Be yourself, but slightly more expressive. It is important that clients feel your presence as if you were in the room together. You want to engage in ways that let them know you are fully there for them. I show this by at times leaning into the camera or making sure to paraphrase (a bit more than I normally would) some of their key concerns. It does not mean that I in any way overpower the sessions, but until that transition has been made to feeling comfortable online, it helps for clients to feel your connectedness.
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 Dr. Alice Shepard.
Alice Shepard is a clinical psychologist and Director of Mirielle Therapy Practice, PLLC, a group practice that focuses on the success of women. She is also a medical advisor at Sesame. Alice holds a BA from Brown University and a Ph.D. from the CUNY Graduate Center. She completed additional training at Barnard, Columbia University, and Columbia Medical Center.
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?
Yes, my “aha” moment was when I decided to begin a group therapy practice. Our daughter at the time was two years old and I had just asked my supervisor if I could stop working the evening shifts that ended at 9 pm two days a week. Although he was incredibly sympathetic, he explained that the setting entailed nighttime appointments and that it might be a few years before we could rotate off of this schedule.
I was sitting in my office replaying the conversation in my mind and feeling very stuck. I was incredibly frustrated and not sure how to move forward. On one hand, I was employed by a wonderful college and cherished my work supervising trainees and meeting with clients. I also greatly enjoyed the people I worked with. On the other hand, I wasn’t happy with the salary or the hours.
As I sat, replaying the conversation, wondering if maybe I hadn’t been assertive enough, it clicked in my mind and I felt an immediate sense of relief and excitement. I had the moment of, “Oh, I can create this on my own and I don’t need anyone’s permission.” I love the work, I am good at it, and I can make it a business. At Mirielle Therapy Practice, I focus on women’s issues and concerns; I also continue to train and supervise other therapists. In essence, I created my dream job.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I have many Life Lesson Quotes from others that I rely on for inspiration. The one that stands out the most in my mind is from my mentor AJ Franklin, who advised me “Don’t take yourself out of the race.” At the time, I had been doubting whether I was ready to apply for a great opportunity. I return to those words whenever I begin to doubt myself or my abilities. The message is simple: Don’t be afraid to go for something hard to obtain.
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 have had many, many people help me along the way, and I am so grateful to my husband and my mentors: Drs. AJ and Nancy Franklin, Dr. Steve Tuber, and Dr. Arietta Slade. My dad has provided continued support and is a source of inspiration. I also belong to a kick-ass friend group of women psychologists.
Hands down, however, is my mother’s influence. As a divorced mom raising two kiddos and working full-time, she was able to earn her doctorate from Teachers College. She saw me for who I was and parented in a way that gave me great latitude. My confidence in many ways comes both from her trust in me during my teenage years and her sense of humor during difficult times. She gave me the beautiful enduring gift of resilience and well-earned New York savvy. By age 16, I was attending Stuyvesant High School, working at a small magazine, and staying out most weekend nights exploring the pre-Giuliani club scene in Manhattan. Learning to effectively navigate these different settings rapidly expanded my worldview. I think that being a good therapist requires having had a wide range of experiences to draw from.
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?
The benefit of being in person is that I can more readily focus on all aspects of a client’s communication. As a therapist, it is vital to be able to pull from both verbal and nonverbal cues to fully assess a client’s level of wellbeing. Just as with casual conversation, if someone says they are fine but you are there with them, you know they are not fine at all. It is the same in the therapist’s office. Being in person allows me more points of data to evaluate a client’s level of functioning.
The therapy room is designed to be distraction-free so that the focus can be on the client and the client’s needs. To give someone our full focus and presence of mind can be life-altering. In our daily lives, however, our attention is too readily divided between work, email, texts, social media, and trying to decide what to order on Seamless. The therapeutic process requires being separated from these intrusions. I think most people crave undivided attention from important others. It’s a universal way of communicating specialness. It is easier to reduce distractions for the client in the IRL therapy office setting. In virtual sessions, we must reduce distractions as much as possible so that the therapeutic work can take place.
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?
In-person sessions involve certain established rituals and artifacts — the travel to the office, the waiting room, the greeting, the warm lighting, and having a box of tissues within arm’s reach no matter which chair you sit in. These cues allow the client to enter into a certain frame of mind. Together, they help set the expectation for a meaningful conversation. The danger of Teletherapy sessions is that patients can view it as just another remote meeting unless we as clinicians take the time to help prepare clients to enter the conversation more thoughtfully. In my remote sessions, I take steps to make sure my clients prioritize the time. I want them to value themselves and to give the session the level of intention their concerns deserve.
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.)
