CBT Options in the DMV: Teletherapy, In-Person, or Hybrid?
What Is Right for You?
Are you considering CBT options and trying to figure out whether to pursue sessions in-person or teletherapy? If so, this post might help you make an informed decision.
Pre-COVID, patients typically received treatment by meeting therapists directly for in-person appointments. However, the COVID-19 pandemic understandably shifted how therapists offered services with social distancing mandates put in place. Telehealth sessions became the primary way therapists provided treatments. They now remain a popular option among both patients and therapists.
Many online articles focus on the pros and cons of teletherapy versus in-person sessions. This blog post advocates pursuing a hybrid option that combines both modalities.
We believe that exploring all CBT options in the DMV area — including hybrid — is appropriate for many working professionals in Washington, DC, Maryland, and Virginia.
Understand Your CBT Options in the DMV
Before discussing hybrid therapy, let’s explore the commonly cited pros and cons of teletherapy and in-person sessions. While not exhaustive, we note some frequently cited reasons.
Telehealth: Advantages of Virtual Sessions
- Saving on commuting time. Time savings gained by not commuting to a therapist’s office represents one of the greatest appeals for a busy working professional in the DMV. Many therapists work in the greater Washington area. At the same time, there’s no guarantee that the therapist you want to work with will be in close proximity to your home, school, or office. Not commuting means not having to consider factors such as transportation and associated costs (e.g., drive and find parking, walk, bike, Metro, ride-share). You may also gain time to focus on other things.
- Portability. Telehealth sessions mean you can access therapy even during your travels. However, you will need access to an appropriate device, steady Internet connectivity, and a private space.
- Continuity. For some people, telehealth can also offer more continuity. With in-person appointments, you might need to cancel or reschedule a session for a range of reasons (e.g., feeling somewhat under the weather, working late in the office, running behind schedule). Whatever the reason, telehealth can help minimize disruptions as you can receive sessions from your present location.
- Possible increase in confidentiality. Additionally, some people might have concerns about someone seeing them coming and going from a therapist’s office. Telehealth can increase confidentiality as you receive sessions from a place of your choosing that you deem safe and secure. Security of the technology used usually should not be an issue as long as therapists are using HIPAA-compliant platforms and taking necessary safeguards.
Possible Downsides of Telehealth
- Therapists cannot practice anywhere. Keep in mind that just because a therapist provides telehealth sessions doesn’t mean they can practice anywhere. Psychologists need to be licensed or have authorization to practice in jurisdictions where the patient is physically located at the time of the session.
- For instance, a DC psychologist working at Dupont Circle can provide sessions to someone living elsewhere in DC (e.g., in NoMa). However, if this psychologist only has DC licensure and does not have authorization to practice in other jurisdictions, they cannot provide treatment to individuals in Maryland, Virginia, or other states. An exception is if the psychologist holds an interjurisdictional compact called PSYPACT. This allows authorized psychologists to practice across many state lines including DC, Maryland, and Virginia.
- For instance, a DC psychologist working at Dupont Circle can provide sessions to someone living elsewhere in DC (e.g., in NoMa). However, if this psychologist only has DC licensure and does not have authorization to practice in other jurisdictions, they cannot provide treatment to individuals in Maryland, Virginia, or other states. An exception is if the psychologist holds an interjurisdictional compact called PSYPACT. This allows authorized psychologists to practice across many state lines including DC, Maryland, and Virginia.
- Sense of connection. For individuals who spend a large portion of their working day in front of screens, having yet another video-based meeting might be too much. Some individuals also note that they feel less connected to therapists when meeting virtually.
- Access to reliable connection and technology. The patient needs access to reliable Internet connection and technology. For patients who take the call from a location with limited cell phone service or patchy Internet, technological issues might disrupt and cause frustration. Should you take part in enough telehealth sessions, technological issues will likely occur at some point.
- Distractions. Telehealth sessions can lead to more distractions (e.g., messages popping up, temptation to check something, immediate environment drawing your attention away). Keep in mind that the setting you choose to take the session might not be the most suitable for therapy.
- Limited visibility. A therapist might not notice subtle cues that may be helpful in responding to a patient’s situation more effectively. Therapists typically receive training in behavioral observations. With a limited view of the patient, they may not be able to respond as effectively as during in-person sessions.
In-Person Sessions
- Sense of taking action. While some people might have difficulties commuting to a therapist’s office, others experience the commuting process as a first step toward addressing their concerns. Taking such actions can feel good, even if you experience nerves during the initial stages of getting to know your therapist or if therapy is addressing a particularly challenging concern.
- Social interactions occur in real life. For many people, living life in a post-pandemic world still means interacting with people directly. When addressing interpersonal matters, some people report that in-person sessions feel more appropriate than talking through a screen.
