Dr. Karisse Callender wondered, “Is there a way I can replicate this virtually?”
An assistant professor and director of counselor education in Marquette’s College of Education, Callender had just completed a study based on dialectical behavior therapy, a type of treatment and skills training for people who experience emotions more intensely than usual.
Looking to fill what she saw as a gap in care — particularly for Black women — she decided to conduct a bit of an experiment. With her next cohort, she sought to integrate DBT with art therapy through a video conferencing platform to reach those in marginalized groups who are often left out. Members of the ensuing group were sent the materials needed to express themselves creatively in the comfort of their homes, communicating with the group via Microsoft Teams.
The results? Just as impactful as the in-person experience.
“Just looking at the ways that these women interpreted what they were learning, how they personalized the information and what they’re art directive outcomes were — it was really an emotional experience for me,” Callender says.
Callender’s project is just one example of the changing nature of the counseling field. Post-pandemic, telehealth has become a viable and popular option.
“Telehealth in our profession before the pandemic, I learned it in grad school as, ‘This is a sort of weird thing that some people do,’” says Dr. Krystyne Mendoza, clinical assistant professor and director of online curriculum in Marquette’s Department of Counselor Education and Counseling Psychology. “It was not a focus. I didn’t get any training on it in grad school. Then obviously the pandemic came, and we had to get training.”
One national study of 36 million working-age individuals found telemedicine encounters increased 766% in the first four months of the pandemic, accounting for 23% of all medical interactions during that period. The unprecedented circumstances proved the field had the capacity to provide care through this emerging channel, or it incentivized providers to build the infrastructure to do so.
Even as isolation precautions and shelter-in-place orders ended, interest in telehealth continued, especially for underserved communities who often go without care due to a variety of factors.
“When you think about some of the barriers, why clients don’t show up in-person to therapy or to groups, it’s access to transportation, childcare, not having resources,” Callender explains. “By removing some of those barriers, it makes it accessible to many people.”
Marquette is at the forefront to meet the changing landscape, with efforts led by the university’s Telehealth Research Community. A cross-disciplinary collaboration, the TRC engages students, staff, faculty and the local community to provide an opportunity to expand and promote the usefulness and accessibility of telehealth as a tool and resource at Marquette and the surrounding community.
The community works in tandem with the Marquette Telehealth Accelerator, founded in 2021 through a $1.5 million award from a private family foundation. Grants help support projects like Callender’s, as well as efforts to train the next generation of caregivers to improve their preparedness for telehealth environments.
Meeting virtually adds factors for counselors and their clients that are typically afterthoughts during in-person interactions. A counselor’s office provides a safe and quiet space, free of distractions. But online? You might have a child running in the background. An email notification could pop up on your screen. The signal could cut out. Someone could overhear confidential information.
Counselors can’t control every facet of the experience, but they can largely control their own environment. “Learning Non-Verbal in Telehealth (LeNViT): A Pilot Project,” led by Drs. Lee Za Ong, Mendoza and Stacee Lerret, as well as doctoral student Shiyu Wang, with the assistance from Sue Nuccio, helps develop the skills necessary to meet patients’ and clients’ needs.
“I think this a very unique study because we’re not just looking at the overall competencies in telehealth,” Wang says. “We’re specifically wanting to train graduate students in counseling and nursing in telehealth and improving their awareness of the virtual environmental etiquette.”
Study participants — all graduate students in Marquette’s College of Education and College of Nursing — first engage in a five- to eight-minute mock scenario to establish their starting proficiency. After completing the ensuring online training, students rewatch this session to see how far they’ve come.
“Participants reported a greater awareness of how easily they can be distracted and how it is to maintain a very private, confidential and quiet online environment,” Wang says.
The Department of Counselor Education and Counseling Psychology is working to incorporate lessons learned from the study into the curriculum, starting with the development of a tele-mental health policy that “ensures students in the master’s in clinical mental health counseling program are practicing legally and ethically, following state licensure regulations, and adhering to state and federal practice guidelines and payer contract agreements.”
Ong is proud Marquette is on the cutting edge when it comes to creating this policy.
“I asked many universities,” Ong says. “No one has one. I proudly say because of this study, it brings up our awareness too. We are one of the few programs that really have a tele-mental health policy in place. My colleagues in other universities ask, ‘Can we see your tele-mental health policy? Maybe we can use that to adapt to our program.’”
With telehealth becoming a permanent fixture in health care, ongoing education is essential to ensure professionals can adapt to evolving technology and consistently provide quality care.
“In terms of education and how we train counselors, we have to be sure that we’re very intentional about training them in telehealth,” Callender says. “I think it’s impossible to escape advances in telehealth and technology in the world, unless you want to live off the grid.”
