Be flexible. We’ve heard it before, these are “unprecedented times,” so what can you do to ensure your services adapt with the changing climate? For me, it’s been offering additional services such as short-term coaching and single session therapy so folks can access mental health care at differing rates. I personally appreciate the short-term goal-oriented approach so these offerings work very well for me. But this might not be your cup of tea. Think outside the box to adapt your services while also incorporating your interests and skills.
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 Mona Eshaiker, LMFT.
Mona Eshaiker is a licensed therapist and mental health consultant with over ten years experience working in the field. Mona is open about her experience with burnout and her current work examines the stress cycle and how it uniquely affects marginalized employees in the workplace.
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 so much, I’m very glad to be part of this very important conversation. I got started back in college when I worked as a writing and art instructor for incarcerated women. There I learned about the power of self-expression and also became aware of the interplay of early childhood trauma, poverty, and racism within the legal system. That’s when I decided to pursue the field of mental health and developed my passion for community healing and empowerment. After receiving my Master’s in Clinical Psychology, I worked at the Department of Public Health providing psychotherapy to LGBTQIA+ youth without permanent housing in San Francisco. I later became a supervisor to new therapists and eventually found my way at a mental health tech startup where I experienced severe burnout. After a cancer scare and an awareness of my own deteriorating mental health, I made the leap to quit my full-time job and open a private practice. My services had to be 100% online since I opened during the pandemic.
Can you share the most interesting story that happened to you since you began your career?
One of the very first places I started practicing therapy as an intern was at a sliding scale community clinic for LGBTQIA+ adults. I was 26 years old and this was my first experience practicing longform psychotherapy. I was considered a “therapy intern” and was working under the license of a supervisor. I was also very single at the time and had a profile up on a dating site that matched based on a series of questions. Mind you, this was before dating apps. One day I was notified I was matched with someone with a 96% compatibility rate. This was the highest I’ve ever seen so I was very excited to find out who this person was. Yep, you guessed it, it was one of my clients. I was horrified. I scrambled to delete my account and sent a panicked email to my supervisor. I was certain I would be kicked out of my internship and that I ruined the sacred therapeutic bond with my client. My supervisor assured me that these things happen, especially in small communities such as the queer dating scene in San Francisco. We discussed the situation at length and decided that I would not bring it up unless the client did since there was a good chance they never noticed because my account was immediately deleted. I was riddled with anxiety before our next session, ready to catch any microexpressions that could clue me to whether they received the match or not. To my relief, they acted perfectly fine and carried along with what they’ve been working on in therapy.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite quote and motto I live by is “accept yourself and accept others.” Self-acceptance is critical for living a fully authentic life in peace. This has been important to me as someone who identifies as gay and a person of color to unlearn stereotypes and internalized self-hate. Accepting others is just as important if we want to coexist in peace. Accepting others as they are helps to let go of resentments or the desire to change someone because that only hurts us. I truly believe we are all just doing our best with the tools we have.
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?
First and foremost my dear mother. She passed away four and a half years ago from cancer. She is definitely my hero. She went back to school when she was 47 years old and received her associate’s degree, undergraduate degree and master’s degree right after the other. She also studied psychology and taught me to never give up on my dreams. She also taught me to always be kind to others. She would say, “If you recognize something positive in someone else, let them know, it doesn’t cost you anything.”
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 psychotherapy there is a term called “the container.” It basically means the safe space the therapist holds during the session so the client may share vulnerable information while also feeling grounded. In my mind, I think of the therapy room as a literal container, lid and all. With a solid container, made possible by trust and rapport, the client feels safe enough to extracract pain and shame from within themselves for the therapist to hold and help organize so it can be seen, experienced and processed safely. When big feelings are properly contained, the idea is that it won’t feel overwhelming or dysregulating to the client anymore. This would be the main benefit of having a client in the same physical space as the therapist. Another benefit would be for the therapist to see the client fully to identify non-verbal cues. For example, if a client is discussing a topic calmly but their leg is shaking, that can be an indication that there may be something anxiety-provoking about the topic.
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?
When the client is not in the same space as the therapist, it can make creating a contained environment quite challenging. While I do feel like it is possible to create a safe and contained space virtually, there are many barriers. First the act of traveling to your therapist’s office, experiencing therapy in a very specific environment meant for healing, then traveling back to your next destination is all part of the experience. There is time before the session to reflect and time after to process or integrate information. All that gets eliminated with virtual sessions.
Also, now in the pandemic with the majority of therapist offices closed, clients are having therapy in their homes, usually in their home workspaces. While very convenient, the downside is that their home or home workspaces are usually not relaxing and are sometimes the very spaces where their frustrations originate. It’s like after a breakup, the best thing to do is separate yourself from your ex because with distance we are able to have perspective. When clients are physically in the same environment that cause them stress, it can make healing that much more challenging. I’m also finding that many people try to “squeeze in” therapy during work hours or during their lunch break. This usually comes from the intention of maximizing someone’s time, but what ends up happening is the person skips a break during their workday which can lead to an increase of stress and can be distracting or even disruptive to a person’s workday.
