiness. In office work was slow, this client juggled home and work life that often resulted in rescheduling appointments and the erratic schedule contributed to difficulties in feeling emotionally safe in the office setting. Then in March 2020, it became impossible for this client to continue therapy in office with teenage children remote learning at home and a sudden lack of transportation due to financial challenges. We immediately shifted to video therapy sessions and this client’s mental health flourished in the middle of a pandemic. This client was able to schedule therapy while at home, using headphones and a closed-door room, while the teenagers completed schoolwork in another room in the house. In addition, being in the client’s own space created a safety that I was unable to duplicate in the office. And once this client felt safe, this client was able to access details of the impact of the trauma that ultimately led to healing, confidence, and feeling joy again. I also loved learning more about this client by meeting the family’s pets and the sharing of special objects and pictures that were in the space used to meet with me. I am not sure this deep connection would have been possible so quicky, or even at all, without teletherapy.
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?
I appreciate the HIPAA compliant video platforms that have made counseling possible and effective when not sharing a physical space. While phone conversations are sometimes useful when alternatives are not available, being able to share facial expressions and gestures, greatly improves rapport and assessment abilities.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I’m pretty simple. I would love an improved system that better helps clients by putting everything in one system for clinicians and does it really, really well. I piece together video platforms (with multiple HIPAA compliant options for when one is not working), online EMDR tools, billing and insurance tracking, and features that increase my group’s ability to collaborate. Having an all in one system would help clients with ease of use and make teletherapy more accessible for both clients and therapists.
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?
I hope people know that it is possible to get just as much out of teletherapy as in office therapy! It does not have to be a “better than nothing” alternative to in office work, but can be the ultimate mode to changing your life.
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?
Yes! I think VR might get us even closer to that experience that more closely mimics an in-office experience. Doing this will further normalize telehealth and reduce remaining barriers and challenges, making mental health counseling more accessible to people.
Is there a part of this future vision that concerns you? Can you explain?
I truly value connection with people. So while the benefits of increasing access to quality mental health services is exciting, I do worry about the impact it has on our ability to connect with each other.
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. 🙂
#mentalhealthisforeveryone ….. I would love to see a movement towards increased access to quality mental healthcare.
How can our readers further follow your work online?
I can be found at www.raftconsulting.com !
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.
Thank you for your time! It is an honor to be included in this series, thank you for having me.