25/09/2020 y RO-DBT via telehealth p o A Radically Open Guide to Webcam-delivered Treatment c t o Conflicts of interest: We don’t receive any direct commercial support for our training companies Radically Open Ltd or Radically Open Blended Learning. However, Dr. Thomas Lynch, the RO DBT treatment developer n and chief RO DBT trainer, receives royalty fees for the RO DBT Textbook and Skills Manual from New Harbinger publishers. He is married to Mrs Erica Smith-Lynch, co-owner and director or Radically Open Ltd. 1 o d e Virginia O'Hayer, PhD s Clinical Associate Professor & Senior RO DBT Clinician Today’s Trainer @Department of Psychiatry and Human Behavior at Thomas Jefferson a University Hospital e l p 2
25/09/2020 In the Background …. Here to help answer questions y p o c t o Erica Smith-Lynch, MA, M.E.C.I., Dip. P.M. Roelie Hempel, PhD Founder & Co-Director of Radically Open Ltd Founder & Co-Director of Radically Open Ltd n 3 o d e s Webinar Housekeeping a e This presentation is being recorded. l p Read live captions. Enter questions for the presenters or support team and read their responses. Upvote questions asked by others by using the thumbs up icon – if a lot of people have the same question, the presenter will answer it live 4
25/09/2020 Your questions from the survey • At the end of the webinar we will discuss the questions we received via the online survey that are not discussed during this talk and that are related to y today’s topic: TeleHealth p • We received several questions that are not related to telehealth but are more general questions about the principles and practices of the treatment. We will o not be addressing these questions today and recommend you consult the text book and/or skills manual, your training binder (if you have attended an intensive training), or the appropriate Blended Learning module. c • Alternatively, you can contact one of our supervisors for a consultation session or supervision https://www.radicallyopen.net/who-we-are/ t • Or drop a line to the RO DBT list serve: https://groups.google.com/g/ro-dbt- o listserve n 5 o d e s Let’s do a Quick Poll a e l p 6
25/09/2020 Overview • Basic orientation to telehealth practices for all y • Ethics in telehealth p • RO-DBT-specific issues in telehealth o • Therapist characteristics • Patient characteristics c • Individual RO-DBT sessions • RO-DBT skills class • Self-enquiry t o n 7 o d e s a e l p Basic orientation to telehealth practices for all Set-up, equipment & space 8
25/09/2020 Invest • Just as you would invest in a therapy office free from distractions y • Ensure an optimal connection with minimal freezing/interference p • High speed internet • Signal booster o • Up-to-date computer • Professional-level Zoom or similar platform (HIPAA-compliant) c t o n 9 o d e s Space a e • As you would with your in-person office, be mindful of how you set up your virtual space l • Consider schedules of others in your home p • Consider the professionalism of your virtual space (e.g. kids/pets present? In a private area?) • More to come re. RO-DBT specific considerations 10
25/09/2020 Useful Resources for Telehealth Practices We have compiled a list of resources, including scientific papers and y YouTube videos, for you, which can be downloaded from the Chat Function p We’d like to highlight this online course to you here: o • Telepsychology Best Practice 101 Series: Webinar series approved by the c American Psychological Association https://apa.content.online/catalog/product.xhtml?eid=15132&eid=1921 Through September 30, 2020 this program is available FREE of charge. t o n 11 o d e s a e l p Ethics in telehealth Location, engagement, others, recording 12
25/09/2020 Location y • During the telehealth sessions, is the patient physically located p in a state/region where you are a licensed provider? • If not, you may need to reconsider… o • Despite HIPAA being waived at a federal level (investigate this c more…) in the United States, one must still be licensed in the state where the patient is located • Often a temporary license is possible, during the COVID-19 t pandemic. Call the State Board of Psychology (or equivalent) in o the state where your patient is located n 13 o d e s Informed consent for telehealth a e • Need to obtain & document this • Need to know emergency contact & emergency services in the area l p your patient is located (in case you need to send an ambulance to their home) • Need an agreed-upon plan for what to do if connection is lost? • What if the patient just disappears from session? 14
25/09/2020 Engagement: approximate an in-person session y • Is the patient driving/otherwise engaged in a way that p could be dangerous to be doing while also doing a therapy session? o • Is the patient holding their phone/screen in their hand in a way that creates constant motion, preventing the c therapist from fully engaging? • Elicit a commitment from the patient to set aside an hour (more for skills class) to be present, in a private t location, preferably seated and able to take notes o n 15 o d e s Others present? a e • Are other people within earshot of the therapy session: • In the patient’s home? l • In the therapist’s home? p • Are you a therapist living in the fresh-hell of having school-age children in the home during the day? Are they likely to burst into your “office”? • Plan ahead, as best you can, to ensure that you and your patient have protected time for a private therapy session 16
25/09/2020 Recording? • Recording sessions has never been more seamless with telehealth y platforms such as Zoom p • Recordings are then converted into a file that you can send to your supervisor o • Be sure to administer a consent form which your patient completes c • Be sure to send recordings via HIPAA-compliant platforms, such as “sendthisfile” t o n 17 o d e s Considerations for your younger patients a e • Adolescents: issues with space, privacy • Get patient to figure out how to structure your environment l p • Who is in your family who can help with that? • How to balance with online school, family obligations, etc. • Trying to recreate an office experience • Same goes for people who live in tight quarters, multi-generational homes. 18
25/09/2020 RO-DBT-specific issues in y p telehealth o c Therapist set-up characteristics t o n 19 o d e s Your digital identity as an RO-DBT therapist a • RO-DBT stands out from many other therapeutic approaches by e providing specific instructions for how to set up the therapeutic space, such that OC patients are able to engage optimally in treatment l p • Cool room (fan/air conditioning – OCs dislike feeling hot/sweating) • Chairs at a 45 degree angle to each other (allowing for heat on/off) • Beverage (to access social safety) • We can maintain this spirit over telehealth 20
25/09/2020 Your digital identity as an RO-DBT therapist • Don’t be too close to the screen y • Aim to show your face and upper body, so gestures can be seen. p o c t o n 21 o d e s Your digital identity as an RO-DBT therapist a e • Is your face clearly visible? • Ensure you aren’t backlit l p 22
25/09/2020 Your digital identity as an RO-DBT therapist • Consider your background y • Where are you located? • What you choose to show on your screen is a social signal p • Do you want to have a digital screen background (e.g. office/library/blank)? o c t o n 23 o d e s Therapist social safety access a e • RO-DBT places great emphasis on the therapist accessing social safety • We must remain flexible in the face of maladaptive OC social signaling l p • Recall: the flat face trumps all! • We will end up mirroring our patients’ flat face, rigid posture, lack of movement, etc. when we don’t mindfully attend to accessing social safety • We need to be able to access social safety when conducting tele- therapy, just as we would in person 24
25/09/2020 Therapist social safety access y • Sit in a comfy chair that allows you to sit back p • Big 3+1 o • Drink a beverage c • Ensure that small children/pets/others who may need your attention aren’t likely to barge into your session (the fear of this can activate t threat) o n 25 o d e s Self-disclosure…intentional/unintentional a e • In RO-DBT therapist self-disclosure is used as a therapeutic tool, deployed with intention, with the purpose of helping our patients l • Conducting sessions from our homes could pull for more self- p disclosure, which may be less deliberate/mindful • Tension between self-disclosure & professionalism • Keep in mind, we aren’t inviting pts into our home, but into our virtual office… 26
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