A therapist’s thoughts on remote video therapy

by Donna Torney, LMHC

How I made the switch from in-person to remote-only sessions, and why you may want to as well.

Even just a few short years ago, the thought of seeing clients remotely would have been a far-fetched idea to me, especially with new clients I had never met in person. But with the accelerated pace of change in the way we communicate, remote video therapy is becoming more mainstream. Since I am taking the next year to promote a newly published book, I decided to close my physical office and try remote video therapy exclusively so that I could stay mobile for speaking opportunities.  

Donna Torney, LMHC in Milton, MA

I am happy to report that remote therapy is going extremely well, and any reservations I had harbored about seeing clients exclusively via video call have disappeared! It is a win/win for the therapist and client in many ways. The ease of giving and receiving therapy in the privacy of your own home allows you to keep appointments when daycare falls through, clients get stuck at work, or the weather is bad. It also lowers overhead, allowing you to see clients without renting additional space. Finally, I am delighted that many insurance companies are now paying for remote sessions*, and that clients have been open to conducting sessions remotely.  

*In Massachusetts, I personally know that Blue Cross Blue Shield, Beacon Health, and United Behavioral Health PPO plans pay for remote sessions.

It is still a brave, new world, so therapists who intend to start conducting remote therapy should keep a few things in mind. Here, I share some tips from my own experience as well as best practices that I learned at a recent telemental health conference at the Brattleboro Retreat Center.

The intake process

Most therapists try very hard to discern if a client will be a good fit for their practice before the first appointment. This takes even more effort if you are not seeing the client in person. In your first phone call, make sure you explain the limitations of remote therapy. Clients must be forthright with any diagnoses that the therapist may not be able to “see” in a video call. These include addiction, eating disorders, as well as some forms of anxiety and depression in which a client may be isolating. In short, therapists should be prepared to ask pointed questions, and clients must know that full disclosure is necessary to make the therapy successful.

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Best practices and ethics

Even though you are meeting remotely, it’s best to act as if you are seeing your client face-to-face. This means making sure the room you are working from is secure and private. As in face-to-face sessions, therapists should try to anticipate and limit interruptions. I learned this the hard way when my two French bulldogs started a fight in the next room in the middle of one of my video sessions. If you are at home, household distractions should be taken care of in advance of your session. Make sure your family knows you are working, even though you are at home. Clients should take the same measures on their end to ensure they can give their full attention to the session. Ask clients to turn off notifications on laptops (quick way to do this on Macs in the last bullet here) and turn off their smart phones, and do the same on your own electronics.

The uncertainties of technology

At the telemental health conference I attended in September, it was suggested that therapists use one of the new HIPAA compliant platforms for video sessions. I am currently testing the free platform doxy.me, which allows me to connect with clients via a Skype-like telecall with an extra layer of encryption. But a quick Google search shows me that there are at least ten other platforms to choose from at this time. Make sure the platform you use has a good track record (however short), and only use a platform that offers a BAA agreement, which means the company hosting the platform has a bigger stake in ensuring confidentiality.

Know your practicing state’s laws on telehealth

Check with your state’s mental health governing body to see if there are any specific laws you need to follow while conducting telemental health sessions. Again, this is likely to be a moving target as telemental health evolves. For instance, Massachusetts currently defers to the ethical codes of the therapist’s governing body (APA for psychologists, ACA for mental health counselors, etc.), but other states require that therapists have specific training in telemental health.

Overall I am finding that in remote sessions, clients can be more open in the comfort of their own setting. I am sure I will discover more benefits of practicing remotely, such as being able to keep appointments during snowstorms or when a client is ill, as well as many quirks, including the challenges of frozen screens and poor Internet connection. And I will continue to fine tune my remote therapist skills: how can I be sure that a client isn’t isolating and using remote therapy as a reason y to stay shut in? Overall, if clients understand the limitations of remote therapy, I am confident that the benefits will outway the drawbacks, and remote sessions will remove barriers for many individuals who might not otherwise  have access to care.