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Straight Talk Recovery – Episode 6: Virtual Addiction and Mental Health Treatment


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Transcription of Episode 6: Virtual Addiction and Mental Health Treatment (with special guest: Nathaniel Israel)

Adam Kostiw: Welcome to another episode of Straight Talk Recovery. I’m your host, Adam Kostiw and my colleague, Raymond Moore. We’re really excited today because today we’re going to actually have our first guest on Straight Talk Recovery. Ray, would you like to introduce our special guest today?

Raymond Moore: I would love to.

So yeah, I’m also very pumped to have this guest on the show. I’ve worked with them for many years now and definitely one of the best I think I’ve seen in my time in the field, we’re very happy to have Nathaniel Israel joining us today to talk about virtual therapy and virtual treatment programs as a whole.

So, welcome Nathaniel.

Nathaniel Israel: It’s a pleasure to be on your show guys, and never expected this to come, but has come. So great to be on here.

Raymond Moore: You’ve reached that level. Welcome.

Nathaniel Israel: Thank you for this.

Adam Kostiw: So as we know that right now with everything going on, it’s a very different world than it used to be before. Before it was so much about face to face where in-person and now COVID has changed the way we all operate.

From online therapy sessions to online treatment programs as well. So, let’s start off with, talking about online therapy and your experiences with that and the transition into it.

Nathaniel Israel: The interesting thing about online therapy was that the majority of organizations were pushed towards that realm.

Over here, we weren’t pushed because we were already beginning that process of going to the virtual therapy. Initially from many clients, especially those ones that you’ve been seeing for a year or two, or what have you, there was that reluctance to say, Hey, Nathaniel I see your face. I get to come in. I get to shake your hand prior to COVID.

And now what you’re pitching to me is a virtual realm where I’m sitting at home. So initially there was a little bit of reluctance from those individuals that we were seeing before. But as time progressed, they, as well as we’ve realized the strong benefits of it.

One of the main benefits is the accessibility, right? I have many clients where unfortunately they might call in and so much as they’re running late from work or they have to pick up their children or, the common day-to-day stuff. Right now, within the virtual realm all you have to do is ensure that you allocate that set up period of time and that you close your door and put on some headphones. So overall, now individuals are noticing the strong benefits of virtual therapy. Another major one that I’m sure you’ve seen this and heard of this item is when you’re working with a client that has difficulties with distress tolerance, so like difficulty managing mood and what happens, your emotions, intense emotions.

And before, when you were doing those distress tolerance skills, such as jumping jacks with tip skills dunking your face in cold water, it was sent in theory. They would practice or implemented it off screen.

I recently had a client that went entering into the session. This individual was a 10 out of 10 in terms of anxiety. And I said, okay, do you remember the skills? Yes, I remember skills. Okay. We can actually do it right now. This individual is able to go pull out the water, put the ice in it, put their head in the ice. I’m saying to them one, two in a melodic tone so they were able to do those things in real time. You’re able to actually implement those skills real-time so, there’s many different benefits.

Adam Kostiw: Have you noticed a difference between those clients? Who’ve actually never done therapy before and all of a sudden, they’re doing online and those clients who started off in-person therapy and moved over to the online platform.

Nathaniel Israel: Yes. I noticed a difference in terms of there was a reduction in attrition rates or missed appointments as I was mentioning a little bit earlier. Now practically there really isn’t that much that’s getting in the way. Geographically. Add, in addition to that, these individuals we could utilize it within therapy.

You can utilize a wall as opposed to sitting there. Okay. So, you missed yesterday’s session. Why was that? And we go through the fact checking and then at the end of the day, it is because I didn’t want to come from X reasons. It’s not because of the logistics.

It offered us the ability to whip through, or very quickly rifle through, potential rationalizations that are provided. I don’t know if that answers your question.

Adam Kostiw: Yeah, it does. Absolutely. So now I’m going to throw the curve ball. The one that you didn’t know was coming because we ask questions and all this.

