Tele-clinical psychology as an additional component to the CIS

When the going gets tough, the CIS keeps growing (services): Tele-clinical psychology as an additional component to the CIS

From the onset of the pandemic, one of the big challenges for cancer patients has been the difficulty for them to access services. This has been in large part due to public health control measures such as travel restrictions; but it also has been due to the conscious decision by many clinical institutions to reduce the risk of cancer patients from getting Covid-19 when coming for cancer care.

One of the services that has been impaired by Covid-19 has been clinical psychology. Patients have found it difficult to travel to seek these services, and many of them de-prioritised (in their minds) the urgent need to be seen and managed by their clinical psychologists during this time.

Unfortunately, the reality on the ground told a different story. Patients actually faced more mental health challenges during this period- with anxiety and uncertainty not only about their cancer treatments; but also, about the increased risk of getting Covid-19 or its complications. In addition to all of this, patients also faced the social and economic pressures caused onto their daily lives by the pandemic.

National Cancer Society Malaysia quickly saw this need for providing clinical psychology services via an online medium; and making it an extension of the services offered by the Cancer Information System (CIS).

Our Cancer Information System (CIS) specialists speaking to patients were trained to offer and upon acceptance, administer the short-form version of the Depression Anxiety Stress Scale (DASS-21) Test to patients. Those who were found to be in need of clinical psychology services were offered these services in a virtual manner, with appointments slated for them with NCSM’s resident clinical psychologist, Michelle Yap. This services continues to be an ongoing service offered by NCSM for patients without any cost to the patient, and has been quite popular.

Despite its novelty, offering tele-clinical psychology services is not as easy as it is made out to be. Clinical psychologist Michelle Yap shares her experience and offers some insights on this in the following section.

Psychological services in Malaysia traditionally offer therapy in a private, face-to-face setting. Due to the pandemic, most of the clinical psychologists started to adapt to tele-consultation as an alternative means of therapy to patients who had difficulties in travelling to access in-person services.

Teleconsultation makes it easier for people to access psychotherapy. With the patient’s consent, it can also improve access for the family members who want to join the session via teleconsultation to have a better understanding of the patient’s conditions. The flexible nature of teleconsultation creates a positive, effective experience to the patient, which may encourage them to seek for help via face-to-face psychotherapy and reduce the stigma of seeking psychological help.

In spite of clear positive outcomes, some limitations are inherent as well due to the nature of delivery. One of these is that teleconsultation does not allow the practitioners to capture the whole experience with their clients. For instance, teleconsultation make it less easy for the practitioner to observe and interpret the non-verbal communication of the clients, which are not detected from the video camera, such as body movement, eye contact, and the use of voice.

When the delivery mode has switched to on-screen methods, practitioners are no longer in control of the setting or the environment which may be a factor the patient connects to. The effectiveness of the therapy session may be reduced when the patient does not have a proper setting in which to attend the therapy session. They may easily get distracted by the surrounding and more conscious with their words and thoughts during session. However, these difficulties can be overcome if practitioners come to a clear standard agreement with the clients, thus encouraging a collaborative therapeutic relationship and ensuring that the session is conducted successfully.

As the accessibility of the psychological services increase, patients can access their practitioners just with a phone call or a video link straight away. This has an unfortunate side-effect where they start to take their appointment less seriously and keep rescheduling appointment dates or abusing the service for personal benefit. The practitioner must draw clear boundaries with the patient to ensure ethical and effective services can be delivered to the patients. 

Clinical psychologists should be aware of the limitations of teleconsultation as well as its benefits. The most important take away I would offer is that first, assess the patient accordingly to check if they are suitable to undergo the ‘treatment’ via teleconsultation or whether they still need face to face consultation. Not all patients are suited to ‘tele-consultation’ and so we should not be using it simply as a ‘blunt’ instrument since it is available.

Every psychologist strives to do and provide their best for their patients. If they can do this via tele-consultation, they should make use of this opportunity.

By: Michelle Yap, Mandy Thoo and Murallitharan M

National Cancer Society Malaysia (NCSM)