Category: Teletherapy

Online therapy, telehealth, telecounseling, telepsychology, telemental health session

Online therapy: What you need to know

The term ‘online therapy’ refers to therapy done by video call. It can also be referred to as telehealth, telemental health, teletherapy, telecounseling, or telepsychology. Online therapy used to be a niche area, far outnumbered by in-person therapy sessions. However, this changed during the pandemic, as clients and therapists saw that they could still do valuable therapeutic work together online. Knowing how to find the best online therapist for your needs involves a few decisions and steps that we describe in this article.

Tips for finding the best online therapist for you

First, decide whether you prefer therapy in-person or online, or some type of hybrid approach. Keep in mind that there is an tangible benefit to being present together with a therapist, much as would be the case in any relationship. You also might feel more comfortable disclosing certain things in a private area that is neither at home, work, or in public. On the other hand, you may prioritize the convenience of an online therapy session – no travel time! – and feel that this benefit outweighs the benefits of in-person.

Many of the strategies involved are the same as using the internet to search for a therapist you would see in person. Nonetheless, here are a few specific tips for telemental health:

Ask your prospective therapist IF they offer online therapy.

It might seem obvious as the world changes, but not all therapists have made the switch to online therapy. When visiting a therapist’s website, don’t make the automatic assumption that they provide telemental health. Also make sure they offer online therapy in the form of a video call and not just regular phone therapy. The visual dimension of face-to-face is an important aspect of therapy even if it is not in-person. Next, and far more important…

Ask your online therapist HOW they would provide online therapy.

Now that more therapists than ever are offering online therapy, you should ask how your prospective therapist would offer this service. The Health Insurance Portability and Accountability Act (HIPAA) has strict requirements about the privacy and security of video call applications. Popular video call apps such as Facetime, Skype, and Google Hangouts are not HIPAA-compliant. On the other hand, others such as Zoom, Vsee, Doxy.Me, and Google Hangouts Meet are HIPAA-compliant because of the encryption they provide and inability for call logs to be traced.

Read More: Do Therapists Have Therapists?

Fortunately, CMS relaxed this HIPAA requirement during the pandemic. Despite this, it is still important to talk with your prospective online therapist and learn how they use technology in therapy. Are they proficient in it? Do they seem to understand the potential and pitfalls of this mode of therapy?

Make sure that all aspects of the telemental health process are secure.

As with regular in person therapy, it is important that every new patient understands and agrees to the process. You should always review and sign an ‘informed consent’ agreement prior to starting teletherapy. Such documents explain your therapist’s approach to treatment. You should also be sure that any sensitive information that you provide is stored in a secure manner. For example, ask your online therapist whether they use a secure online patient portal or encrypted email to send and receive such information. Additionally, ask your telemental health provider how they process credit card payments and store any credit card information.

Now that we’ve discussed the technical stuff, lets get to the universal human side of this process…

As with in person therapy, make sure you have a good connection with your online therapist.

A fast internet connection isn’t the online important connection in online therapy. The connection you have with your therapist is the most important factor to predicting the success of treatment. Studies show that the therapeutic alliance or rapport developed in the first three sessions is predictive of the outcome of therapy. If you like your online therapist, therapy is likely to go well. If you feel lukewarm about your online therapist, it is much less likely to be successful. It is always good to ask questions by email, phone, or even a brief video call prior to starting treatment. Even if you don’t do that, use the first session as a ‘try-out’ session to see if it feels like a good fit.

Pay attention to the process of telemental health, not just the content of what you talk about.

How does it feel when you talk to your online therapist? Do they do a good job of making eye contact and holding your gaze? Do they pay attention to your nonverbals, including things like how you breathe, how you hold your body, and how you show (or don’t show) emotion? Even though you can’t be in the room together, it is important to find a telemental health provider who is attuned to you and with whom you feel a secure attachment.

Find a telemental health provider with whom you can meet in-person, if necessary.