Finally, having therapy in your home while cohabitating with others can make it difficult for clients to feel comfortable to share freely. Let’s say someone wants to vent about their partner but they are in the room next to them, this can restrict folks from fully expressing themselves. I’ve seen clients have therapy in their cars, whisper when talking about someone they live with or ask to change the subject because of this very reason.
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.)
- State challenges upfront. It’s important to be transparent with your client about some of the challenges of working virtually. This awareness is helpful for the client’s understanding if you ask clarifying questions. For example, asking your client what they are experiencing in their bodies during a session can aid in identifying emotions that would normally be lost because we are not in the same room. Or confirming if their eyes are watering as they are discussing a certain topic. This also aids in rapport and trust building because it also shows you are interested in their full experience.
- Ask for feedback. Everyone needs something different. Regularly asking for feedback after a session invites the client to share their experience and to speak up if something is not working. Many of the non-verbal cues can get lost in virtual sessions, so creating an environment where feedback is allowed and expected gives clients permission to share their thoughts. For example, I usually state upfront that it may take a few sessions to find our pace and structure, but with continued feedback we will co-create our groove.
- Support your client in creating an optimal environment for therapy. Without the containment of a therapy office, it’s important that the client is experiencing therapy in a relaxing space. Ask your client where they are taking their teletherapy sessions and help explore the pros and cons of that space. If the client discovers that the space is not conducive to their healing, you can support them in identifying alternative spaces or things they can do to cultivate a therapeutic environment. For example, if a client has no other option than to take teletherapy calls at their work desk, they can add a ritual before a session such as journaling or lighting a candle to set the tone. Or it can be taking a walk after therapy to help process and integrate information from the session.
- Set clear parameters of therapy. With the general increase of stress from the pandemic, some clients may be more inclined to email you between sessions or to reschedule at the last minute. To avoid unnecessary misunderstandings, it’s important for practitioners to identify beforehand what they are okay with and where their limits are. Is it okay if clients email you between sessions? If so, what are the expectations around your response time and response type? How soon in advance do your clients need to notify you of a cancellation? If they pass that threshold, will you charge them? If so, how much? Be crystal clear about your boundaries and be sure to articulate them at the beginning.
- Be flexible. We’ve heard it before, these are “unprecedented times,” so what can you do to ensure your services adapt with the changing climate? For me, it’s been offering additional services such as short-term coaching and single session therapy so folks can access mental health care at differing rates. I personally appreciate the short-term goal-oriented approach so these offerings work very well for me. But this might not be your cup of tea. Think outside the box to adapt your services while also incorporating your interests and skills.
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! The biggest benefit has been the improved access clients have to providers. Now that most providers offer virtual services, clients who live hundreds of miles away in a different part of your state can now work with you. I also know of colleagues who have gained licensure to practice in different states so they too can expand their network of potential clients.
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’m only aware of telehealth video tools such as SimplePractice and Zoom which I use. One thing I really like about both is that it gives the client and practitioner the option to hide their video from view. This really helps to reduce the distraction of looking at the client while also having a view of myself. I’ve heard from clients that this option is useful for them as well since it reduces distraction and the self-consciousness that comes with having a view of yourself. Having a single-person view also mimics being in an actual room together because having a view of yourself is quite unnatural. I also enjoy the waiting room feature because it gives everyone the chance to take a deep breath before starting a session.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
Oh I love this question! It would be great to design an audio system that increases privacy for clients who share spaces with others so they feel comfortable sharing freely. Perhaps a tool that muffles their voice so it’s inaudible to anyone aside from the provider.
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?
Yes! I would love to share the importance of the container in therapy. With that knowledge, clients can make informed decisions about when they schedule therapy, where they physically are located when in the teletherapy session and if they need time before or after to feel grounded.
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?
Very cool! I’ve heard of VR therapy used to treat folks with phobias so they can safely be exposed to stimuli they’ve developed phobias around, but not as a general tool to mimic shared space in therapy. That would be very interesting! I wonder too in the context of group counseling, how it could be to feel like you are sharing space with others given our increasingly isolated lives.
Is there a part of this future vision that concerns you? Can you explain?
I suppose my only concern would be with the increase of technology for patients to access providers from the comfort of their home would be that it could develop into a habit. I’ve found that since the pandemic with many of us working from home, we are leaving the house less and feeling stuck at home. The problem is, the less we leave the house, the more that behavior becomes a habit and it can feel even harder to leave. Staying in the same space all day can make our lives feel monotonous which can contribute to loneliness and depression.
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. 🙂
Such a nice question. I’ll go back to my motto, “accept yourself and accept others” with an emphasis on the latter. Having the perspective as a therapist, I’ve had the opportunity to meet with all types of people from all walks of life and I can say with certainty, pain is universal. We all suffer the same and I think that is the key to our humanity. If you do not understand someone, that is okay. We need to accept that we will never understand anyone completely, but we can provide everyone dignity and respect.
How can our readers further follow your work online?
They can follow me on Instagram @MONALMFT or on my website www.monalmft.com
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.
Appreciate the consideration and for inviting me to the table.