Delivering Remote Therapy Effectively Blog Series - Part One
As Ieso's Chief Clinical Officer and chair of the BABCP IT Special Interest Group, Sarah Bateup provides advice and guidance to clinicians on how to adapt working practices and deliver therapy effectively during the current coronavirus outbreak. In this regular blog series, Sarah will cover a number of topics including:
- The best preparation for seeing patients using digital therapy methods during COVID-19
- Housekeeping and consent when moving to digital therapy methods
- How to deal with patient contact in-between therapy delivery
- The common phenomena when moving to non-face to face therapy delivery
- …and much more.
As we navigate through the coming weeks and months and adjust to this changing world, we will continue to provide guidance on digital therapy methods, and what to think about and look out for during this challenging time.
Part one: Preparation for seeing patients using digital therapy methods
The coronavirus outbreak and the move to lockdown in the UK has brought about new challenges in therapy delivery, particularly for those that deliver treatment in a face to face environment. With many people still currently confined to homes and unable to get out for treatment, normal pathways to mental healthcare have been disrupted and, service providers, including the NHS, have moved to providing treatment digitally to keep services running.
As a provider of online cognitive behavioural therapy (CBT), we believe at Ieso that digital mental healthcare delivery is equally as effective as face to face CBT. However, with anything, the delivery method is only ever as good as the person delivering it, and this is the same with clinicians. If you are a clinician that has recently moved to digital therapy, then the way to get the best out it is through training and learning the methods that work for you.
We also understand that there are many digital methods you can consider using in your clinical work. However, because of the sheer number of tools and terms related to digital methods, it might be confusing to understand what is out there and the best approach. We hope this post supports you in defining this during this crisis and can bring some clarity to the digital delivery world.
Digital methods can be highly effective, but it really is down to each clinician to bring digital therapy to life and enable patients to make the most of what is on offer to them. Digital methods of therapy sit on a continuum. At one end, there are self-help methods offered to patients and accessed online. Then somewhere in the middle, there are guided self-help methods, traditionally using online platforms with digital materials, which the clinician will guide the patient through. We know from the research work of Henry Maudsley and David Clarke that guided self-help is very effective in treating patients with conditions such as social anxiety disorder.
At the other end of the continuum, there is therapist delivered digital interventions, which use communication methods like video, telephone and email, or text-based messaging to deliver treatment. The latter is how we provide online CBT at Ieso. All offer varied benefits for delivering interventions. However, with our experience working with therapists for many years, we find that those that adopt digital methods, come up against at least one of three things as they learn the process.
About 10% of therapists can adapt to digital delivery really well using whatever communication method that works for them. The majority, however, need some support and training, and we've been lobbying hard to get digital method delivery on the training curriculum for IAPT therapists, and those in the NHS. On the whole, the healthcare industry needs to support therapists to work smarter online because it does take some time to adapt, especially if it is different from the way they usually work with their patients. Whatever digital method you choose, you will need to think about how you use it and don't assume that you can just plug in and play.
There are many therapists out there who have worked online for longer, and our advice to them is to build a community of peers who have experience using alternative methods of delivering CBT. By creating some peer supervision groups, you can share learnings about the particular techniques that you're using and what is working and not working for you. Discussions on what you're finding difficult, and what your patients are finding difficult will help you understand if these are unique to you others experience it too.
For those clinicians more used to working in face to face IAPT services and clinics, it is easy to take for granted the informal support and consultancy from our colleagues that we might meet in a coffee room or the office. We use these engagements to seek some informal guidance regarding a patient – something that is harder online. Perhaps if we've seen a patient that is a little more complex, or someone that worries us or has maybe made us feel a little distressed, we can seek some reassurance regarding risk or safeguarding. These type of informal conversations are really important to our work and should continue in a digital environment.
We encourage you to build a community where you have informal support, which is the fastest way to disseminate learning and share experiences about how to deliver CBT online.
We would like to get your feedback on this topic so please feel free to email us on email@example.com to share your thoughts, or take the time to read other blogs in this series by clicking the links below: