Telehealth sessions through platforms like Zoom have made counseling more accessible than ever, even for people who don’t want to leave their homes. For many, online psychotherapy is their preferred main vehicle to use on the long road toward recovery. But, what about those who need to transition to in-person care?
Telehealth-only addiction and mental health treatment are not always enough for people with more severe addiction or mental health concerns. For these people, having access to in-person, structured care is what’s needed if they want to recover. Unfortunately, making the transition to in-person care is sometimes easier said than done.
The Limits of Virtual-Only Treatment
Telehealth sessions can be a lifesaver for some, but for many, they have limits that can leave some participants stuck in the addiction cycle. Here are some of the many reasons virtual-only counseling might contribute to worsening addiction:
Missing Critical Cues
Telehealth therapists can only see the headshot of a person. The person’s body language, surroundings, and their clothing are missed. While these might seem like small clues, put together they can make up a bigger picture for therapists.
Disheveled clothing, jittery hands, the smell of alcohol, and even fidgeting can all signal that something is wrong. But how can a therapist get any of this information when someone’s camera only shows their face?
In short: they can’t. Unless a client is honest and forthcoming about what they’re struggling with, the face of bravery and sobriety they put on for a therapist might be the only thing that the therapist sees, preventing the therapist from knowing when to intervene.
The Comfort and Risk of the Screen
For some, the anonymity of a screen provides safety and comfort, making it easier to share and be vulnerable – crucial elements in addiction treatment. While therapists always recommend people appear on screen, camera issues, shyness, or simply not wanting to make eye contact can all make it easy for someone to turn off their camera while receiving treatment.
Some people might leverage this opportunity for anonymity to participate in therapy just enough to seem engaged without truly confronting the core issues of their addiction. They might attend sessions but remain emotionally distant, never fully grasping the foundational concepts of recovery. The result will always be stalled progress that prevents someone from completing the deep, transformative work that happens in a more intensive, in-person setting.
Red Flags: When to Seek In-Person Care
Recognizing when virtual therapy is no longer sufficient is a crucial step for both clients and their counselors. Red flags that point to someone needing more intense treatment might include the following.
Signs of Relapse or Increased Use
Of course, one of the most severe signs that someone needs more intense care is a full-blown relapse. Thankfully, therapists can recognize the signs of emotional and mental relapse and prevent the physical relapse from happening, whether a client is attending in-person or telehealth sessions. If a client has admitted to a relapse, is daydreaming about using, or is actively putting themselves in situations where they might be able to use again, it’s a clear sign that intensive, in-person intervention is now needed.
Deepening Isolation
If someone says they feel overwhelmed with loneliness, continues to withdraw, or even wants to pull away from their support system altogether, there are signs that more intensive treatment is needed. Residential or intensive outpatient programs (PHP) can help clients get back on track toward lasting sobriety.
Disengagement from Treatment
Skipping virtual sessions, showing up late, or being mentally checked out during group meetings are all signs of disengagement. When a person starts to pull away from their treatment, it often means they are losing motivation or that the virtual format is no longer holding their attention. The structured schedule and accountability of an in-person program can help re-engage individuals in their recovery journey and provide the momentum they need to move forward.
Building a Bridge to In-Person Treatment
It can be hard to make the transition to in-person treatment feel natural. But, when teams of providers collaborate and start the process of transitioning early on, it makes it easier for a client to accept the change willingly. Building rapport to help clients transition can include:
- Virtual Tours: Offering video tours of your facility to help the client get familiarized and explore without leaving their home first.
- Meet-and-Greets: Arranging introductory video calls with staff, from therapists to aids and managers.
- Alumni Testimonials: Getting a client connected with an alumnus who has been through the program and can offer advice and additional guidance.
The goal is ultimately to help get rid of the anxiety that someone has surrounding in-person treatment. There’s no better way to do that than to offer a warm hand-off and take the mystery out of an in-person rehab center.
“Referral Readiness” Criteria for Therapists
For virtual therapists, knowing when to recommend a transition is key. But how do you know someone’s ready to transition to in-person treatment?
- Safety of the Client: Ask yourself, is the client in a safe living environment? Is there a risk of overdose, or might they be able to harm themselves or others?
- Medical Needs: Does the client require medical detoxification or management of co-occurring health conditions that cannot be handled remotely?
- Lack of Progress: Has the client hit a plateau in their recovery, or are they regressing despite consistent virtual therapy?
- Environmental Triggers: Is the client’s home environment filled with triggers like friends, access to drugs and alcohol, or poverty that can make it easy to go back to using?
- Client’s Own Desire: Has the client said they want a more intensive or immersive treatment experience?
If the answer to one or more of these questions is “yes,” it’s probably time to begin the conversation about moving your client to in-person treatment or another higher level of care.
Making the Transition to Deeper Healing
Moving from the comfort of a screen to a structured and somewhat rigid rehab facility is a huge step in recovery. This step requires courage and coordination, and while difficult, is never impossible. Working together with your provider, recognizing the signs you need help from in-person care, and bridging the gap from telehealth to in-person treatment is all you need to make your recovery journey that much more powerful.
About The Author
Mark Gladden is a U.S. Veteran-in-recovery who has been serving the recovery community of San Diego for a decade as Founder and CEO of Present Moments Recovery, a leading residential and outpatient addiction treatment program for adults in San Diego that also offers a specialized military program for veterans and a year long comprehensive inpatient addiction treatment program that includes sober living. If you’re looking for help to battle addiction and live a sober life, contact Present Moments Recovery at (619) 367-4767.