Drawbacks of Virtual Work

DRAWBACKS OF VIRTUAL WORK:

Virtual work is not appropriate for all types of clients: Clients who are frequently in crisis or dangerous situations, have a high degree of suicidal thought, or have severe mental illness that require care coordination with a psychiatrist are likely not a good fit for virtual work. While this seems to contest my comment earlier about accessibility to populations that generally wouldn’t seek traditional therapy, it is less of a black and white issue. Clients should be assessed for safety, and all clients starting virtual work should immediately complete a safety plan. The provider is the best judge of whether or not a client is a good fit, and will likely share that during the consultation or first session. 

Virtual providers cannot respond in crisis: While having messaging capabilities may give the impression that providers are available 24-7, that isn’t actually the case, and providers are often keeping “regular” business hours with good boundaries. Crisis situations will require the use of alternative resources, much like those of traditional therapy- this includes the suicide hotline, crisis centers, local community mental health agencies, and of course emergency rooms or psychiatric facilities. Additionally, providers are held to the same standards of traditional therapists when it comes to mandated reporting practices, or contacting outside authorities in cases of harm to self or others, or reported abuse or neglect of children or vulnerable adults. 

Confidentiality is often dependent on the client: In a traditional therapy office, methods are used to ensure confidentiality- doors without windows, noise machines, receptionists who limit exposure to your private information upon check in or appointment scheduling. With virtual sessions, how much or how little privacy the client has is dependent on where they choose to conduct their sessions. The therapist is always obligated to be in a safe, HIPAA compliant space when conducting business including messaging, but if a client messages their provider in line at the grocery store, there is always a risk that the person behind them saw it. 

Basic logistical issues: Some states will not allow providers to see clients traveling to different states. There are rules about who can see how and in what locations. As a general rule, unless the provider is licensed in multiple states, getting a therapy session while on vacation in another state or country is probably out of the question. Additionally, technology issues have the potential to interrupt sessions, both during live sessions or on client platforms. While every effort is made to avoid this, sometimes technology doesn’t meet our standards of using it. In that same vein, if a video session is conducted with the camera showing the client from the neck up, there may be missed physical and nonverbal cues that a provider would traditionally pick up on. Assessing tools including odor, gait, etc could be missed. This may hinder the provider’s ability to truly assess the client’s level of functioning. Obviously in a phone session, these abilities are hindered even further.