studio4rt on Freepik
A woman has a therapy session via video chat.
Gabi Koren has strong relationships with her clients — some of whom she has been seeing regularly for over three years, but has never met in person.
Koren, a therapist at Lake City Counseling who specializes in substance use disorder and behavioral addictions, would have never thought building strong relationships over Zoom was possible. When the COVID pandemic first hit, and many mental health services shifted to virtual sessions, she was unconvinced of telehealth’s efficacy in mental health counseling. On top of that, she wasn’t sure how she was going to work from home while caring for two young kids.
Now, Koren provides individual counseling, couples therapy and runs two groups — one for dual diagnosis clients with a focus on addiction, and a women’s group — all from her home office.
“It's been really nice to be home and be able to throw in a load of laundry between clients,” Koren says. “As a working mom, it can be so hard to be away from home all day.”
According to the Wisconsin 2022 Health Care Workforce Report, telehealth was a “lifeline” at the beginning of the COVID pandemic. A 2021 study by researchers at Virginia Commonwealth University found that psychologists used teletherapy in 85.5% of their work during the pandemic, up from about 7.1% pre-pandemic. While the use of telehealth by general practitioners fell after a peak in 2020, mental health providers have seen telehealth use remain consistent.
Koren and other counselors and clients Isthmus talked to in Wisconsin say they appreciate the option of telehealth counseling because of its convenience, comfort and accessibility. So far, telehealth has been reimbursed the same as in-person therapy, but it remains to be seen if that will continue long term.
Lisa Moon is a substance abuse counselor at Connections Counseling, an outpatient substance and mental health clinic. She says she wants to see telehealth continue because it gives the patient more options in their recovery.
During COVID, Moon began co-leading a virtual “process” group at Connections Counseling two nights a week called Wisdom & Recovery. She says some people in the group responded well to the all-virtual meetings and felt more comfortable sharing their feelings from the comfort of their own home. But this wasn’t the case for everybody.
“There were people who did not care for it at all,” Moon says. “My take on it is that it depends on the person.”
Telehealth has required adjustments from counselors and clients. Moon and Koren have had to set new boundaries to address the distractions that can come with doing therapy from home. Connections Counseling created a list of rules for clients that outline expectations during counseling sessions.
“You can't be vaping, you can't be laying down, you can't be doing your dishes,” Moon says. “You have to be here. It has to be a quiet environment. We had people trying to do two things at once.”
Now, Moon splits her time between virtual and in-person appointments. Her favorite, she says, is a hybrid approach.
That’s preferred by some clients as well. Sara Hanson, a client at Connections Counseling who has been sober from alcohol abuse for 19 months, says there are “Zoomers” — people who prefer virtual sessions — and there are “roomers” — people who prefer in-person sessions — in recovery.
“I’m both,” she says.
After leaving outpatient treatment in December 2021, Hanson was required to attend daily AA meetings for 90 days. But Hanson lives in Hollandale, a small town almost an hour away from Madison, so a one hour in-person meeting is a three-hour time commitment.
“I really try to make meetings a priority,” Hanson says. “But with the weather and the winters in Wisconsin, I probably would've missed half of my appointments December through April if they had been purely in person.”
Now, Hanson does therapy at Connections Counseling virtually. She sits on her front porch tucked into a corner away from her husband and three teenage boys.
“It’s my sanctuary,” Hanson says. “It’s a no-boys zone. I’ll make a cup of coffee or bring a warm blanket to make it my space at that time. And when the appointment is over, I take a little time in my own space just to process like I would on the drive home from an in-person meeting.”
Koren says she has also noticed a drastic decrease in no-shows and cancellations because she and her clients can be flexible with their schedules. This, in turn, leads to more successful therapy.
“There's more consistent therapy and then that leads to better outcomes,” Koren says. “In my experience, the more often we get to meet and check in and focus on things tends to be equivalent to more success.”
Moon says telehealth has been particularly helpful for her clients in addiction counseling. Some in recovery do not have driver’s licenses and some, like Hanson, live far away from the Connections Counseling facility.
Koren has seen the most profound benefits for the people in the women’s group — a group of people in recovery who meet in the evening. Many of the women are working moms who have told Koren that they wouldn’t be able to attend the group if it was in person.
“The women are not gonna come home from work, be with their families and then leave to go to group therapy,” Koren says. “So I think telehealth has allowed people to receive therapy that they otherwise wouldn't be able to utilize or participate in.”
