For this month’s Consult The Expert interview, I spoke with Seth Grobman, Psy.D., a clinical psychologist here at The Anxiety Center. Dr. Grobman has been practicing traditionally for more than twenty years. When the covid pandemic hit, he pivoted to telehealth so he could continue to treat patients during the shutdowns.
Today, telehealth is still very much a part of his practice, as it is with the other clinicians in our office.
“So far, telehealth doesn’t seem to be going away after the pandemic, the way the work from home model has changed to require staff to work in an office setting,“ Dr. Grobman said. “Telehealth is a way for people to access mental health counseling like never before. It is fantastic because it provides ease of access for those who, due to circumstances, would likely not ever see the inside of a therapy office.”
“For example, I’ve worked with people who struggle with varying degrees of agoraphobia [an extreme fear of leaving home or of being in open or crowded places]. That person is most in need of therapy, but can’t leave their home. So, telehealth is a great way for them to start therapy until they are able to come in to my office.”
Are Patients Comfortable With Telehealth?
In a word, yes, says Dr. Grobman. “As you’d expect, young people are relatively more receptive to telehealth. You’d think older clients would be more resistant, but I do have a significant number of clients in their 60s to 80s and they find that telehealth is a game changer for them.”
“It’s a good alternative for patients. For example, last week with the hurricane, having telehealth appointments allowed clients to keep their appointment, despite the storm. It reduces cancellations and reduces disruption to the therapeutic process. It’s definitely more practical.”
“Another plus is the ability to pick and choose a therapist, even if they aren’t local to your area,” he said. “I have clients from across the state. These people may not have ever found themselves in therapy, except for the advent of telehealth. And, many people like the idea of not fighting traffic to travel to an appointment. They prefer talking from the comfort of their familiar surroundings and they like the convenience of scheduling on a lunch break or other suitable time. It seems like telehealth is here to stay.”
Is Telehealth As Effective As In-Person?
I asked Dr. Grobman whether telehealth visits are just as effective as an in-person session. “I don’t have statistics,” he answered, “so I can’t say with certainty that the outcome is much different between in-person and by video chat or by phone, but from a process perspective, psychotherapy may work better if the client and I are in the room together.”
“In therapy, the client is asked to be candid and open, so it may work better if we’re in the same room. But sometimes a video chat is more helpful because it feels like a safer way to have therapy than being in the room with the therapist. As a therapist, I think it’s wonderful that someone who feels threatened can do this remotely – it’s a tipping point for many. As I said before, if not for the telephone or video, some people would not or could not seek help.”
Visual Or Voice? Or Both?
I asked Dr. Grobman if his teletherapy work is conducted strictly by video chat or by phone. Or perhaps by a combination of both modalities? “Visual telehealth can be great,” he replied. “I can see my clients in their element. I don’t endorse using phone therapy alone, though, because I lose every visual data point there is.”
“A lot of communication happens through gestures, expressions, and physical actions,” he continued. “It is extremely helpful for a therapist to observe their client during a therapy session.”
“That said, some people I have worked with just cannot make the leap to using a computer and prefer speaking over the phone. In those rare cases, I explain the limitations that exist with therapy done strictly by phone, for both me and the client. Sometimes they will try the video method first after hearing my concerns. If that doesn’t seem to be working, however, I may try do therapy by phone, but it very much depends on the person and their presenting condition. “
What Are The Cons Of Telehealth?
There are other challenges the therapist has in determining whom to treat via telehealth, according to Dr. Grobman. “The biggest of these is the nature of the client’s presenting problems. For example, if I am seeing someone who is struggling with impulse control disorder and acting out a lot, as a therapist, I might feel uncomfortable treating them unless they were in the room with me. There are some things I can’t see on a monitor, like I can face to face.”
“In other instances, someone may not be able to attend the session adequately because they are distracted or have distractions in the room from where they are speaking. At the outset, I explain to my clients that this is a great opportunity to work on some issues, but it is imperative that we do our best that you have no distractions. It is essential that there are no other open pages and windows on your computer while you are talking to me. No children or pets competing for your attention. I also discourage patients from completing a session while lying in bed. Each session needs to replicate being in my office as closely as possible.”
“Another obstacle is that a client who is struggling may simply not pick up the phone or answer the video session when I call,” he said. “And, although this doesn’t happen often, we can experience dropped calls, which interrupts the flow of the session.”
Insurance And Telehealth
I asked if insurance companies treat telehealth visits differently than an in-office visit. “At present, insurance companies don’t distinguish between the two,” Dr. Grobman answered. “Our fees are based on our time, so there isn’t really a difference.”
Does he think the insurance industry will continue to support telehealth? “We know that mental health concerns are skyrocketing post-pandemic,” he responded. “I don’t see the insurance companies pulling back on this. By doing so, they would be implying they are reducing access and they wouldn’t want to do this.”
There are many other situations to consider, as well, he believes. “For those who are financially challenged, to ask them to take time off work to schedule their therapy and lose time and pay would be irresponsible.”
“I believe telehealth is here to stay and proliferate. As technology improves, you’ll have a more seamless experience. In fact, I can see virtual goggles in the future, with “holographic” technology making telehealth therapy even more realistic.”
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About Seth Grobman, Psy.D.
Dr. Seth Grobman is a licensed clinical psychologist who has been practicing in South Florida for over twenty years. He obtained his Bachelor’s Degree in Psychology at the University of Rochester where he graduated cum laude with honors in psychology. He obtained his Doctorate in Clinical Psychology at Nova Southeastern University with a pre-doctoral certificate in psychoanalytic psychology. Dr. Grobman then worked ten years on staff at the Renfrew Center, the nation’s first residential treatment center dedicated to the treatment of women with eating disorders. There, he conducted evaluations and provided treatment to hundreds of young women from across the country. He has provided extensive supervision on the evaluation, treatment and management of eating disorders to practicum students, interns and postdoctoral residents.
In his private practice, Dr. Grobman regularly provides psychotherapy to individuals with bulimia, anorexia and binge eating disorders. He works closely with family members to assist them in navigating this most challenging of mental illnesses. He regularly consults with other healthcare professionals (pediatricians, gastroenterologists, psychiatrists, nutritionists, exercise physiologists) in order to provide his patients a multidisciplinary approach.