Essential Tips to Consider When Offering Online Therapy
Do you want to offer online therapy, but don’t know where to begin? I want to give you a few tips to get you started!
If you’re considering including online therapy in your services, this is what you’ll need to consider:
Client’s Presenting Issues
Presenting issues like relational distress and mild to moderate anxiety, depression, grief, and loss, etc. may be treated effectively online.
In my practice, I require that clients have basic emotion regulation skills and don’t regularly experience symptoms like overwhelm, dissociation, and panic attacks that might make it unsafe for us to be working together online.
If a client has a more severe mental health disorder, has difficulty staying present during a session, has experienced complex trauma, is currently experiencing an addiction, or anything else that might make it difficult for them to orient to a computer screen and stay present with you for the duration of the session, then it might be better to refer them to an in-person therapist.
Client’s Safety
When working online, I always think about “worst case scenarios” when taking on a new client. If something were to happen to that client either during the session or outside of a session, what would I do?
I make sure that I always have additional ways to reach them, just in case. If something were to happen to the secure platform I use, I ensure that I have a back-up platform we can use instead. If something were to happen to the internet connection, then I want us both to have our phones beside us, so I can call them if necessary.
If I am ever concerned about the client’s safety outside of a session and they require in-person support, I want to have the name and information of an emergency contact that the client has given me permission to reach out to.
I rarely work with clients online who are experiencing suicidal ideation or express the intent to self-harm. On the rare occasion suicidal ideation or self-harm comes up during the course of therapy, I make sure to have the contact information of local emergency centers or places that either the client or myself can reach out to for in-person support.
Your Treatment Approach
Was the approach you are trained in conducive to online therapy? Most of the research on the effectiveness of online approaches was based on cognitive or “talk” therapy. When working with adults and using a talk-based approach, online therapy may be suitable.
However, if you work with small children or offer modalities such as art therapy, play therapy, or tend to include a lot of interactive activities, online therapy may not be appropriate.
The number of clients you work with is also an important consideration. Online therapy can be done effectively with couples, but if you work with families and there are three or more people present, it can be very tricky to get them all on screen at the same time and have everyone be able to see each other.
Your Governing Body
Be sure to check with your governing body to see if they have any specific regulations regarding conducting online therapy. At this point, few organizations do, or the regulations they have are quite vague. You’ll want to confirm, however, that your governing body deems it ethical and appropriate for you to be offering online therapy and that you are in compliance with any guidelines they have.
Insurance
Offering online sessions opens up the possibility of working with clients outside of your province, state, or even country. You’ll want to be sure that your insurance covers you to do so. In most cases, you will be registered or licensed where you live, but you may also be required to comply with the licensing or registration guidelines of the area your client lives in as well.
If you are unsure about taking on a client out of province/state or country, I would recommend contacting the governing organization in your client’s area and asking them if they have any issues with an out-of-area therapist working online with a client in that area. Many organizations do not have specific rules or guidelines around it, but some do.
Your best course of action is to check with your insurance company and a lawyer. Your insurance company will be able to tell you where you are covered to work (provinces, states, and countries), and you will also want to make sure they specifically cover online therapy.
A lawyer will be able to tell you what you need to do to protect yourself when working with clients outside of your area and about the risks involved. If you are a member of the CCPA, they offer free legal advice to their members.
PHIPA Compliance
Assuming you are already PHIPA-compliant in your practice, the only additional piece you will need to consider is ensuring that the video conference service you use is PHIPA-compliant.
There are many platforms out there that provide a secure, online platform for you to meet with your clients for a monthly fee. One company, Doxy Me, offers a free version that works fine if you’re just starting.
Monthly fees range from $30 to over $200 per month and vary in the quality of the connection as well as the various features such as virtual waiting rooms, screen sharing, file sharing, how many users you can have, etc. Some of the more popular platforms include Zoom, Doxy Me, VSee, NousTalk, OnCall Health, and Thera-Link.
Although many therapists working online still use Skype, please be aware that Skype is not a PHIPA compliant platform.
British Columbia and Nova Scotia are examples of provinces that have strict guidelines about therapists using servers that aren’t based in Canada. If you live in one of these provinces, you’ll want to check with your governing body and potentially ensure that you are using a platform with a Canadian-based server.
Informed Consent
Whatever provisions you are making for online therapy, including information your clients needs to know and information you need from your clients to effectively offer online therapy, should be included in your consent form.
Your clients should be informed about the risks and benefits of online therapy, and just like face-to-face therapy, be fully informed about the nature of online therapy so they can give informed consent to working with you online.
Private, Quiet Space
Last, but certainly not least, you’ll need to make sure that both you and your client have a private, quiet space to meet. That means a room or area where you both feel comfortable, where you won’t be overheard or interrupted, and where you can both talk openly.
For you, that might be a bit easier to secure. You can work from your regular office, or a home office as long as you are able to manage interruptions such as children and pets. If you work from home, you might also want to make provisions for things like ringing doorbells, phones, voices from other people in your home, or contractors or repair people who might come by regularly.
For your clients, it isn’t possible for you to ensure their safety and comfort in the same way you can in your office, but you will need to educate them about what they need. It will be their responsibility to make sure they feel safe and comfortable in the space they’re in. I usually recommend their bedroom or living room, and ideally, they should have no one else in the home during their sessions, unless the room they are in is quite soundproof.
I recommend that my clients do not have their sessions from work unless no other arrangements can be made. In most office environments, it’s hard to ensure they won’t be interrupted by either a phone ringing or a knock at the door. If the client becomes emotional during the session, they may not want to go back to work afterward, or they may hold back because they don’t feel comfortable to express their emotions while at work.
I also do not conduct sessions while clients are in public or while driving. I educate my clients that it is imperative that they create a space for themselves that mimics the kind of safety and privacy they might have if they came to my office.
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