“I'm an options type of person,” Ana M explained. “No day is the same, and some days, you want to have the option to talk by phone.”
Like many clients of the Substance Abuse Treatment Unit (SATU) of Connecticut Mental Health Center, Ana M has welcomed her new option to participate in counseling sessions with her clinician over the phone. “Telehealth”—also known as “tele-mental health”—became the norm this spring, when the COVID-19 pandemic closed SATU and other satellite locations, moved all services to CMHC’s main building at 34 Park Street, and changed staffing schedules to reduce the number of people in the building. All measures were designed to protect clients and staff from the virus.
Scattered and separated, the clinical staff had huge adjustments to make. Telephone became a lifeline for them, and for their clients.
It’s a lifeline that is here to stay—at least for the clients who are doing well with the format, said Donna LaPaglia, PsyD, Director of SATU. The move to telehealth for therapy has had some surprisingly positive results, she noted, including improved “show rates.”
LaPaglia, an associate professor of psychiatry who also teaches in Yale’s renowned Addiction Psychiatry Fellowship Program, said that in her 24 years of treating people with addictions, stigma is still a big issue. Many clients are choosing to speak over the phone, eliminating the hassle of leaving home (particularly helpful for parents) and the exposure of going to a public place to receive care. LaPaglia and her team speculate that telehealth might be helping those clients feel more comfortable.
It’s exactly the word Ana M used, explaining that while she likes to have an in-person option sometimes, she enjoys being able to attend therapy from her home, occasionally in her pajamas.
“When I’m in my comfort zone, I’m able to just delve into my emotions more,” she said. “I feel safer to be vulnerable. I’ve noticed that I brought up things and said things that I thought of in the past but didn’t say when I was in the office.”
Catherine Segura, MSW, LADC, a substance abuse counselor at SATU, said she’s noticed two distinct things about her clients since the pandemic arrived. First, many have expressed a deeper sense of universality in the wake of the pandemic’s effects.
“There’s this sense that we’re all in the same boat,” she said. “Yes, I’m the therapist, but we’re all here together.”
The other thing she’s noticed is that some clients have been able to disclose traumas that they’ve never shared during in-person therapy sessions. They seem to feel more comfortable expressing their emotions, whether deep anger or intense sadness. Some have even cried, something they never did at the clinic.
She’s seen other transformations, too. Some clients have left situations that they previously knew were bad for them. Others have developed new insight and understanding around issues that have long plagued them. While the telephone doesn't explain everything, it does appear to be a powerful tool that offers definite advantages.
“There's something about being on the phone and not being seen,” Segura reflected, noting that being in one’s own personal space gives clients the freedom not to put on a brave face after an emotional moment.
But as the pandemic wears on, Segura said she does see some fatigue among her clients. And the phone hasn’t been the right format for every client; some prefer or require a face-to-face session.
She said the early days of the pandemic were a struggle for her personally as she had to figure out a semblance of work-life balance while working from home. She found herself working from her couch and having a hard time ending her workday.
“It felt pretty intrusive to my wellbeing and personal life,” Segura recalled. “I was very stressed.”
Segura said that talking to her supervisor and to Dr. LaPaglia helped her find some balance, which in turn helped her better guide her clients as they made the adjustment to telehealth. And that’s exactly what LaPaglia wanted SATU staff members to do when they were feeling overwhelmed.
The SATU staff has always been a tight-knit group, with traditions such as staff potlucks and an ethic of looking out for one another. Closing their office and relocating a skeletal staff to CMHC’s main building was a big adjustment. But they took it on by pitching in to help make the stripped-down staffing and services work.
The pandemic, Dr. LaPaglia noted, has made the SATU staff a true team.
“We now have a ‘felt’ sense of the word ‘team,’” she said. “We always used the term pre-COVID to describe our operation; however during the isolation…the phone with a team member on the other end became a lifeline of support, encouragement, and companionship.”
Instead of staff potlucks, they started swapping recipes or eating lunch over Zoom. Those meetings occasionally featured children and family pets. LaPaglia, along with her senior leadership team of Ray Raw, LCSW, Matthew Steinfeld, MD, Sri Muvvala, MD, and Denise Romano, APRN, encouraged staffers to lean into their self-care routines.
LaPaglia explained that due to the ongoing crisis, many people, particularly those who work in healthcare, are in what she calls “action mode,” which means it’s a hard time to be self-reflective.
“You have to do self-care first,” she emphasized. “You’re going to have nothing left to give if you aren’t doing that.”
It’s an important lesson to keep in mind, especially now that the weather is getting colder, flu season is upon us, and coronavirus case numbers are rising in Connecticut. The pandemic is looking like a marathon rather than a sprint; to keep pace, continued flexibility around client care is essential.
At One Long Wharf, SATU’s phased reopening plan is underway. They’re now admitting clients for in-person visits on a very slow basis. Telehealth is continuing. And while clients have found telehealth to be very supportive, LaPaglia said many of them are eager to come back to the clinic to see their caregivers in person.
As for Ana M, she’s just grateful that despite the pandemic, SATU found a way for her to continue her sessions and keep working on her addiction.
“It’s amazing there is a place like CMHC that would help anyone who wants to be helped,” she said.