- It is the clinician’s responsibility to learn the technology so that the basics of the sessions appear effortless. Invest in great lighting, a headset, and the latest software to facilitate the session. I chose ZOOM medical because there is only one link that clients need to reach me for sessions. Additionally, it has a waiting room feature that I can message them in to let them know if I’m running a few minutes late. Choosing an easily accessible and reliable telehealth platform was worth the money. You don’t want to spend precious session time stating that you can’t hear or see the client well.
- Be yourself, but slightly more expressive. It is important that clients feel your presence as if you were in the room together. You want to engage in ways that let them know you are fully there for them. I show this by at times leaning into the camera or making sure to paraphrase (a bit more than I normally would) some of their key concerns. It does not mean that I in any way overpower the sessions, but until that transition has been made to feeling comfortable online, it helps for clients to feel your connectedness.
- Teletherapy should mirror the contained experience of in-person sessions. Encourage clients to keep much of the therapy “space” the same. Remind clients to silence notifications on the computer and close work email, etc. Have clients continue to reserve the same day and time in their schedules. I ask clients to set up their space so that they can have privacy, quiet, tissues, and something to drink. This enables us to be fully focused.
- Feel confident in the services that you are providing. Just because it is not in-person does not mean the quality of care has decreased. In many ways it helps to focus on the client’s facial expressions; slight adjustments that I might have missed are now more evident. The convenience for the patient is also unparalleled. I now can see clients for urgent sessions who would have needed to wait a week to see me in my office. I can be there, in the moment, helping them navigate their challenges.
- Remember to prioritize yourself. It has now become even easier to fit more patients into your schedule. However, just because you can does not mean that you should. Self-care is now more important than ever. Remember to take breaks; connect with things that support your creativity and relaxation. Also, allow yourself to be creative about new ways in which you might want to help clients. Do you want to develop an online class or offer workshops, etc.? Allow yourself to take advantage of new opportunities available in the online world. Your feeling good and having success in your own life are essential to helping you care for your clients.
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?
Yes, I think it has changed the industry forever. The convenience for patients and therapists alike is incredible. A 45-minute session is no longer a three-hour excursion, inclusive of a roundtrip commute to midtown. In many ways, the increase in accessibility has led to an increase in demand. It has opened the possibilities of being able to serve clients who might be in remote settings or whose busy schedules previously could not accommodate therapy times. I know that for me, I’m able to be much more available to clients who might request a same-day appointment. I also feel that Telehealth will enable more therapists to expand upon how they serve patients by offering new services such as webinars and other online products.
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 think it can be hard to replicate the exact feeling of being together in the same space. However, I think that is okay. Instead, the virtual therapy platform has enabled me to get to know my clients in their lived context. In some ways, it changes the treatment by becoming less formal. It is good and important to keep the essentials of the therapeutic frame, such as time, meeting length, and privacy, but this new way of being in each other’s presence can help to move the treatment forward.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
The relationship between therapists and clients is one of the most important aspects of treatment. It provides the model of an emotional experience that is the cornerstone of a good treatment. Platforms like Sesame enable clients to find and connect directly with therapists. The simplification of the process helps reduce the barriers to treatment. My perfect telehealth feature would also include developing private pages for clients to store snippets of session content as well as online journal entries for them to better track and engage in the work between sessions.
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?
Whether sessions are in-person or virtual, it is very helpful to have clients give thought to the sessions in between meetings. This enables the next session to feel more like a continuation and requires less time for us to get back into the work. This can be done by journaling or just spending some dedicated time reflecting or practicing skills between sessions.
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?
I think technology development will continue to create exponential progress in the field of mental health and wellbeing. Although it will take some training and adjustment for therapists to incorporate VR, AR, and Mixed Reality into their everyday work, ultimately most of us will incorporate it. I have heard that some therapists use VR to effectively treat phobias through exposure therapy. As our society becomes comfortable with new technology, it will become another tool therapists utilize to connect with their clients to be there with them in their journey.
Is there a part of this future vision that concerns you? Can you explain?
My concerns are related to the quality of care. I feel that it is important to see where technology takes us. We must always work to center the patient and their needs. As long as technology helps mental health professionals to improve the care of our care for clients, I am all for 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. :-)
I love this question! We are taught about our emotions in kindergarten, and then it seems to abruptly stop for the remainder of our education. This is a missed opportunity that can be easily corrected. Learning effective communication skills and anxiety tolerance are needed, as well as mood assessment and regulation skills from an early age and into one’s college years. Incorporating and prioritizing this instruction as part of our education system would radically improve our society.
How can our readers further follow your work online?
The best way is to go to our website mirielletherapy.com.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.
Author: Dave Philistin, CEO of Candor