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Virtual eating disorder treatment has made it possible for countless people to receive the high-quality care they need to recover and heal. Unfortunately, not everyone has the option of going away to in-person treatment, either because of responsibilities like caregiving and work or geographical or transportation barriers.
Telehealth expands treatment access and allows people to receive treatment in their homes or wherever they’re comfortable. Many individuals find it more powerful and healing to receive care in their home environment because they can work through triggers that are present and find long-term healing that way.
However, telehealth can also be risky, especially for those with a history of trauma or those in an active trauma situation at home. Patients need to feel safe in their homes and in themselves to benefit from eating disorder treatment.
Trauma-informed care, both in-person and virtually, is vital to ensuring patient safety. Clinicians using a trauma-informed approach assume a patient with an eating disorder is more likely to have experienced trauma than not. As such, treatment providers create a safe, respectful, and compassionate environment that minimizes the risk of retraumatizing or triggering patients while helping them heal.1
Some benefits of trauma treatment via telehealth include:2
Although virtual trauma treatment has many benefits, it also comes with some risks, such as:2
Not every client is a good fit for virtual eating disorder care, especially regarding trauma work. Like any other treatment setting, there are pros and cons to telehealth.
Pros:2
Cons:2
People with eating disorders and a history of trauma need to feel safe within the virtual treatment space, their therapeutic relationship, their homes, and their bodies.
One of the first things clinicians do when working with an eating disorder patient via telehealth is screen and assess for acuity of safety concerns, such as suicidality, homicidal ideation, non-suicidal self-injury, substance use, medical conditions and stability, dissociation, mental status, and activities of daily living.
It’s essential to assess for these things regardless of the setting, but they are particularly important for treating someone via telehealth. For example, if a clinician determines that someone has safety concerns, they may refer them to in-person care, such as in a hospital or inpatient setting.
An essential part of creating a safe virtual space is using secure technology, such as an encrypted and HIPAA-compliant telehealth and communication platform. Ideally, the client should have access to a secure internet network with a high-speed connection. Unfortunately, not every client has private WiFi access. Still, clinicians should troubleshoot and problem-solve with them, whether that looks like using a hotspot, finding low-cost internet plans, or finding WiFi grants for low-income people.
Informed consent is a paramount part of entering the therapeutic relationship. This involves talking to clients about the benefits and risks of telehealth, the potential risks of confidentiality, communication between settings, and clinician and client responsibilities. Essentially, informed consent contributes to a safe space by educating and empowering the client.
Clinicians also want consistency in how they show up to calls, how they dress and present, and the video call etiquette they follow.
Creating a private and safe therapeutic space is essential to the therapeutic relationship, client safety, and the healing process. A few things that can help create a safe physical environment include:
It’s important to have telehealth-specific safety planning in place, which may include:
Psychodrama is an experiential, action-based psychotherapy that employs guided dramatic action to examine problems or issues. It’s often used as a form of trauma treatment. This type of group therapy facilitates insight, personal growth, and integration of cognition, affect, and behavior, allowing participants to learn and practice new roles and behaviors.3
This type of therapy merges someone’s thoughts with their feelings and their somatic and behavioral presentation in such a way that participants can practice new behaviors, have healing conversations, and try out new roles they might be uncomfortable with otherwise.
Core concepts and goals of psychodrama include:
Structure is fundamental in psychodrama groups to ensure patient safety and meet their goals. The structure tends to follow these three phases:
When treating patients with a history of trauma, psychodrama can be a great way to facilitate healing.
Some benefits of psychodrama and trauma treatment include the following:3,4,5
It’s important to note that psychodrama therapy doesn’t re-enact trauma, as that can be extremely retraumatizing for the patient.
Some risks for psychodrama therapy and trauma treatment may include:6
Although there will always be risks, there are a few ways to mitigate these risks, including:
At the end of the day, patient safety is of the utmost importance, especially in the telehealth space, where there is less oversight and professional monitoring. And if, at any point, a patient feels unsafe, triggered, or is experiencing a mental health crisis, they can always transition into an in-person care setting to receive a higher level of care.