I suggest working with someone with whom you would have the possibility of meeting with for in person therapy sessions if these are necessary at any point. While many people can and do choose to work with out-of-state providers for telehealth, this doesn’t mean it is always ideal. While the relationship and fit with your online therapist is the most important factor, make sure to have a backup plan in the event there is ever an emergent need for an in-person session.

Eric Spiegel, Ph.D. is a licensed psychologist and practice director of Attune Philadelphia Therapy Group. He was the President of the American Society of Clinical Hypnosis (ASCH) for 2018-2019, and has won numerous awards from ASCH, including their Early Career Achievement Award (2012). Dr. Spiegel is the co-author of the book Attachment in Group Psychotherapy, published by the American Psychological Association. He has also published journal articles and book chapters on subjects such as attachment therapy, hypnosis, group therapy, anxiety, trauma, and relationships.

Hypnosis: Natural IBS Treatment

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder (FGID). Functional GI disorders tend to be characterized by recurrent and persistent GI symptoms such as abdominal fullness or bloating, cramping, and diarrhea and/or constipation. IBS is the most common FGID and tends to effect the middle and lower digestive tract. IBS sufferers tend to report discomfort, pain, and cramping in the adbominal and intestinal regions. Patients who inquire with me about hypnosis for IBS have often exhausted standard, medical avenues of treatment. I often hear about trying different gastroenterologist doctors and various medication treatment regimens – with limited results. By the time they reach me, patients are hungry for a natural IBS treatment. This is where IBS hypnotherapy comes in.

Mind-Body Interaction in IBS

IBS and FGIDs are examples of psychosomatic disorders. Psychosomatic disorders are conditions with real, physiological symptoms and impacts that have a significant mind/mental/psychological component. An applicable is that your body is an ‘instrument’ that your mind plays – the keys, pitches, chords, etc. are ‘in tune’ with your mental experiencing. Your body will express physiologically mental and psychological experiences. This means you might feel and express stress through your body. Sometimes, emotions and physiological sensations will feel concordant – that is, they will be expressed together. Other times, your body will express emotions that you may not consciously be in touch with. Stress, depression, and anxiety are examples of psychosocial factors that directly impact the gut. According to Harvard Medical School, mental states affect the gut in a number of different ways. Psychological factors can affect gut contractions, increase susceptibility to infection, and worsen inflammation. There is also research to suggest that people with FGIDs experience pain more acutely, and that stress increases this perceptual sensitivity to pain. But there is good news! What goes up can of course go down… and that is where psychotherapy, and in particular hypnosis, can be of help. Ready to learn more about this effective natural IBS treatment?

Why Hypnosis for IBS?

Hypnosis is completely natural, easy to learn, utilizes your own mind towards healing, and does not have the side effects associated with medication. Learn more about the state of hypnosis, facts and myths about hypnosis, and how the hypnotherapy process works in this blog post.

People are often surprised to learn that hypnosis is one of the more successful approaches to both medical and natural treatment for IBS. Most research studies indicate that the response rate to treatment is approximately 80% and better. Additionally, the IBS hypnotherapy treatment can help in cases where other treatments have failed to yield benefits (Palsson et al, 1997, 2000; Whorwell et al., 1984, 1987). Furthermore, hypnosis for IBS can yield positive treatment effects long after the completion of the IBS hypnotherapy treatment process.

In 2015, a meta-analysis examined 30 years of IBS hypnotherapy research: 35 empirical studies, 17 of which were randomized control trials (RCTs). The results were clear – professional utilization of clinical hypnosis for IBS generated superior results in comparison to standard medical treatment alone, for both children and adults. (American Journal of Clinical Hypnosis, 58(2), 134-158).

Here are additional findings, courtesy of my colleague in the American Society of Clinical Hypnosis David Alter, Ph.D.

