Logan Potter is a senior at Boise State University. Like many others, the pandemic affected her mental health.
"I was struggling quite a bit, so I was like, 'I need to go to therapy,'" she said.
With the lockdown, going to a provider's office wasn't an option. But her school's health services helped her find a therapist online. Once she started seeing them, though, she realized there was a problem: privacy.
Potter was living in a studio apartment with her boyfriend, she said, "and there was literally nowhere to go unless I was going to, I don't know, go to therapy while in my bathroom or something?"
So she ended up having him leave whenever she had a session, even if that meant he had to get up early just to walk around the block for an hour.
It also turned out that it wasn't that easy for Potter to find the right therapist.
"I think that she was really nice," she said of her match. "I think that she, like, just wasn't a good fit for me. But then finding somebody who is a good fit for me is very challenging using telehealth."
Potter also needed a psychotherapist to prescribe medications and who would be available with advice if she had side effects. She found someone and got medication, but when side effects like suicidal thoughts cropped up, that telehealth communication didn’t happen.
"I ended up actually disliking the experience so much that I just stopped going," she said, giving up on teletherapy and the medication altogether.
For Boise resident Jennifer Ekstrand, though, teletherapy has been a positive experience, save some grainy video and her rabbits chewing computer cords.
"It's had a surprising benefit in making me feel less self-conscious," Ekstrand said. "I sometimes struggle to maintain eye contact while discussing my trauma in person. But since eye contact is so different with video, I don't feel like I'm breaking any social norms when I break eye contact."
Beyond that, she’s grateful she doesn’t have to worry about getting COVID-19 during the sessions because she’s still in her own home.
These different experiences echo out to the thousands who adopted teletherapy during the pandemic, partially thanks to loosening regulations and stay-at-home requirements. Telehealth’s unprecedented growth is only expected to continue as time goes on, though.
So people like Logan Lamprecht think we need more research into teletherapy best practices as patients face these range of experiences. He’s both a psychotherapist and a professor in the counseling department at the Idaho State University, Meridian.
"A lot of the clients that transition to telecounseling, I would say about a third to a half of them have asked to come back to in-person – just wearing masks with physical distancing in our office space," he said.
Lamprecht’s students take on their own clients to learn, and they've had to go through a crash course on teletherapy over the last several months.
"I think a lot of the training that's available hasn't been incredibly good," Lamprecht said. "I think our students, even though they went through a certification process, we saw a lot of gaps in terms of really thinking about, like, the interpersonal applications of telecounseling."
So he’s now working with his students to create their own best practices as part of their education. And that’s something Chris Fore would stands behind. Fore is the founder and director of the Telebehavioral Health Center of Excellence, which serves Native tribes through Indian Health Services.
From his own experience with the center, he believes teletherapy should be part of a general counseling education going forward, and that would lead to more research.
"That research often takes place in those types of institutions and universities," Fore said. "So if they were starting to train, my assumption would be they would also start researching and developing those best practices that would have a broad evidence base."
Fore noted that there has been some research into telehealth being as effective as in-person counseling, especially from Veterans Affairs. And while there could be more research into how they provide teletherapy, he says they’ve learned a lot in the clinic’s 12 years.
For instance, he says providers should be more demonstrative with how they talk and use their hands to get more subtle points across. But that’s not all.
"People tend to stare at themselves, and we have to train the provider to stare at the camera, because then it looks like you’re looking into that patient’s eyes, and you're making that eye contact," he said.
But aside from a lack of research on best practices, he pointed to another big issue – internet access. The center used to provide telehealth at clinics, but with the pandemic moved to a more in-home model.
"As someone that's been doing this for many years, I knew the digital divide existed, but I had no idea, unfortunately, of the breadth of the digital divide in Indian Country," he said.
They've had to use phone calls instead for some, which he said isn't ideal, but at least provides access.
Fore said it's clear that many patients are really liking access – any kind of access – that's close to home. So he expects telehealth to just keep growing and becoming more of the norm, even though some areas and some people may have a harder time with it than others.
Many different types of mental health treatment switched online since the start of the pandemic, including addiction treatment. As some states experience an increase in overdose deaths, access to treatment can be the difference between life or death.
The OMNI Institute, a nonprofit research firm in Denver, surveyed more than 500 people receiving addiction treatment through telehealth in April and May, a month or two into the pandemic. The results suggest that the vast majority of respondents found telehealth helpful.
"I think there are some folks who responded to the survey who generally had a very positive experience with telehealth services and had a positive experience in their recovery, sort of as a result of the pandemic," said Holen Hirsh, the OMNI Institute's director.
A positive recovery because of the pandemic might sound counterintuitive, but, according to Hirsh, that could be attributable to respondents having less access to substances and more support from loved ones while in lockdown.
But for others, Hirsh said, troubles with technology and its impersonal nature have made them feel even more alone during the pandemic.
There’s a famous experiment from the 1970s where rats that had a fun, diverting and social habitat were less likely to indulge in addictive substances. Psychologist Annie Peters says we don’t have those diversions anymore.
“You can't really go to Rat Park anymore. You have to go to a Zoom meeting. So people are struggling to feel engaged,” she said.
Peters is the director of research and education at the National Association of Addiction Treatment Providers. She said the OMNI survey is just the start of learning about telehealth as a treatment.
"That study is showing a lot of the more positive aspects of telehealth that, yeah, technology helps us connect, but we don't know too much about how well addiction treatment delivered via telehealth works," Peters said.
At the very least technology seems to have been a crutch during the pandemic, helping us hobble along and stay in contact with loved ones and counselors when we otherwise couldn't. But health professionals want to know: How do we use it to its full potential, so that it's less of a crutch and more of a tool?
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.