Beyond Video: Enhancing Telehealth Sessions with Interactive Features

Vol. 1, No. 12     |     June 25, 2024     |    By Dave Larsen, Väsentlig Consulting LLC

As telehealth becomes an increasingly prevalent mode of mental health service delivery, practitioners are looking for ways to enhance the virtual therapeutic experience beyond simple video conferencing.

By incorporating interactive features and tools, solo mental health practitioners can create more engaging, dynamic, and effective telehealth sessions that rival the depth and impact of in-person therapy (Békés & Aafjes-van Doorn, 2020).

In this article, we'll explore a range of interactive features and their potential applications in telehealth, drawing on research and best practices in the field.

Screen Sharing: Collaborative Visualization

Screen sharing is a powerful tool that allows mental health practitioners to share their screen with clients during telehealth sessions, enabling collaborative viewing and interaction with digital materials (Backhaus et al., 2012). By using screen sharing, practitioners can:

1. Review and discuss client homework, such as thought records or mood tracking charts, in real-time (Békés & Aafjes-van Doorn, 2020).

1. Guide clients through psychoeducational materials, such as presentations or videos, to enhance understanding of mental health concepts and coping strategies (Glueckauf et al., 2018).

1. Collaborate on treatment planning, goal setting, and progress monitoring using shared documents or spreadsheets (Backhaus et al., 2012).

1. Facilitate exposure therapy by sharing virtual environments or stimuli, such as photos or videos, to help clients confront and process feared situations (Glueckauf et al., 2018).

To effectively use screen sharing in telehealth sessions, practitioners should ensure that they have a stable internet connection, a clear understanding of the screen sharing tools within their telehealth platform, and the ability to maintain client confidentiality while sharing their screen (Békés & Aafjes-van Doorn, 2020).

Virtual Whiteboard: Interactive Problem-Solving

Virtual whiteboards are collaborative digital workspaces that allow multiple users to write, draw, and interact in real-time (Glueckauf et al., 2018). By incorporating virtual whiteboards into telehealth sessions, mental health practitioners can:

1. Brainstorm and visualize problem-solving strategies with clients, such as creating pros and cons lists or decision trees (Backhaus et al., 2012).

1. Facilitate art therapy techniques, such as collaborative drawing or collage-making, to help clients express and process emotions (Hsin & Garner, 2013).

1. Create and update genograms or family trees to explore family dynamics and intergenerational patterns (Glueckauf et al., 2018).

1. Teach and practice mindfulness or grounding techniques, such as guided imagery or body scans, using visual aids and prompts (Békés & Aafjes-van Doorn, 2020).

Popular HIPAA compliant virtual whiteboard tools include Google Jamboard, Microsoft Whiteboard, and TigerConnect and may offer integrations with telehealth platforms (Hsin & Garner, 2013). Please note: Google recently announced the discontinuation of its Jamboard application effective October 1, 2024. Check the Google Jamboard webpage for instructions on how to export your Jam files, if needed. (Google, 2023).

When using virtual whiteboards, practitioners should ensure that they have obtained client consent, maintain confidentiality, and provide clear instructions and guidance to clients on how to use the tools effectively (Glueckauf et al., 2018). Remember that activities that involve the use or disclosure of PHI necessitate that the healthcare organization(s) must have assurance that the information is protected through a signed business associate agreement (BAA).

Polling and Quizzing: Engaging Assessment

Polling and quizzing features allow mental health practitioners to gather real-time feedback and assess client understanding during telehealth sessions (Backhaus et al., 2012). By using these interactive tools, practitioners can:

1. Administer brief symptom or mood assessments to track client progress and inform treatment planning (Békés & Aafjes-van Doorn, 2020).

1. Assess client comprehension of psychoeducational materials or coping strategies to ensure understanding and identify areas for further clarification (Glueckauf et al., 2018).

1. Gather anonymous feedback on the therapeutic relationship, session pacing, or other aspects of treatment to inform clinical decision-making and improve the quality of care (Hsin & Garner, 2013).

1. Facilitate group therapy activities, such as icebreakers or consensus-building exercises, to promote engagement and cohesion among participants (Backhaus et al., 2012).

Many telehealth platforms, such as Zoom and WebEx, offer built-in polling and quizzing features, while others can be integrated with third-party tools like "Poll Everywhere" or "Kahoot" (Glueckauf et al., 2018). When using these features, practitioners should ensure that the questions are clinically relevant, appropriate for the client's literacy level, and do not compromise client confidentiality (Békés & Aafjes-van Doorn, 2020).

Breakout Rooms: Targeted Interventions

Breakout rooms are virtual sub-rooms within a larger telehealth session that allow practitioners to divide clients into smaller groups for targeted interventions or discussions (Backhaus et al., 2012). By using breakout rooms, practitioners can:

1. Conduct multiple-family therapy sessions, allowing each family unit to have private discussions and then reconvening as a larger group to share insights and progress (Glueckauf et al., 2018).

1. Facilitate group therapy activities, such as role-playing or skills practice, in smaller, more focused groups to enhance engagement and learning (Hsin & Garner, 2013).

