When Telehealth Works…and When it Doesn’t

Reflecting on the last year of Telehealth practice with clients from preschool through graduate school, there have been many instances where Telehealth is an amazing mental health tool. There have also been some clear examples of when Telehealth really isn’t the best way to deliver services. Based on experience and recent research presented through the Anxiety and Depression Association of America, here are a few examples of when Telehealth works wonders and when it may not be the best treatment option:


When Telehealth Works Wonders

One of the reasons so many providers switched to Telehealth in March 2020 was the COVID-19 pandemic, but the benefits go far beyond being pandemic-proof. Telehealth increases access to services when clients are experiencing illnesses of all kinds, from the common cold to cancer. Telehealth is also wonderful for individuals who live in rural or underserved areas; a strong internet connection and/or cell signal can provide access to a wealth of healthcare services that were previously unavailable.  In larger cities like Austin, Telehealth offers a wonderful workaround for the time constraints of the after-school rush and rush-hour traffic. For clients who are concerned about visiting a therapy office (due to anxiety, stigma, and/or confidentiality), Telehealth provides services where otherwise they might be avoided.  Many providers have also noticed a decrease in missed appointments and late arrivals, resulting in more time spent with clients. 

Besides purely logistical benefits, Telehealth can also provide particular advantages to the provision of mental health services. In the treatment of anxiety, obsessive-compulsive, and related disorders, Telehealth allows for real-life exposure and response prevention in the client’s home, school, or community environment. Switching to Telehealth can also reduce confidentiality concerns related to in vivo public exposure practice during in-person sessions. Telehealth sessions offer excellent generalization of skills when addressing behavioral issues with parent training interventions; providers can teach, observe, and coach parents interacting with children at home rather than in an office setting. No matter the presenting symptoms, Telehealth can allow mental health providers to maintain continuity of care and relationship when clients are away from home. For example, when teens move away to college or when families take a vacation, mental health providers may be able to provide care without interruption. 


When to Consider In-Person Treatment

Telehealth is not for everyone, however. We have all experienced the tremendous frustration of slow internet speeds, glitchy videos, and computer crashes. There are sometimes concerns related to cyber security and the client may have a harder time finding a confidential place to talk. For children and teens, the use of Telehealth can sometimes offer additional distractions (think unlimited internet tabs, using phone off-screen) that can impact treatment. 

From a mental health perspective, the most important consideration for Telehealth is the client’s physical safety. In situations where clients experience suicidal ideation or non-suicidal self-injury, in-person assessment and safety planning is preferred. There are also some fears or exposures that may be difficult to replicate in an online session (e.g., driving). For some clients with inattentive and hyperactive/impulsive behavior, it can be difficult to keep kids and teens engaged without the help and supervision of an adult. Some providers might have props, books, or toys in the office that clients don’t have access to at home. While many clients and providers can find solutions to these problems, they are worth consideration before deciding whether Telehealth or in-person sessions will work best in each situation. 


Overall, providing Telehealth treatment has been such a challenge and a joy in a year of great difficulty. With these ideas in mind, providers, parents, and clients can work together to determine the best treatment type for everyone. 



Alvord, M., Busman, R., Emanuele, J., Furr, J., & Shiffrin, N. (2021, March). Ethical Applications of Telehealth for Evidence-Based Treatments for Anxiety and Depression [OnDemand Video Session]. Anxiety and Depression Association of America Virtual Conference.

© 2021 Erika J. Vivyan, PhD. All rights reserved.

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