Like many others during the first weeks of the coronavirus crisis, clinical psychologist Peggy Van Raalte felt the ground shift — and her therapy practice change with it. Instead of clients seeing her in the office, they were increasingly calling her. Rather than working through the usual struggles with marriage, kids or identity, primal survival fears now dominated the bulk of her sessions.
"The first week the pandemic was declared, anxiety was absolutely huge,” says Van Raalte, who is based in Montclair, New Jersey. “It was all my clients could talk about.”
That week her clients returned again and again to their fear of falling ill or having loved ones get sick. And Van Raalte wasn't the only one whose phone was suddenly ringing constantly with pandemic panic.
Given the stay-at-home orders issued around the country, therapists, conducting their sessions from their homes (with expanded coverage options offered through Medicare; see below), report hearing a dramatic increase in health concerns.
Older clients, they say, feel especially vulnerable, their apprehension compounded by memories of other health crises they may have faced or by their current isolation.
Several weeks into the pandemic, stress from the unknown timeline of the virus, as well as fears of health care rationing, is growing, to the point that psychologists report that older clients are having difficulty sleeping, with some, as one New York–area therapist observes, “consumed by anger and regret” as they face an uncertain future.
People of all ages are suffering from job insecurity, too. One licensed social worker, who sees clients outside Philadelphia, says that as the crisis continues, she hears “more anticipatory anxiety: ‘What if I lose my job?’ ‘What if I run out of food?’ ‘What if I or a family member gets sick?’"
On the other hand, she notes, adults who suffer from generalized anxiety seem to be functioning well under the circumstances. “Many people who are always living in a state of anxiety do better in a crisis. Anxiety is familiar to them."
What a virtual session is like
Although technology had been bringing patients and therapists together on-screen for at least 10 years, some providers shied away from teletherapy. Van Raalte was initially skeptical about therapeutic videoconferencing. “I like to feel the energy that occurs in person,” she explains.
But her recent experiences with remote sessions have proved more successful than she imagined. “I'm surprised about how well the video sessions are working,” she says. “I find that the screen disappears after a couple of minutes and people get comfortable.”
Older adults using teletherapy during the pandemic say it offers them comfort and connection. A 61-year-old professor at a small college in the Midwest, for one, says that her remote sessions help her handle her “very high” feelings of anxiety.
She adds that her “caring” therapist, even over the computer's video connection, serves as a “a stable, loving force... she's the community I don't have in this crisis."
Getting Teletherapy Covered
What to know about expanded Medicare options
Prompted by President Donald Trump's emergency declaration during the pandemic, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telehealth services, including psychotherapy and other mental health practices.
While this improvement will enable some of the 44 million Medicare beneficiaries to use teletherapy, people with private insurance plans may have to negotiate coverage. Insurance reimbursement for teletherapy varies from state to state and policy to policy. Currently, 30 states have mandated private-payer reimbursement for care delivered via telemedicine. Many other states have similar pending legislation. Plus, plenty of state Medicaid plans cover teletherapy.
What's more, before COVID-19, only software programs with certain built-in privacy and security safeguards (like Doxy and Zoom, for health care) were eligible for Medicare reimbursement, which made providers more likely to use these programs.
But on March 17, the U.S. Department of Health and Human Services (HHS) decided that it would no longer impose penalties against health care providers “in connection with their ‘good faith’ provision of telehealth during the COVID-19 public health emergency.”
This means that providers may use popular applications — including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video and Skype — to provide telehealth during the public health emergency without facing penalties for violating the HIPAA (Health Insurance Portability and Accountability Act) regulation. (HIPAA provides security provisions to keep patients’ medical information safe.)
When the coronavirus crisis passes and remote therapy is no longer required, will it have already changed the landscape so much that it replaces in-person sessions? Though the government says that the new policies will be in effect on a “temporary and emergency basis,” it might not be so easy to wean clients (and their therapists) off the screen.