1. Provide individualized interventions or support to clients with specific needs or challenges, such as breakout rooms for clients with social anxiety or trauma histories (Backhaus et al., 2012).

1. Allow for private consultations with co-therapists or trainees during group sessions to discuss clinical observations and treatment planning (Békés & Aafjes-van Doorn, 2020).

To effectively use breakout rooms, practitioners should establish clear guidelines and expectations for client participation, ensure that each breakout room has a designated facilitator or moderator, and provide instructions on how to navigate between the main session and breakout rooms (Glueckauf et al., 2018).

Chat and Emoji Reactions: Enhancing Non-Verbal Communication

Chat and emoji reactions are interactive features that allow clients to communicate non-verbally during telehealth sessions, enhancing the richness and depth of the therapeutic interaction (Backhaus et al., 2012). By incorporating these features, practitioners can:

1. Encourage clients to share thoughts, feelings, or questions in the chat box during sessions, providing an additional outlet for self-expression and engagement (Békés & Aafjes-van Doorn, 2020).

1. Use emoji reactions to gauge client responses to interventions or discussions, such as a thumbs-up for agreement or a raised hand for a question (Glueckauf et al., 2018).

1. Facilitate non-verbal communication for clients who may have difficulty expressing themselves verbally, such as those with social anxiety or autism spectrum disorders (Hsin & Garner, 2013).

1. Enhance rapport and connection by using chat and emoji reactions to convey empathy, validation, and support (Backhaus et al., 2012).

When using chat and emoji reactions, practitioners should establish clear guidelines for appropriate use, monitor the chat for any concerning or inappropriate content, and ensure that the use of these features does not detract from the overall therapeutic process (Békés & Aafjes-van Doorn, 2020).

File Sharing: Collaborative Documentation

File sharing is an interactive feature that allows mental health practitioners to securely send and receive documents, images, or other files with clients during telehealth sessions (Glueckauf et al., 2018). By incorporating file sharing, practitioners can:

1. Share and collaborate on treatment plans, goal-setting worksheets, or progress monitoring tools in real-time (Backhaus et al., 2012).

1. Provide clients with psychoeducational materials, such as handouts or articles, to reinforce learning and promote engagement between sessions (Hsin & Garner, 2013).

1. Review and discuss client-generated content, such as journal entries, artwork, or music, to gain insight into their experiences and promote self-expression (Békés & Aafjes-van Doorn, 2020).

1. Securely exchange and sign consent forms, release of information documents, or other administrative paperwork to streamline the therapeutic process (Glueckauf et al., 2018).

When using file sharing, practitioners must ensure that they are using a secure, HIPAA-compliant platform and that clients are aware of the potential risks and limitations of electronic file exchange (Backhaus et al., 2012). Additionally, practitioners should establish clear guidelines for the types of files that can be shared and the expected timeframe for reviewing and responding to shared materials (Békés & Aafjes-van Doorn, 2020).

Conclusion

The integration of interactive features into telehealth sessions offers solo mental health practitioners a powerful toolkit for enhancing the depth, engagement, and effectiveness of virtual therapy. By leveraging tools such as screen sharing, virtual whiteboards, polling and quizzing, breakout rooms, chat and emoji reactions, and file sharing, practitioners can create a more collaborative, dynamic, and personalized therapeutic experience that rivals the impact of in-person sessions.

However, the successful adoption of these interactive features requires careful consideration of ethical, legal, and clinical implications, as well as a commitment to ongoing training and professional development (Glueckauf et al., 2018). Practitioners must ensure that their use of interactive features aligns with their scope of practice, client needs and preferences, and the overall goals of treatment (Backhaus et al., 2012).

As telehealth continues to evolve and expand, mental health practitioners have an exciting opportunity to harness the power of interactive technology to transform the delivery of mental health care. By staying informed about emerging best practices, seeking out training and consultation, and prioritizing client safety and confidentiality, solo practitioners can effectively integrate these interactive features into their telehealth practice, ultimately improving the quality and accessibility of mental health services for all.

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References:

Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorp, N. M., Lohr, J., & Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111-131. https://doi.org/10.1037/a0027924

Békés, V., & Aafjes-van Doorn, K. (2020). Psychotherapists' attitudes toward online therapy during the COVID-19 pandemic. Journal of Psychotherapy Integration, 30(2), 238-247. https://doi.org/10.1037/int0000214

Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E. L. (2018). Survey of psychologists' telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(3), 205-219. https://doi.org/10.1037/pro0000188

Hsin, H., & Garner, R. (2013). Digital art therapy and professional identity. The Arts in Psychotherapy, 40(3), 243-248. https://doi.org/10.1016/j.aip.2013.05.009

Liu, S., Heinz, M., Zackoff, M. W., Sontag, A., Drake-Brooks, M. M., Ruehlman, L. S., & Ernst, A. (2022). The effectiveness of using virtual reality in treating psychopathology: A meta-analysis. Psychological Medicine, 1-13. https://doi.org/10.1017/S0033291722001283 Google Workspace. (2023). Next phase of digital whiteboarding. Google Workspace Blog. https://workspace.google.com/blog/product-announcements/next-phase-digital-whiteboarding