Laurie Carmichael: “Prepare”

Prepare. It is so much easier to be ready for the worst to happen so that when it does, you don’t have to be caught off guard! Make sure to have a backup Telehealth platform ready that both your clients and you are already familiar with or your client’s phone number on hand so that […]

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Prepare. It is so much easier to be ready for the worst to happen so that when it does, you don’t have to be caught off guard! Make sure to have a backup Telehealth platform ready that both your clients and you are already familiar with or your client’s phone number on hand so that sessions can pick up where they were interrupted no matter what.

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 Laurie Carmichael, Licensed Marriage and Family Therapist.

Laurie Carmichael is a Licensed Marriage and Family Therapist who works out of her practice, Made New Counseling, in Sierra Madre, CA. She has been practicing for four years and the last year has all been virtual due to COVID-19. Laurie enjoys working with individual adults, adolescents, and premarital couples and has a special interest in helping people find a work-life balance that combats “hustle culture”, increases rest, and emphasizes being present.

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?

Thank you for having me! I first became interested in psychology when I was a senior in high school and took a psychology class. Following my curiosity led me to study psychology in undergrad and grad school. I loved learning specific language for expressing how I have always experienced the world and relationships. The more involved I became in my study of psychology, the more I came to discover that a deeper understanding of others and why we as humans do what we do could be incredibly impactful and healing, especially when channeled in the special space of the therapy room. I worked at a clinic for four years learning how to be a private practice therapist and I recently branched out on my own to start Made New Counseling!

Can you share the most interesting story that happened to you since you began your career?

Since I began my career as a therapist, I have found it to be most interesting when my client and I both want to start session on the same topic or when we find that we have the same questions or ideas about an issue the client is going through. That level of connection is hard to find in many other relationships!

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I have always struggled with comparison and competitiveness throughout my life and often have to remind myself that, “Comparison is the thief of joy”. If I compare myself to other therapists and how many clients they see or how much money they are making, my clinical work becomes about measuring up rather than focusing on client care and being present in my sessions. I consistently find that the joy from my work skyrockets when I presently sit with my clients, rather than spend energy comparing and ruminating on what others are doing. My journey is mine, which is more than enough.

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?

When I was in high school, I attended a youth group at my church and the leader of the girls’ group was a strong woman who I came to love and respect. I remember her asking much more in-depth questions in small group than what I was used to. I learned she was training to be a Marriage and Family Therapist and after that, her and I became close as I turned into the one asking questions and learning from the steps she was taking. I ended up mirroring her college trajectory and even attended the same graduate school as her because I saw the success she had found and the woman she was becoming professionally and personally. I wanted to emulate that and still attribute much of my success and confidence in my career path to her guidance.

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?

Absolutely. Three of the main benefits of having a patient in front of me are reading body language better, tangible means of comforting my clients, and the ease of sitting in silence. Reading body language provides so much insight into what a client may be internally experiencing without being able to articulate those feelings with words. Our bodies hold on to experiences from our past and when those memories resurface, our bodies may show that even through a slight foot twitch. It’s helpful for me to be able to spot that and discern whether to lean in or out based on the severity of the movement. Second, I love being able to offer my clients a tissue, a blanket, sometimes even a stuffed animal, all for the purpose of comfort and feeling me close by. Lastly, sitting in silence and reflection is an essential component of therapy — I have noticed that it can feel slightly awkward to sit in silence on a video call because of how direct eye contact can feel when I am only seeing my clients’ faces and them mine. In a room together, it feels more natural to sit together in a still moment and not feel pressured to fill a virtual space.

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?

The majority of challenges I have come across have to do with technology issues that arise before or during session. It is really difficult to lean into a poignant moment with a client when they freeze on screen. This has happened during inopportune times where I have to ask a client to repeat something that was terrifying or painful for them to say in the first place. It can be challenging for both my client and me to be gracious and patient with technology knowing it is not the other’s fault but feeling frustrated all the same. I have also felt like it has taken longer to build rapport with some new clients due to the unfamiliar nature of engaging in therapy at all, let alone starting it virtually. This has been a new concept for so many of my clients and it has taken more “buy in” than conventional work might otherwise.

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.)

Practice. The better you know the telehealth systems you are using, the clearer and calmer you can teach your clients. Without practicing, you will be just as lost as they may feel and that is not helpful to either party.

Patience. When learning anything new, the fastest method of self-sabotage is losing patience with yourself and others. Do your best to give yourself enough time to settle into session and encourage your clients to do the same so that the first few minutes can be peaceful rather than chaotically sorting through tech issues or getting last minute items. This allows for more patience and less franticness for both you and your client.