So Nathaniel, we talk a lot about in generalities and stuff like this. And the one thing that clients never get to hear about is because they have experience with their own actual experience with online or whatever, what I’d like you to talk a little bit about is your experience and how it’s affected you transitioning into the virtual world, what struggles you had. Let our listeners hear about the difficulties that you have faced.

Nathaniel Israel: You want the candid response?

Adam Kostiw: It’s Straight Talk Recovery. So, we want the straight talk.

Nathaniel Israel: I wonder what the rating is on this.

Nonetheless, everyone knows with respect to technology. Technology is rife with its own difficulties, right? So, there is this whole learning curve in terms of- I’ll just speak from my own experience as opposed to general, as I would say it to my people that I work with. So, with respect to myself, there was a learning curve when we were utilizing OnCall Platform. What are the options? What’s available? And what are some of the limitations?

One thing, one of the inherent limitations is that some individuals aren’t inherently, they’re not tech savvy. So, as a therapist, we all come from the same environment, residential, inpatient setting, within the residential inpatient setting, you wear multiple hats.

So early on myself, as well as my other colleagues, we had to quickly turn or quickly put on the hat of IT specialists. So, we actually had to identify as what were some of the common issues in terms of logging in. Okay, what are you using? Are you using a Mac or using a laptop? How close is it to your router? Are you using an ethernet cord, those sorts of things, right? To be able to provide them with some solution focus approaches to deescalate and to have them effectively participate in the psychotherapy session.

So that was one, one of the major barriers, but that’s something that can be sussed out beforehand onboarding. So, we learned after some time that there’s a certain population that inherently is going to have difficulty. So as a means to bypass that, let’s build in a timer and we spend some time with them and just hash out some of the mechanics.

Adam Kostiw: As an audio podcast here, our listeners can’t actually know that, when you talk about those people who may be not technologically savvy, I believe your eyes and my eyes both went to the screen where Ray was sitting and my thought process and I’ll share with the listeners today is I actually had to ask Ray to pull his mic out of his headset because it was tucked back in. So, it works for all of us here.

Nathaniel Israel: Exactly at large, it’s a constant learning curve, constant evolution.

Raymond Moore: And that’s where I wanted to go with this question. Because there’s some people that are just against technology and it’s just going to be therapy.

For me, however though, I put an effort in and I just don’t have that skill to navigate technology. If it wasn’t for Adam, I’d probably be talking to the televisions expecting it to talk back. I’m just not very good with this stuff.

Got me thinking though about kind of the demographics in terms of age. And I do understand, age really has nothing to do with whether your tech savvy or not, but definitely the younger generation. There’ll be very vague when I say that. Of course, but the younger generation are extraordinarily tech savvy.

But do you find that the younger clients or your younger participants tend to benefit more from online versus when you had, face to face?

Nathaniel Israel: Yes. Yes. Because the younger crowd, especially within the concurrent mental health and addictions population, oftentimes, the term codependency that they’re, depending on someone to take care of, whether it be physically, emotionally, and a lot of the younger clients are often reliant on their parents to bring them to, or from, or they’ve had a DUI where they can’t get around. So inherently, like there has been, I can’t give a statistics, but we had this spike and younger clientele that have sought out the services because of again that accessibility as well as because the normalization, this is what we know. I’ve got to lock myself into that group. What we know?

Raymond Moore: I think that’s where I was getting, because I think where I’m really going with this is a lot of a lot of the younger people, a really good way of expressing their emotions is typically through technology, text message.

I know TikTok seems to be a big thing. People are kind of expressing their emotions, opinions, whatever it may be. So I kind of figured this particular venue for people that are more geared towards social media that like to communicate via text message and basically go out of their way to avoid face-to-face contact, even when there’s no pandemic happening, whether this is actually more of an easier avenue for them to talk about what is actually happening for them and to feel more comfortable about doing it. Having that distance, I know we can create a fairly strong argument that you really want to learn to have that face-to-face connection, but in the process of learning all of that, is it a good thing that people have this particular way of connecting with people? That may be more comfortable for them.

Nathaniel Israel: You know me, in so much my focus, my ears heard comfort and my mind was like, okay, let me focus on that. My therapist senses went up, and so typically when I’m working with a client and they’re saying to me, I’m comfortable, I think, are we doing the work?

