Virtual therapy: Is it as good as in-person?

A January 1913 rural Alabama newspaper reports a joyful Christmas wedding of a young woman from one of Randolph County’s “most prominent families,” noting that she was a contestant in the newspaper’s popularity contest for young ladies in the area. The article describes the groom as a “hustling young farmer” in a nearby community. He is commended for winning the bride’s heart and hand. This story has a beautiful beginning, but sadly it doesn’t have a happy ending. The couple set up their farm in Alabama and went on to have 3 children, but the young bride struggled with mental illness throughout her adult life, dying in Bryce Hospital in Tuscaloosa at the age of 38. Mental health treatment to promote recovery simply was not available at that time, and even care to manage symptoms required hospitalization far from home and family. 

Research on mental health treatment in the following decades led to evidence-based psychotherapies for a variety of mental health conditions, such as insomnia, depression, anxiety, and PTSD. However, access to such therapies would have required at least a drive to Anniston, if not Birmingham, Montgomery, or Huntsville. Even if one was fortunate enough to live in one of these cities, or perhaps Mobile, Florence, or Tuscaloosa, access would require driving to an office and taking time off work, leaving these therapies out of reach for many Alabamians. This young bride and groom could not have imagined that one day their descendants who are dealing with mental illness could access quality care via a video connection on a personal computer, tablet, or smartphone. However, the rise of telehealth has revolutionized access to high-quality mental health care. Just 15 years ago, Upward Behavioral Health would likely have been limited to providing services only to Birmingham residents, or individuals willing and able to drive to Birmingham. Thankfully we are now able to offer care anywhere in Alabama. Our telehealth platform is private, secure, and simple to use, even for clients who do not consider themselves to be computer-savvy. If you have an email address and an Internet connection, then chances are that you can use our platform with ease. 

Although mental health access is greatly improved with the advent of telehealth, one might wonder if therapy via telehealth is as good as traditional in-person care. The most wonderful news of all is that no one has to sacrifice quality mental health care when using telehealth. Research has compared therapies delivered via telehealth and in person for a variety of conditions, including depression, anxiety, PTSD, insomnia, OCD, panic disorder, and substance use disorders and has found that therapies delivered via telehealth are just as effective as those delivered in a traditional office setting. We know that the therapeutic alliance between therapist and client accounts for around 50% of the improvement in symptoms that clients experience, and multiple studies have demonstrated that a strong therapeutic alliance can be developed and maintained via telehealth.  In further good news, multiple studies demonstrate that drop-out from therapy via telehealth is at least comparable to in-person therapy, and in some cases, clients are more likely to continue therapy if seen via telehealth. Although more research is needed, recent studies do indicate that video telehealth works better than care via telephone (audio only). 

Upward Behavioral Health uses a secure video platform via Simple Practice for all of our telehealth sessions, and all Upward providers have completed specialized training in best practices for telehealth. Therapists and clients use a secure messaging portal to share handouts and other treatment resources, as well as completed out-of-session practice assignments. The COVID-19 pandemic gave rise to additional research and innovation in the provision of telehealth, which is helpful as pandemic-related stress also increased the number of individuals seeking mental health care. Many Alabamians also became more adept at using video platforms, such as Zoom or Facetime, during the pandemic as a way to safely stay in touch with loved ones. Furthermore, many Alabamians also had a chance to try telehealth technologies during the pandemic and reported satisfaction with them. 

Psychotherapy via telehealth may still require some time off work, but taking an hour during the day for 6-12 weeks of video sessions is within reach for many Alabama residents; whereas, taking 3 hours per week for travel time plus the session simply may not be doable. A young parent may have a much easier time setting aside an hour of quiet time for a session from home than hiring a babysitter for several hours. Just as you would for in-person care, it is key to dedicate distraction-free time and space to fully engage in your session. You should feel free to wear comfy sweatpants and t-shirts, but we do maintain a “Clothing Required” policy. Shoes are totally optional 🙂. At this time, clients are required to be located in the state of their therapist’s licensure, so it is key that you are located within the state of Alabama during your Upward sessions. While many clients are in their home during their sessions, that is not required. You only need to be a safe, private place within the state of Alabama. Many clients choose to meet from a private space in their office, from their parked car, or from a relative or friend’s house for maximum flexibility. 

We are extremely grateful to live in a time where evidence-based mental health treatments are available to a wide variety of people in need. As native Alabamians, we have certainly witnessed difficulties accessing quality mental health care, and we are absolutely thrilled to be able to bring you high quality mental health care–wherever in Alabama you are!