Prepare. It is so much easier to be ready for the worst to happen so that when it does, you don’t have to be caught off guard! Make sure to have a backup Telehealth platform ready that both your clients and you are already familiar with or your client’s phone number on hand so that sessions can pick up where they were interrupted no matter what.

Plan. Have a framework in place so that your client and you can feel as natural as possible. This includes naming your scheduling practices, what is needed during session, and a consistent way that you begin and end session. I tend to start sessions in the typical fashion of asking clients how they are and I end by saying, “Let’s pause for now and pick up here next time.” Especially via Telehealth, this provides a soft exit with the expectation set that there will be more time in the following session to continue processing.

Presentation. Consider how you would present yourself in a normal office setting — professionally, kindly, and inviting. Care can be communicated through the screen just like in person. Don’t forget how far a smile, soft tone, and gentle presence can go to a client who is struggling.

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?

One of the most rewarding benefits of Telehealth is the access it provides to see clients I would not have otherwise been able to see due to distance. For my existing clients, I had a few people who would spend more time driving to our session than in the session itself. Being able to do our work virtually allows them to come into our space calmer and more comfortable knowing that less work has to go into taking care of their mental health. On the other hand, I have started with several new clients who live in different counties and without the accessibility of Telehealth, the logistics would prevent sessions from starting at all. I would have recommended those clients see someone located closer to them to ensure consistency in their care. Telehealth alleviates all of those hurdles.

I have also come to appreciate the flexibility provided by Telehealth specifically in regard to scheduling for both my clients and me. For the most part, I run a tight ship when it comes to clients maintaining a regular weekly appointment time. I find that I can be more flexible with scheduling, though, when we can simply open our screens rather than going to the office for miscellaneous reschedules.

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?

With my adult clients, I have found an effective tool to be automatic scheduling reminders that include the confidential link to our Telehealth session. This is wonderful for many reasons — I can count on my clients to show up for our sessions or communicate on time if they need to reschedule, my clients can click directly on the link from the reminder to join session, and its automatic, which means less administrative work for me!

With my minor clients, I really enjoy using the Annotate Tool on Zoom. This was especially useful in sessions where my client and I would actually color together like we would in person. I downloaded coloring page pdfs to my desktop, screen share on Zoom, and we would both use the Annotate Tool to color the pdf in. At the end of the session, I would screengrab our progress and resume the following session!

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

One of the most disruptive parts of a Telehealth session are internet connectivity lags both for video and audio. I would design a system that could guarantee the highest quality video and audio connection for the entire session. I could envision a Telehealth system containing an external hotspot that only connected to that system and was separate from a household router or hardwiring. The hope would be for clients or therapists never again having to ask, “Can you see and hear me? How about now?”

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?

For the maximum efficacy in a session, I encourage my clients to test out their internet connection first to avoid any issues on their end and ensure that I do the same. I also let them know to try and create a setting that is as comfortable and peaceful as a therapy office would be. This includes being in a confidential space with a closed door, having tissues, water, a blanket, a comfortable chair or couch, and as many distractions removed as possible. Of course, being at home means some distractions are unavoidable such as a baby monitor or a dog barking. But my goal is for my clients to feel like we are together, and their needs are being met, despite being across a screen.

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?

While I will always champion in-person work as the best quality of care, I continue to be interested with the new technologies that are coming out as long as they lead to more people having access to the care they need if in-person work is not an option. I am aware that the possibilities are endless and that they are right around the corner, but I find myself holding a combination of curiosity and trepidation.

Is there a part of this future vision that concerns you? Can you explain?

To me, there is nothing more fulfilling, authentic, and connecting than sitting with a client in a room together experiencing each other’s essence fully. I fear that a move towards more technology-heavy therapy will negate the value of in-person work. On the other hand, I recognize how much of a privilege it is to make an appointment with a therapist, have the means to pay for sessions, and the time to attend in person. At the end of the day, I have mixed feelings, but I am not closed off to opportunities to make therapy more accessible to people who need it.

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. 🙂

All fields and activities are pointing towards virtual in some way or another. Youth activities, sports, networking, church, everything has gone to social media, online video games, countless apps, and streaming. People are accepting this as the new normal, but my movement would be to maintain in-person connection through accessibility, affordability and intentionality. We are becoming a nation of isolated consumerists, but I believe we need to stay in community in order to meet our basic human needs to be known, understood, and loved. Society would look beautifully different if love, connection, and safety were the bottom line.

How can our readers further follow your work online?

I can be found on my website,, as well as on Instagram at @madenewcounseling, where I post observations I make as I journey through life.

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 the opportunity to share my thoughts and experiences!

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