The Pandemic and the Necessity of Telehealth

Let's start with some honesty: I hated telehealth when I first started using it.

I loved (and sometimes, still miss) my office in Fells Point in the heart of Baltimore City. It was the office where I started my practice and where I started so many of my clinical relationships that continue today. It was a convenient walk to my house, it was cozy, and it was centrally located for most of my clients.

Then, like most psychologists, I abruptly transitioned to telehealth in 2020 out of necessity. The pandemic meant that meeting in person was no longer an option, and everybody adapted to virtual meetings on the fly. As a clinical psychology student, so much of my learning was grounded in the importance of what happens "in the room" and being forced to immediately pivot felt like a real threat to my effectiveness as a clinician.

And at first, it was as clunky as I thought it would be. Most of us had never been clinicians or clients in a telehealth setting, and it showed. Constant disconnects, poor technology setups, children and pets running in and out of the room, and the never-ending loop of "can you hear me now?"

Over the course of a few months, things got easier. Humans adapt. They always do. We all got more familiar with being online and on-camera for our meetings and appointments. We figured out our technology setups. We put a lock on the door so that our toddlers couldn't bust in at the worst time.

My belief was that while telehealth was better than nothing, it couldn't possibly be as good as in-person therapy, right? At the end of the first year, I sent out a survey to my clients to find out what they thought about telehealth, whether they would prefer to return to the office, or whether they felt like they were getting the same level of care virtually as they did in the office. The initial response set was about 50/50.

I was a little surprised that some people even said they preferred telehealth. Regardless, I planned to go back to an office as soon as possible.

That's not what happened.

Another piece of the puzzle I haven't disclosed is that I became a father in February of 2020. I had planned to take a little time off and then slowly transition back to the office. The world had other plans.

As someone who was committed to best practices to keep myself, my family, and my community safe, I made the choice to remain telehealth-only through most of 2021.

It's hard to know when exactly the shift happened, but somewhere in there, telehealth started to feel very different. I was not feeling disconnected from my clients. They were still making the same kind of progress they had been making in person. Many clients started saying they were appreciative of being able to stick with telehealth because if I was back in the office, they likely wouldn't be able to continue with me for any number of reasons.

When I sent my "state of the practice" email out in 2021, nearly 85% of my respondents reported that they would prefer telehealth over a return to office. It was a staggering result. The most common reasons people gave included:

And while I ended up hanging on to my office for a while longer, just in case, I never had another session in it and I committed to being fully telehealth in 2022.

As someone who appreciates data and analytics, I've continued to track outcomes and survey the client experiences in telehealth. Every year, the results remain consistent.

Clients show up more consistently. The barrier to attendance dropped. It turns out that no traffic, no parking, and fewer logistical hurdles matter a lot for outcomes. The work you don't miss is more effective than the work you do.

I had feared that it would be difficult to build rapport or get to know clients as easily without seeing them face-to-face. Those fears turned out to be unfounded.

I had worried what the impact would be on the clinical relationships I had already established with clients, especially the ones I had worked with for years. To my surprise, some clients were more open on telehealth than they had been in person. The slight distance, for some people, made vulnerability easier, not harder.

And the research supported what I was seeing. Telehealth therapy performs about as well as in-person therapy for many of the concerns I work with most often, including anxiety, depression, ADHD, and relationship issues.

When clients aren’t burning energy on logistics, that energy goes somewhere else. Sessions feel more consistent. The work compounds differently.

I became PSYPACT-authorized in 2022. PSYPACT is an interstate compact that allows licensed psychologists to practice telehealth across participating states without obtaining separate licensure in each one. It is a designation specifically designed for psychologists who practice across state lines.

While there was a temporary allowance for interstate practice during the majority of the pandemic, this was groundbreaking territory in terms of opening up the clients I could serve. Combined with my Maryland and New York licenses, this means I can see clients across most of the country.

As I've narrowed the scope of my practice and become a specialist in the areas of ADHD, executive functioning, and neurodiversity, that has meant that many of my ideal clients aren't necessarily within the geographic region of Baltimore or Maryland. Telehealth is what makes that possible.

Honestly, my ideal clients. High-functioning adults, often comprised of professionals, executives, parents with demanding schedules who are also struggling to prioritize their own care. Therapy is one more thing that requires energy and logistics, and it's the thing that tends to get deprioritized by these groups.

Removing the travel piece changes the calculation. A 50-minute session from your office, or your home, or a parked car is a different proposition than blocking three hours of your day for something that feels like it could wait.

For people with ADHD or executive function challenges specifically, the friction of logistics is not trivial. Every extra step between "I should do this" and "I did this" is a place where things fall apart. Telehealth removes potential points of failure.

I also see clients across a wider geographic range than I would from an office in Baltimore. People in rural areas without access to doctoral-level psychological services. People who've relocated and want to maintain continuity of care. People who simply prefer a provider whose approach fits them, regardless of zip code.

Sessions run on a HIPAA-compliant platform through SimplePractice. You can book a consultation directly on my website and start the process quickly.

Most clients use a laptop or desktop; a phone works if that's what you have. You need a reasonably stable internet connection and a private space. That's most of the technical setup.

Some clients do sessions from a home office. Some from a guest bedroom with the door closed. A few have a regular spot in a quiet part of their office building.

Others get creative. I've had clients choose to do therapy on a rooftop deck. One person I worked with had a designated "therapy park spot" — the same parking lot, every week, reliable privacy.

You're in charge of your setup. And the work is still the work no matter where you are.

What surprised me most wasn't that telehealth could work. I knew that was possible, and the research moved pretty quickly in support of it.

What did surprise me was what it did to the arc of the work. When clients aren't burning energy on logistics, that energy goes somewhere else. Sessions feel more consistent. The work compounds differently. Momentum builds in a way that feels different.

I also want to be clear that I'm not suggesting that telehealth is superior to in-person work. Some people, whether it be the clinician or the client, simply work better in a shared physical space and luckily there are plenty of great clinicians who continue to offer an in-person experience.

But for the clients I work with, who ultimately are the clients that are the "right fit" for my practice, the trade-off has consistently been worth it.

That's why I've committed to keeping it this way.