Getting Paid: Guiding Reluctant & Resistant Clients into Teletherapy

Many psychotherapists now have tele-practices and conduct video and phone therapy sessions instead of, or in addition to, face-to-face sessions in an office as a result of the majority of mental health providers switching to, or experiencing, Teletherapy sessions during stay at home orders during the pandemic. 

While these types of online video or phone services are not for every client or practitioner, many therapists are reporting that, after moving their practices online and doing therapy with clients over several months, they find video or phone tele-sessions are not only effective but convenient to both them and their clients. After the pandemic quarantine many therapists kept offering some form of Teletherapy along with in-person sessions once the quarantine was lifted.  

However, clinicians are also reporting that when some new prospective clients find out in-person sessions are not an option they seem reluctant, resistant, or unsure about beginning or making the switch to virtual therapy. This causes psychotherapists to feel conflicted because client consent is needed to work virtually when in-office sessions aren’t offered. Therapists also wonder if it’s okay to influence a client towards Teletherapy when the client doesn’t seem to want it or is less than comfortable. Should therapists address it or just refer? 

While there are many good reasons that people are reluctant to do teletherapy—no private place, no equipment but their phone, weak internet connection, etc., it’s important to remember that when in-person services are not available some individuals may initially find it hard to switch to or commit to therapy that’s different from what they’ve thought about, imagined, or come to expect. Teletherapy is that kind of different. No couch, just a screen.  

While clinicians know that some reluctance or resistance to beginning therapy is usually present in any intake, and are used to addressing that, what counselors aren’t as used to is handling intakes where the reluctance is around the only option offered. 

The truth is that many of the issues that are expressed as client reluctance about Teletherapy aren’t about the tele-sessions at all, but like in intake calls where in-person sessions are possible, are a manifestation of the client’s issues that are inherent to therapy—and these would come up even if the therapy was face-to-face.  

While online services are not for every client or practitioner, a client’s reluctance, discomfort, and resistance is most often not about Teletherapy, but about entering a new world where they are moving from a familiar way of operating to the therapy context where different rules apply. 

Our job as therapists begins with helping clients enter, become familiar with, and safely navigate the therapeutic context. We are, and need to be, their guide. 
 
As you read the following information, be sure to remember:

• Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines.
• You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in. 

What’s the best way to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when a therapist isn’t seeing clients in person in the office? 

Teletherapy reluctance, discomfort, and resistance are clinical issues. The therapist needs to take charge of any conversations regarding teletherapy issues. Yes, it’s part of therapy and it’s the therapist’s job to aid-educate-facilitate pre-therapy (intake) or Teletherapy resistance conversations.

New clients don’t really know what teletherapy is or what it’s like if they’ve never had therapy or online therapy before. They only have an idea of what it’s like or the description of what someone else told them. Teletherapy with a clinician who is a good match can be a great option when in-person therapy is not available and many clients are great candidates for video or phone therapy.

​Use your clinical skills to address and respond to a client or prospective client’s Teletherapy issues when they come up—just like you would address anything else. Treat the issues that come up about teletherapy sessions the same way you’d treat any other client issue.
   
Taking it personally = Countertransference!

Don’t take a client’s Teletherapy reluctance and resistance talk personally when clients demonstrate their issues and skill level—take or use a therapeutic stance just like you would about any other topic or issue. Under your guidance clients can then make an informed decision about beginning, continuing or ending Teletherapy. 
To review:

1. Conversing with and helping influence or change a client or prospective client’s mindset about Teletherapy when reluctance or resistance comes up is part of doing therapy!
2. Educate clients-prospective clients-referral sources about Teletherapy, how Teletherapy works, how you work, what successful Teletherapy takes, how much Teletherapy costs, etc.
3. Reset a client’s or prospective client’s mindset and expectations for Teletherapy, price, frequency, duration, participation/involvement, and ways to optimize the teletherapy experience.

It’s important to remember that it’s normal for the clinician and new client to experience an adjustment period with remote care. New clients might need extra guidance if they’re unsure about how to navigate teletherapy when working from home with family members, roommates, or small children around. Portions of sessions can be used to formulate solutions and manage creating a physical and interpersonal zone that works to provide a safe space for therapy.  

Teletherapy is definitely here to stay. Its effectiveness is equivalent to face-to-face sessions and the flexible nature of video and phone sessions benefit both clients and clinicians. Add in the ease and convenience of scheduling a video or phone therapy session and talking with a mental health practitioner from the privacy of your home or another convenient location, and you find that these virtual services are a huge draw, especially for many people who are seeking therapy for the first time. 

Telepsychiatry, teletherapy, telepsychology, and video therapy are more than just trends. In fact, a good number of mental health professionals found they prefer working with clients using teletherapy video and or phone sessions and have not returned to in-office sessions. Yes, quite a few therapists are reporting that they plan to keep or have kept their therapy practices solely virtual, and they have. Other therapists report they do both virtual and in-person sessions in their hybrid practice.

Both in-person therapy and Teletherapy have advantages. Some view office sessions as a way to get some distance from problems at home and find it easier to see and deal with challenges objectively. Some clients prefer phone therapy over video therapy, which works fine in many situations. 

While Teletherapy and online services are not for every client or practitioner, online therapy is here to stay, like it or not. Consumers are changing, and so are therapists and their practices. Teletherapy has become another viable option for mental health practitioners. It may not be the best option for everyone but the good news is that it is just as important and effective as the traditional therapist’s couch. 
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​Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping professionals develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com.