Are we doing the work right now? But no. Going back to your question in terms of comfort, I think it goes hand in hand with building a therapeutic relationship. Because that’s the first and foremost thing that’s required in order for us to do the work with someone like a younger client. And when you’re able to put them at ease, being in a comfortable, safe environment, now there’s a safe right there in their own room with some of the healthy stuff that around, whether it be a pillow, whether it be memorabilia so on and so forth.

It brings down that guardedness. And then let’s just say we build that relationship and who’s to say after, or at some point in time after legislation, we can’t meet in person at times. So, it’s just like the anxiety mark module we’re in, you deal with some of the lower hanging fruit and expose yourself and then gradually start to expose yourself.

Adam Kostiw: So what I heard there, sorry Ray, I didn’t mean to cut you off there, but our listeners are probably going to want to know about this as well is, we are coming where more and more people are getting vaccinated and we’re moving. And so, where do you see this going forward?

How do you see an adaptive model that’s a hybrid model, I would say? In our center where we work at, we actually use a hybrid model where the therapist comes in and actually sees a client once a week. And the other two sessions they do is virtually. So, do you see this continuing to work once we get to a new norm.

Nathaniel Israel: Yes. Yes. Yes. And actually, yeah I perceive that this hybrid model will play out, especially after I was hearing some anecdotal statistics in terms of employee retention rates. And what did they say? Happiness and enjoyment at the position, I think was like 40% and that when they’re not happy, they just leave in the midst of this pandemic.

The reason why I bring that up is because, I like to practice, I know you guys do a client centered model and that applies to us as well, as so much as there are going to be clinicians that would like to come in periodically and see clients. And we’re not going to negate that’s going to be open to them as long as the legislation provides for that.

But in addition to that, being that we have been virtual for a year and a bit we have a lot of therapists that are far from the nuclear Trafalgar (124) Merton Street Facility. They’re all the way in Barrie, Ontario. They’re all the way at one point an individual in BC, Canada and et cetera, et cetera. Chances are, they’re not flying out here on a daily basis. I think it’s safe to assume.

In short I believe that we’re going to offer an open client or client slash employee model where certain individuals that want to come in as a therapist can come in on a hybrid size as well as with clients. Because again, the same model, actually, the majority of our clients aren’t in the GTA. They’re in like Northern Ontario, many times when they get an intake I’m typing in this area just to make sure for safety reasons that this individual is truly in Ontario, never heard of this place, they’re referencing a place that’s like a place that I know that is five hours or 10 hours away from here.

So a lot of our clients are in remote areas. So, I perceive that a lot of those individuals that are in the remote areas that don’t have access to very strong therapists, specialized therapists, CSAT therapists, et cetera, et cetera are going to naturally continue on in that row.

Raymond Moore: I definitely think this is here to stay, I think just virtual therapy and then, group therapy also that goes virtually as well. I think we can talk a little bit about that as well but I think the whole idea of virtual therapy part of it was, is letting go of the old idea that therapy was done one way.

You’re sitting in front of your therapist, you’re on a comfy couch. I think if the show Frasier, if you guys ever remember that, like the idea I think really what the pandemic, it forced everybody to look at doing things differently. And I think online therapy, I actually took part in it.

And for me as technologically, not bright as I am, I can honestly say virtual online therapy helped me a great deal. And I think exactly what Nathaniel said. There was something comforting for me about not being in an environment that was, situated and set up for me by the person.

But sitting at home in the comfort of my own home, comfortable, maybe with my dog around, all those peaceful surroundings, engaging in therapy that way. So, I think it really breaking out of the old and in with the new, I really think that the virtual therapy is a great thing. I don’t really see it going anywhere, pandemic or not.

I definitely see it as being a major convenience for many people.

Adam Kostiw: So what I’d like to take us now into it a little bit different direction. But I’d like to talk a little bit about now not just virtual therapy but virtual programming. Because again, for addiction treatment the main go-to has always been residential in place and all this, but now as your program that you run is a virtual one as well which includes groups and all the same criteria that a residential program basically runs, but you do it virtually.