Emerging research trends suggest the use of clinical hypnosis not only impacts the reported improvements levels of comfort and control over IBS symptoms. It also impacts measures of digestive functioning, such as gastric emptying rates (Scandinavian Journal of Gastroenterology, 47(12), 1480-1487).
Clinical hypnosis was found to yield not only symptom improvement in IBS sufferers, but to also generate significant reports of improvement in overall quality of life (Neurogastroenterology & Motility, 25(2), 169-186.)
When compared to psychoeducational interventions, the use of clinical hypnosis activated measurable changes in selected brain regions associated with reports of diminished reactivity to gut-related stimulation (Alimentary Pharmacology & Therapeutics, 37(12), 1184-1197).

How does the IBS Hypnotherapy Treatment Process Work?

The sessions work in several ways. First, they establish a pathway for hypnotic deepening and relaxation. The hypnotic interventions focus heavily on somatoaffective grounding and containment – suggestions focus on discernible sensory and physiological experiencing, building positive sensation and mastery into the process. This is an important part of reducing baseline physiological reactivity. Why is this important? If your average baseline level of distress on a SUDS scale is 6 on a scale of 1 to 10 (highest), it won’t take much for external stressors to trigger reactivity in your body. On the other hand, as we are able to consistently and systematically reduce this reactivity, let’s say this number goes down to a 3 (or lower). The reason that is significant is that subsequent mild to moderate daily stressors -an inevitable part of living – will be less likely to trigger your GI symptoms. Think about it this way – everybody has ups and downs, positive and negative moments, relaxed and stressed, etc. An image of this pattern might be like a wave. The wave always maintains it’s structure, but the discernible difference in magnitude between a stormy ocean wave and a typical lake wave is striking. As we help you develop healthier and consistent ways of being in your body in a peaceful and grounded way, you will be less likely to be as triggered during times of stress.

Second, the IBS hypnotherapy directly addresses your GI symptoms and physiology. Hypnosis for IBS incorporates language (both words and vocal prosody) and imagery. The hypnosis sessions feature both direct and indirect hypnotic suggestion. Direct suggestion involves language that is specifically formulated for the GI symptoms associated with your IBS. Hearing these kinds of suggestions, and hearing them in a repetitive way, promotes healing by seeding them in your mind in a way that you can hold onto. Indirect suggestion is also an important part of this treatment process. Here is where the narrative comes in. Images and words that are metaphors for the change process help your unconscious internalize the therapeutic change. In this way, hypnotic stories take you through a healing progression, helping you imagine a metaphoric parallel of healing that applies to both your current experiencing and imagined future experiencing. The integration of direct and indirect hypnotic suggestion is an important part of hypnosis for IBS.

IBS Specialist Philadelphia: ‘Hypnosis for IBS Near Me’

I follow Dr. Olaf Palsson’s University of North Carolina IBS Hypnosis protocol – 7 standardized hypnosis sessions that have been empirically tested and supported through research. As an approved provider of this treatment approach, I have been using it for over a decade. After an thorough initial evaluation appointment, which includes an initial assessment questionnaire of IBS symptom severity, I offer 7 hypnosis for IBS treatment sessions. Despite the standardization of the treatment process, I still believe it is important to utilize the subjective aspects of a patient’s identity, presenting concerns, goals, and history as part of the IBS hypnotherapy treatment. Personally meaningful language is important, and I weave it into the sessions. Each person’s relationship with food, and more importantly with themselves, is unique.

Ready to get started?

Eric Spiegel, Ph.D. is a licensed psychologist and practice director of Attune Philadelphia Therapy Group. He is the President of the American Society of Clinical Hypnosis (ASCH) for 2018-2019, and has won numerous awards from ASCH, including their Early Career Achievement Award (2012). Dr. Spiegel is the co-author of the book Attachment in Group Psychotherapy, published by the American Psychological Association. He has also published journal articles and book chapters on subjects such as attachment therapy, hypnosis, group therapy, anxiety, trauma, and relationships.

How to find the best online therapist