- Some approaches are more conducive to in-person appointments. Many interventions developed for in-person therapy can be applied to teletherapy. However, some interventions might be more appropriate for in-person sessions. For instance, exposure-based work has historically been applied as in-person interventions, even if therapists can apply them virtually.
- Let’s say a therapist wants to show a patient with dog phobia how to interact with dogs. In-person sessions might be more appropriate as the therapist can model a range of ways to interact with dogs.
- As another example, DC CBT’s Building Social Confidence group therapy for social anxiety only occurs as in-person appointments. This is because we think patients learn to navigate interpersonal interactions better through in-person interactions.
- Let’s say a therapist wants to show a patient with dog phobia how to interact with dogs. In-person sessions might be more appropriate as the therapist can model a range of ways to interact with dogs.
DC CBT’s Suggestion: Hybrid Therapy
In an ideal scenario, if you can pursue a hybrid option that allows for both telehealth and in-person appointments, you will not have to choose one or the other. Among the various CBT options in the DMV, hybrid therapy stands out for its flexibility.
While needing some planning, a hybrid option will allow you to take advantage of the benefits of both telehealth and in-person sessions. The way in which hybrid therapy is offered will vary from therapist to therapist. It might be more than just following a set pattern (e.g., alternating between in-person sessions and telehealth). The modality of how CBT is delivered can take your specific circumstances into consideration.
Case Example of Hybrid Therapy
Let’s wrap up by discussing a hypothetical case to illustrate some of the benefits of hybrid therapy for CBT.
“Bill,” a lawyer in Washington, DC has historically struggled with OCD. After graduating from law school several years ago, Bill moved to DC. While he pursued therapy during law school, he chose not to pursue treatment upon arriving in DC. He was busy settling down and getting used to his new job. He got used to life without therapy.
Now, as a senior associate, Bill sometimes works long weekday hours, as well as on weekends when things get particularly busy. He also needs to travel on occasion to take depositions or attend trials.
Recently, Bill noticed his OCD becoming more problematic and he implemented what he recalled from past CBT treatments. While experiencing some success, his struggles persisted. Bill decided to connect with a local therapist.
Based on past therapy experiences, Bill preferred to have therapy sessions in person as he felt more connected to therapists this way. He also remembered how beneficial it was when he and his former CBT therapist practiced exposure and response prevention (ERP) in session. Bill did not particularly like ERP but knew its importance. He thought that with in-person sessions, he can ask the therapist to model what to do. He also valued the potential feedback he could receive based on what the therapist observed.
Bill also understood the importance of continuity. If he skipped therapy during the busy times of the year, he might stop therapy altogether again, possibly putting his mental health at risk. As such, Bill found a therapist who could also meet with him virtually when needed. He knew that on occasion, his work might run over and there would be a need to cancel, reschedule, or convert his appointment to a virtual session so he could take part in therapy from his office.
Finally, Bill wanted to make sure that when he traveled, he had the option to continue sessions virtually. As such, he decided to connect with a psychologist who was authorized by PSYPACT.
For someone like Bill, a hybrid option would be the most appropriate way of pursuing therapy. Rather than seeking out the services of a therapist who only provides in-person therapy or telehealth sessions, he has the flexibility to pursue sessions even on busy days and needs to stay late at work, or when he is traveling. Additionally, while exposure work to address his OCD (exposure and response prevention; ERP) can be conducted virtually, Bill found it helpful to practice ERP in person so that his therapist can provide more specific feedback on the exposure process.
Finding the Appropriate CBT Option in the DMV
Finding a therapist who feels right for you can sometimes seem like quite the hurdle. If you are unsure which modality is better for you, one option is to narrow down your therapist criteria to those who offer both telehealth and in-person sessions.
If you remain uncertain, it will be appropriate for you to bring this matter up when you are initially reaching out to a therapist. The therapist might have their own recommendations and share thoughts on what would be good for you, taking your specific circumstances into consideration.
Perhaps you are new to therapy and are in the process of finding your first therapist. Perhaps you are like Bill and had taken some time off from therapy but are now looking to restart. Whatever the circumstances, DC CBT is here to help you navigate life’s challenges.
Therapy in the DMV with DC CBT
DC CBT offers telehealth, in-person, and hybrid therapy options. Dr. Noguchi can practice telepsychology across many state lines as he holds an active Authority to Practice Interjurisdictional Telepsychology (APIT) authorization that has been granted by the PSYPACT Commission.
The PSYPACT map shows the current states that take part in this interjurisdictional compact. You may also find the PSYPACT verification tool useful as you search for authorized holders.
Additionally, Dr. Noguchi frequently treats OCD and regularly uses ERP in his treatment sessions. Whether you’re a busy professional in Washington, DC looking for flexibility or someone seeking specialized treatment, we’re here to help you find the right approach.
Contact DC CBT today to discuss which therapy format — or combination of formats — works best for your lifestyle and treatment goals.