So, I’d love for you to talk about how that’s opening up the doors to again, first of all, your education in geography is getting better.

And how it opens up to those individuals who may not have had access to a residential treatment program strictly because of geography or finances and all those other pieces.

Nathaniel Israel: Okay. So with respect to residential, of course, when someone is coming in inquiring about treatment, we do that screener to see whether that individual is even suitable for treatment and outpatient setting, because there’s a great amount of motivation and safety that’s required for an individual to participate in an outpatient and a virtual program.

So, with that said, what we’ve been doing is we’re able to screen a lot quicker, right? Being that we already have a process set up. So, we’re able to sit down with the client face-to-face this is what’s really going on what support is really required. And then if they’re eligible and so much, it’s that, they’re not in a serious state of withdrawal, or if, let’s say for example, they are having difficulty, we’re able to coordinate and say, okay, who’s in the household right now and you can raise your hand.

Who’s in this room right now, mom, so on and so forth. Okay. That’s great. Now you can start to participate in the outpatient programming. I don’t know if I answered that question now. I’m a little bit muddied on that question.

Adam Kostiw: And again, so I think, what I was really also asking is, the screening process, so what makes someone better eligible for a virtual treatment as opposed to residential.

Nathaniel Israel: Motivation, motivation, motivation! Because in a residential or in-person treatment, when you’re in an establishment, you’re held in those four doors. In virtual therapy, you’re held into your room. You can pick off the screen if you want to. And I’ll call you, back frantically, maybe from a blocked number, just so that I could get ahold of you, therapeutically.

The individual has to have an element motivation, strong motivation. And if there is strong elements of symptoms of withdrawal than an individual isn’t suitable for programming at this point. But actually, let me speak real to you. One of the benefits is that someone say, I’m not even gonna say the names, person X comes in and they’re interested in it.

And then they sit down with me and I’m like, okay, I’m kinda on the fence. Let’s put in these preliminary precursors to sure you up a little bit. And then let’s say for example, they have difficulty in this virtual realm, all they need to do. And we’d notice this, all we do is we just pause the treatment, and to re-refer, oh, we re-refer out and then they come back to treatment. One of the things of being virtual is that you have to be more communicative. In that process they know real-time, we know real time whether it’s working out or whether it’s not, and we’re able to relay that to them.

Adam Kostiw: Yeah. Because you used that real important word motivation, what about commitment?

Nathaniel Israel: A commitment is something that can be built upon as long as they have elements of motivation. Once you’re able to notice what their Achilles heel is or what’s driving them. I think that individually, even myself, all we need to do is reframe it back to that.

And then that shows up commitment as well as, they have the option to participate. They’re coming into the room. If they’re sitting in the room, they’ve chosen to be here. So that speaks to their commitment that speaks to their motivation. And oftentimes they use that with them.

Adam Kostiw: And again, the reason I ask that question is because our listeners, aren’t only people who are in active addiction or in recovery, but it’s their family members and other people. And those caregivers who, hence the word care, they’re worried and they’re trying to fit, people are trying to figure out, what’s right for them.

My son, my daughter, my best friend, my spouse, all these different people. And I think you’ve answered that question, it gives them a little bit of guidance to look for.

Nathaniel Israel: Exactly.

Adam Kostiw: All right. So anyways, that is wonderful. We really appreciate you being on today Nathaniel. I want to give a big shout out to Nathaniel Israel who is Director of the IOP program and a great supporter in many ways to me and Ray and we really appreciate him being on here. So, I’d like to just say thank you on behalf of myself and Raymond Moore, and just remember everyone, keep talking.

Nathaniel Israel: Pleasure, take care, guys.


Other Episodes

Episode 1: Introduction

Episode 2: Anger

Episode 3: Relationships

Episode 4: Co-dependency

Episode 5: Self-Compassion

Episode 7: Mindfulness

Episode 8: Grief

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Nathaniel Israel, MA, RP

Clinical Director, Virtual Intensive Outpatient Program

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Clinical Director, Virtual Integrated Programming

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