“She said,’ ‘Why not?’” Dr. Yellowlees recalled, in an interview. “She was disappointed. She wanted a copy; she said that she’d never been on TV before and wanted to show her community. It taught me about people’s attitudes. Patients have always liked being treated on video — it’s the providers and physicians who were the major obstacles.”
Many Freudian-based therapists have been particularly skeptical, concerned that going virtual might alter or weaken a therapeutic bond built, often painstakingly, through the shared physical space of analysis. Others worry that a rich dimension of body language is lost in video interactions.
“In terms of trauma, one of the things many of us track is micro-expressions, these flickers of emotional tone, when people are talking,” said Dr. Andres Sciolla, a psychiatrist in the U.C. Davis clinic. “I cannot tell you how many times I have noticed a flicker of tears or fear in the gaze of a patient, perceived a shift in feeling, and explored that — and found a lot behind that change.”
If widely used approaches such as cognitive-behavior therapy lose something crucial by being virtual, it is not evident from the studies done so far. In one study, for instance, a team led by researchers based at the Baltimore Veterans Affairs Medical Center tracked more than 100 veterans being treated for depression over six months, half of them engaging in traditional, in-person therapy, the other half receiving care online. Both groups improved, on standard measures, by the same amount. Another study, led by Leslie Morland of the Department of Veterans Affairs, Pacific Islands Healthcare System, compared in-person and virtual talk therapy for 120 veterans with post-traumatic stress. It reached a similar finding: improvement across the board, no difference between the groups.
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated August 27, 2020
What should I consider when choosing a mask?
- There are a few basic things to consider. Does it have at least two layers? Good. If you hold it up to the light, can you see through it? Bad. Can you blow a candle out through your mask? Bad. Do you feel mostly OK wearing it for hours at a time? Good. The most important thing, after finding a mask that fits well without gapping, is to find a mask that you will wear. Spend some time picking out your mask, and find something that works with your personal style. You should be wearing it whenever you’re out in public for the foreseeable future. Read more: What’s the Best Material for a Mask?
What are the symptoms of coronavirus?
- In the beginning, the coronavirus seemed like it was primarily a respiratory illness — many patients had fever and chills, were weak and tired, and coughed a lot, though some people don’t show many symptoms at all. Those who seemed sickest had pneumonia or acute respiratory distress syndrome and received supplemental oxygen. By now, doctors have identified many more symptoms and syndromes. In April, the C.D.C. added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed. Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste. Teenagers and young adults in some cases have developed painful red and purple lesions on their fingers and toes — nicknamed “Covid toe” — but few other serious symptoms.
Why does standing six feet away from others help?
- The coronavirus spreads primarily through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using that measure, bases its recommendation of six feet on the idea that most large droplets that people expel when they cough or sneeze will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. Sneezes, for instance, can launch droplets a lot farther than six feet, according to a recent study. It’s a rule of thumb: You should be safest standing six feet apart outside, especially when it’s windy. But keep a mask on at all times, even when you think you’re far enough apart.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
I’m a small-business owner. Can I get relief?
- The stimulus bills enacted in March offer help for the millions of American small businesses. Those eligible for aid are businesses and nonprofit organizations with fewer than 500 workers, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The help being offered, which is being managed by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan program. But lots of folks have not yet seen payouts. Even those who have received help are confused: The rules are draconian, and some are stuck sitting on money they don’t know how to use. Many small-business owners are getting less than they expected or not hearing anything at all.
What are my rights if I am worried about going back to work?
“The evidence so far from these equivalency trials, comparing face-to-face versus over video — every trial I’ve seen shows no difference in clinical outcomes,” said John Fortney, director of population health in the University of Washington’s psychiatry department. For more than a decade, Dr. Fortney has been trying to get teletherapy adopted in rural areas, where people have little or no access to mental health specialists. “About 90 percent of patients report being satisfied with the experience,” he said.
And with the threat of coronavirus at large, safety has become a paramount concern.
“My psychiatrist literally saved my life, about 10 years ago, when I had a couple of suicide attempts,” said Margaret, 70, a retired nurse, who, like Mr. Raymos, received in-person care at the U.C. Davis clinic and had to go virtual in March. “I know how powerful those office visits can be. But I don’t want to go out. I don’t want to be exposed to this virus; I like that I can do this from home. My therapist, I feel his personality online; that still comes through. He’s listening very carefully. He’s really present to me.”
Not everyone who could benefit from psychiatric care is a candidate for the virtual variety. For people who are deeply delusional, who are scared, paranoid and alone, for instance, a Zoom call in these situations can be an invitation to confusion, or much worse. The rich sensory experience of full human interaction with a gifted therapist — that quality that defies measurement and study, in any randomized trial — is what many such people need.