The Changing Face of Substance Abuse Treatment:

How telehealth has impacted client engagement

Imagine the experience of stepping into your first day of substance abuse treatment. You and your loved one would arrive at the clinical building where you would be warmly greeted. The building would be bustling with staff, care providers, and counselors all of whom would be eager to make you feel welcome. You would meet in a comfortable, cozy office with a counselor to begin your intake interview. Before long, our nutritionist would ensure that you had a healthy lunch, and you would be introduced to all of the clients who would fold you into the group and make you feel welcome. By the afternoon you would be invited to join a small group where you would sit in a circle and get to know your peers and some of the counselors. The experience may feel scary and overwhelming, but you are surrounded by support.

At Bridging the Gaps we pride ourselves on the warm, personalized care that we provide every client and their families. We support new clients in overcoming the apprehension of treatment through our compassion and care. With the Coronavirus pandemic and social distancing mandates to ensure all of our safety, the experience of starting treatment looks very different.

Now imagine coming to a building where there are only a few faces because most of the staff and all of the clients are sequestered and participating via telehealth. When you are greeted, distance is maintained and a handshake is avoided. You meet with a clinician across a large room while both of you are wearing a mask making it uncomfortable and hard to trust the counselor whose face is veiled. You finish your assessment and are whisked back out of the building with a promise that you will receive an email to join a video chat in the morning. When it is time for your first session, you have to show up on camera with a group of strangers and be prepared to engage without the opportunity for idle talk and building relationships as you would in person.

The stress of overcoming these hurdles is too much for some. Clients have to be motivated to show up in what can feel like a very intimidating and disconnected process. The Wall Street Journal came out with an excellent article about why meetings via video conference can feel so exhausting. The article explains how unnatural it is for us to make such sustained eye contact and to seemingly be so close to individuals who you would normally maintain greater social distance. The act of being on video changes our social dynamics. This article was referring to interacting with co-workers, but those challenges are heightened in a group therapeutic process. It is hard to open up and be vulnerable when you have multiple faces gazing directly at you. If you are new to treatment, all of those eyes are complete strangers who you haven’t even met in person.

The challenges of engaging openly on a telehealth platform are not reserved solely for new clients. Seasoned clinicians have to change their approach. Denise Reeves, Clinical Director of Bridging the Gaps, shared that one of the biggest challenges she has faced has been “Transitioning from traditional group therapy in which we use circular seating to foster connection within the group. We now use the close visual connection we have with each other through the screen. As a counselor, I am working on finding ways to foster the group’s connection to each other so that they work the process and provide feedback, empathy and support.” While Denise says that it is coming along, the shift has taken weeks to become more comfortable.

Moving onto a telehealth platform has allowed for growth amidst the frustrations for the clinical team and the clients. Marcie Dunnet, Substance Abuse Counselor at Bridging the Gaps reflects:

“My first thought when I heard we were shifting to telehealth was, “How is this going to be effective?” It didn’t take long for me to hit “a bump in the road.” One thing that frustrated me was my lack of control over the environment. Examples of technology issues and struggling clients come to mind. Thankfully, it also didn’t take long to fix these problems. My most successful technique is patience. We are all learning and it’s not easy. I allow extra time for simply “saving space.” If there is a technical issue, we all work together to alleviate the problem and eventually it gets fixed. If there is a client who is emotional or irritated that day, I model more patience. This demonstrates compassion to the entire group and eventually, they all begin to learn this same patience. During the most difficult of sessions, we work together as a “team” to adapt and overcome. Telehealth has actually been somewhat of a blessing. I feel more connected to my clients because of the struggles we continuously work through together.”

The team at Bridging the Gaps has worked to come together to support one another through the obstacles that we are facing. We have also relied on our core value of continuous improvement by asking the clients for their feedback. We have found some of the same frustrations reflected by the clients as we did the counselors. One such challenge is keeping the clients’ attention while they are at home. Instead of sitting in an intentional space, clients are in their living rooms and bedrooms joining treatment from an environment that is not tailored to group therapy. Enforcing behaviors such as not eating and not using your phone in group has become more difficult, and the clients agree. Their number one frustration with telehealth has been the manners and cooperation of their peers. Attaining feedback like this allows the team to work on improving the group process.

Most clients have shared that they would prefer in-person services. An anonymous client reflected, “I completely dislike the group chat. Video chat with my counselor is okay.” Other clients were milder in their dislike of the telehealth platform stating that “As best as this platform allows, I feel connected.” Clearly the comfortability of group on video is having an impact on the clients across the boards. As the client above reflected, individual sessions seem easier to participate in. Our clinicians agree. Denise Reeves shared, “Individual client sessions have not posed much of a challenge. It seems that the client is able to connect, open up and engage in a manner that is like when we have met in person. The primary challenge here has been with tech-connection issues such as when a storm is moving through the area and disrupts our dialog.”

While the transition onto a telehealth platform has come with plenty of bumps along the road, the counselors and clients are all slowly adjusting. One client shared that “The first week was rough. The second week was a little better. Now we’re getting back to more than normal.” Further, when asked “Do you feel your personal therapeutic process is on track since converting to telehealth?” 89% of clients said their therapeutic process was the same as before with 11% sharing that it was better than before. Despite the difficulties with engagement, the clients continue to benefit from their substance abuse treatment. While we would all like to open our doors and get back to normal, we are honored to be able to support clients through both their recovery and the fears and uncertainty of COVID 19.

If you, or a loved one, are looking for substance abuse treatment please reach out to us at 540-535-1111. We will do our best to warmly welcome you into our virtual treatment setting.

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